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Wednesday, March 19, 2014

Cervical Osteoarthritis






Arthritis of the neck, cervical spondylosis, or degenerative joint disease of the neck.

  • Cervical Spondylosis is a degenerative process that affects the cervical spine.
  • Cervical Spondylosis is a condition that mainly affects older people, usually over 40. Men are affected more than women. This condition results from degenerative changes that occur in the cervical spine (the part of the spine in the neck). Over time, the degenerative changes lead to changes in the vertebra. This can then cause nerve compression or inflammation.
  • Symptoms depend on the location of the nerve compression, but can include pain, numbness, weakness, headaches, urinary problems, etc. Treatment is usually with medications and use of a cervical collar. However, if this fails, then surgery may be necessary.

  • Initially the person may not have any symptoms.
  • Others will have neck or shoulder pain, headaches in the back of their head, or stiffness of the neck. They may have difficulty turning or bending their neck from side-to-side.
  • Some will have pain that shoots down a certain part of the arm. They may also notice numbness, weakness, or pain in the arm. One or both sides may be affected. Often it causes the hands to become clumsy.
  • Some individuals will have numbness or weakness in their legs. Many with this condition will have decreased vibration-sense in their legs. They may be unsteady while walking. In fact, spondylosis is a fairly common cause of unsteadiness in the elderly.
  • Others will have a specific level on the chest or abdomen where there is a noticeable change in sensation.
  • Problems with urination may occur. Some will have to urinate more often, while others will have to urinate urgently. A few will develop urinary incontinence.
  • The symptoms may get worse with turning, extending, or bending the neck. In others, coughing or straining may temporarily cause shooting pain in the arms or shoulders or it may worsen weakness in the legs.

  • Cervical Spondylosis is caused by degenerative changes that occur in the cervical spine over time. This can lead to a herniated disc, Calcium build-up within the disc, or bony growths on the spine.
  • These changes can then cause certain nerves to become pinched, compressed, or inflamed.
  • Also, depending on which way the disc herniates or the direction of the bony growths, there is a possibility that the spinal cord could be compressed.
  • There is also the possibility that the blood flow to certain nerves may be affected.

  • Physical exam may reveal numbness or pain along a certain nerve distribution. Certain muscles may be weak and the reflexes not as brisk as normally. The affected individual may have difficulty with turning the neck or bending it from side to side. The arms or legs may be stiff. The hands may be weak and the muscles of the hands atrophied.
  • X-Rays - can be helpful in making the diagnosis. However, though X-Ray findings of degenerative changes are often found in many older people, only a few will truly evidence the neurological changes caused by this condition. Alone, finding degenerative changes on X-Rays is not conclusive but part of an overall determination of this condition that must take into consideration other factors.
  • CT scan - can be used to look at the spinal column and see if there is any narrowing or other abnormality.
  • MRI - can also be used to look at the spinal column and see if there is any narrowing or other abnormality.
  • Nerve conduction studies and Electromyography can be done to test the nerves and muscles.

  • Risk factors include any degenerative process that may affect the cervical spine.

  • The primary treatment for this condition is to restrict neck movements. This is usually done with a cervical collar. If a cervical collar is not sufficient, then a more rigid brace for the neck may be necessary.
  • If that does not work, then surgery to decompress the nerve and stabilize the neck may be necessary. Surgery is usually done if:
  1. Conservative measures such as a cervical collar do not work.
  2. There is severe pain.
  3. There are significant neurological deficits, such as difficulty walking, severe hand weakness, or bladder problems.
  4. There is compression of the spinal cord.

  • With any nerve condition, if it is not treated early, there is a danger that the loss of nerve function may be permanent. Nerves are very delicate. Once they are injured beyond a certain point, they do not recover. Therefore, the symptoms that can be caused by this condition could become permanent if not treated appropriately (i.e., numbness, weakness, urinary problems).

  • Seek medical attention.
  • If there is a sudden onset of numbness or weakness, then you must seek medical attention immediately. If the nerve damage is severe, delay in treatment may result in permanent loss of function.

  • There is no specific way to prevent this condition. However, good posture should be maintained.
  • Also, avoid repetitive injuries to the neck and cervical spine.

  • Amyotrophic lateral sclerosis
  • Multiple Sclerosis
  • Subacute combined degeneration
  • Cervical strain
  • Spinal cord tumors
  • Cervical rib syndrome
  • Brachial plexus neuropathies
  • Acute cervical disc herniation
  • Syringomyelia
  • Ankylosing Spondylitis
  • Atlantoaxial subluxation
  • Tropical spastic paresis

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