Cervical Spondylosis
Updated: Nov 26, 2020
Cervical Spondylosis is a neck condition in which ‘osteophytes’ (bone spurs) grow on any of the seven vertebrae in the cervical spine (neck), ranging from the base of the skull, C1 vertebra, to the base of the neck, C7 vertebra
Osteophytes in the spine are a normal sign of aging and can be associated with conditions such as degenerative disc disease, osteoarthritis, spinal stenosis, and others. Osteophytes are not a cause for concern unless they result in pain or neurological symptoms—such as tingling, numbness, or weakness—that can sometimes radiate from the neck into the shoulder, arm, and/or hand.
Cervical osteophyte formation typically occurs when ligaments and tendons around the cervical spine’s bones and joints are damaged or inflamed. This process usually happens with wear and tear over time.
Bone spurs, or osteophytes, are not painful in and of themselves. Many people with cervical bone spurs experience no pain or neurological symptoms. However, symptoms may occur if the osteophytes encroach upon the individual spinal nerves, the spinal cord itself, the vertebral discs, or the blood vessels in the region of the cervical vertebral column.
Symptoms
People who do experience problems associated with cervical spondylosis may exhibit a wide range of symptoms, including but not limited to:
Dull neck pain. This type of pain can be a general achiness.
Neck stiffness. The neck is likely sore and has reduced mobility, especially if experiencing increased pain when turning from side to side.
Headaches. Cervicogenic headache, which can result if an osteophyte pushes against a cervical nerve root that radiates pain to the back of the head—and sometimes to the top or sides of the head and/or behind the eye.
Radicular pain. A searing or shock-like pain can radiate along the nerve pathway from the neck into the shoulder, arm, and/or hand. It is usually only on one side, but it can also be on both sides.
Neurological problems. Numbness or tingling in one or both arms and/or hands. There could also be progressive weakness in one or both arms and/or hands with or without impairment of finger dexterity.
Myelopathy. If the cervical bone spur starts going into the spinal canal and irritates the spinal cord, then a person may have additional neurological problems such as balance and/or coordination issues, excruciating shock-like pains through the arms and/or legs that might be made worse when bending forward, weakness or numbness anywhere beneath the neck, and possibly loss bowel or bladder control.
Dysphagia. In rare cases, individuals can experience progressive difficulty swallowing.
Such symptoms as those described above are similar or the same as those that can be caused by a number of other neurological and/or spinal conditions. An accurate diagnosis is necessary in order to successfully manage or treat the associated symptoms of pain or neurological abnormalities.
Diagnosis
For most people, cervical osteophytes do not cause symptoms. In fact, it is common for people to have bone spurs show up on x-rays or MRIs without them being a cause of pain or other symptoms.
If someone is experiencing neck pain or symptoms of tingling, numbness, or weakness radiating into the shoulder, arm, or hand, then a doctor will likely start by taking a patient’s history and performing a physical exam. Oftentimes, non-surgical treatments of neck pain can begin without performing advanced diagnostics such as imaging studies or electrodiagnostic tests.
If symptoms persist or worsen, then advanced diagnostics might be used, which are the only way to confirm is osteophytes are present. Here are some common techniques used to determine if osteophytes might be a cause of pain for the patient:
MRI scan. An MRI shows detailed cross-sections of the soft tissues and bones. It does not use radiation, and it tends to be better for showing possible damage to soft tissues—such as discs—than x-rays or CT scans. If the results of an MRI match up with what the patient is complaining about (for example, large osteophytes found near the C6 nerve correspond to the patient’s symptoms), then that may be all that is needed for the diagnosis. However, MRI findings do not always match up with the patient’s symptoms, so it is important to treat the patient and not the MRI.
Electrodiagnostic testing. A nerve conduction study can test the nerves’ electrical activity in the arms; this test is usually followed by an electromyogram, which tests the muscles’ electrical activity. These tests can help determine the location of where a nerve might be having a problem, which could be useful if imaging studies have been inconclusive.
Most cervical osteophytes, or bone spurs in the neck, have no symptoms and thus require no treatment. However, if bone spurs become symptomatic, numerous treatment options are available. Typically, non-surgical treatment options will be tried first.
In rare cases when non-surgical treatments are not working or symptoms are getting worse, then surgery might be considered as a definitive therapy.
Non-Surgical Treatments
Treatment options for symptomatic cervical spondylosis in the neck could include:
Activity modification. Perhaps a day or two of rest, or limiting strenuous activities, could help. Other possibilities might include using better posture. For example, hunching over a desk 8 hours a day could be exacerbating the problem, so sitting up straighter—and taking more frequent breaks—may relieve symptoms.
Ice and/or heat therapy. Cooling or warming the neck area, such as with an ice pack or heated gel pack, may help reduce pain for some people. Other options for heat therapy could include taking a warm shower or using an electric blanket.
Medications or injections. Sometimes medication, such as anti-inflammatory medications or muscle relaxant pain medications, can offer relief. However, a doctor will likely want to reassess the patient within 4 to 6 weeks of having started the medications.
Several other options could also be considered for relieving symptoms of cervical osteophytes. As a few more examples, some people report pain relief from massage, acupuncture, and/or traction but the role of all these therapies is still unproven.
Role of Surgery
If symptoms of Cervical Disc Herniation (nerve compression in the neck) or cervical myelopathy (spinal cord compression in the neck) continue to progress despite non-surgical treatments or the patient experiences severe symptoms like continuous pain, numbness or tingling, then surgery may be considered to preserve nerve and/or spinal cord health.
For a Cervical Disc Herniation, a likely surgical option could be anterior cervical discectomy and fusion (ACDF). If instead the spinal cord is being compressed, then some type of spinal cord decompression surgery will be performed, such as anterior cervical corpectomy or posterior cervical laminectomy.