What is cervical spondylosis and c5 - c6 and c6 -c7 disc shows diffuse circumferential bulge?
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Cervical osteoarthritis
Definition
Cervical spondylosis is a disorder caused by abnormal wear on the cartilage and bones of the neck (cervical vertebrae) with degeneration and mineral deposits in the cushions between the vertebrae (cervical disks).
Causes, incidence, and risk factors
Cervical spondylosis results from chronic degeneration of the cervical spine including the cushions between the neck vertebrae (cervical disks) and joints between the bones of the cervical spine. There may be abnormal growths or "spurs" on the vertebrae (the bones of the spine).
These accumulated changes caused by degeneration can gradually compress one or more of the nerve roots. This can lead to increasing pain in the neck and arm, weakness, and changes in sensation. In advanced cases, the spinal cord becomes involved. This can affect not just the arms, but the legs as well.
A previous neck injury (which may have occurred several years prior) can predispose to spondylosis, but the major risk factor is aging. By age 60, 70% of women and 85% of men show changes consistent with cervical spondylosis on X-ray.
Symptoms
neck pain (may radiate to the arms or shoulder)
loss of sensation or abnormal sensations of the shoulders, arms, or (rarely) legs
weakness of the arms or (rarely) legs
neck stiffness that progressively worsens
loss of balance
headaches, particularly in the back of the head
loss of control of the bladder or bowels (if spinal cord is compressed)
Signs and tests
Progressive neck pain is a key indication of cervical spondylosis. It may be the only symptom in many cases. Examination often shows limited ability to flex the head to the side (bend the head toward the shoulder) and limited ability to rotate the head.
Weakness or sensation losses indicate damage to specific nerve roots or to the spinal cord. Reflexes are often reduced.
A spine or neck X-ray shows abnormalities that indicate cervical spondylosis.
A CT scan or spine MRI confirms the diagnosis.
A myelogram (X-ray or CT scan after injection of dye into the spinal column) may be recommended to clearly identify the extent of injury.
An EMG may also be recommended.
An X-ray of the lower (lumbar) spine may reveal degenerative changes in this region.
Treatment
The goal of treatment is relief of pain and prevention of permanent spinal cord and nerve root injury.
In mild cases, no treatment is required. Symptoms from cervical spondylosis usually stabilize or regress with simple, conservative therapy including a cervical collar (neck brace) to restrict motion and non-steroidal anti-inflammatory medications (NSAIDs). Cortisone injections to specific areas of irritation may also be helpful.
Rarely, intermittent neck traction may be recommended instead of, or in addition to, a cervical collar. This usually consists of a halter-like device placed on the head and neck and attached to pulleys and weights.
For severe cases, hospitalization with complete bedrest and traction for 1 or 2 weeks may be needed. Narcotic medicine or muscle relaxants may help to reduce pain. Surgical decompression of the spinal cord in the neck may be recommended for severe pain or for significant loss of movement, sensation, or function.
Surgical procedures may involve removal of bone and disc tissue impinging on the nerves of the spinal cord and stabilization of the neck by fusing the cervical vertebrae.
Expectations (prognosis)
Most patients with cervical spondylosis will have some chronic symptoms, but they respond to non-operative interventions and do not require surgery.
Complications
Chronic neck pain
Progressive loss of muscle function or feeling
Permanent disability (occasional)
Inability to retain feces (fecal incontinence) or urine (urinary incontinence)
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