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Cervical spondylosis(popularly known as “cervical”) is a condition where the cervical spine shows wear and tear, usually due to overuse with age, which may lead to pain in the neck and other symptoms.
It is considered that changes of wear and tear begin to develop in the cervical spine by the age of 30 years and more than 85% of the people over the age of 60 years show significant changes.
In many people, cervical spondylosis doesn’t produce any symptoms at all. However, the commonest symptoms it can lead to are pain and stiffness in the neck which may increase with the movement of the neck. It may also cause compression of the nerves which lead to tingling, numbness, or weakness in arms to loss of function of hands.
Most of the cases of cervical spondylosis, complaining of symptoms respond well to conservative treatment using medicines and physical therapy.
Many people with cervical spondylosis don’t have any significant symptoms and are not aware of their condition.
The most common symptoms of cervical spondylosis are pain and stiffness in the neck. Pain may range from mild to severe in intensity. It may be worsened by keeping the head in one position or by looking up or down for a long time, as seen while reading a book or using a mobile or a computer.
Other symptoms may include are:
• Stiffness or soreness in the neck.
• Spasm of neck muscles.
• A grinding or popping sound or sensation while turning the neck.
• Headache or dizziness.
In severe cases of cervical spondylosis, the spinal cord or nerve roots may get compressed resulting in additional symptoms. This condition is called cervical spondylotic myelopathy (CSM). This may cause the following symptoms:
The cervical spondylotic myelopathy (CSM), may cause the following symptoms:
• Tingling, numbness, or weakness in one or both arms.
• Loss of function in hands with trouble in writing or holding.
• Problem in walking or loss of balance (feeling of unsteadiness on feet).
• Incontinence of bladder or bowel- issues in controlling urine or stools.
The cervical spondylosis tends to progress slowly with time. In many people, the symptoms may get worsen over time. If the symptoms get worsen or interfere with daily activities, the person should seek medical help to get relief from the symptoms and avoid further progression.
A person should seek immediate medical help if he or she observes the following things:
• Sudden onset of weakness or numbness in arms, shoulders, or legs.
• Loss of bladder or bowel control.
• Problems in walking or loss of control.
With increasing age the spine undergoes regular wear and tear which may get aggravated by some injuries or physical factors.
Multiple components of the spine such as IV discs, cartilage, bone, and ligaments undergoes repeated wear and tear with age. Damage to any component affects the biomechanics of the entire spine and predisposes the other component to stress and damage.
These changes typically begin in middle age and may progress in a different manner in different individuals. These changes are collectively called as cervical spondylosis:
• Disc degeneration: with time the gel-like material present inside the IV disc gets dehydrated. This leads to loss of height and loss of cushioning effect which in turn predisposes other structures of spine to bear more stress and get degenerated.
• Cartilage degeneration: cartilage is smooth structures present along the joint surface. Due to continuous wear and tear on the spine, the cartilage gets thin and eroded. This allows the bone to rub against each other.
• Bone spurs or overgrowth: due to loss of cartilage, the bones tend to rub against each other, developing a rough damaged surface. In order to heal the damaged surface, the bones tend to grow small parts of the bone again. These new parts generally extend beyond their normal bone margins resulting in compression of the spinal cord or nerve roots in some patients called cervical spondylotic myelopathy (CSM).
• Disc herniation: with dehydration, the disk becomes weak and predisposed to breakage along its margins. This allows the disc material to come out and extend beyond its regular margins to compress the adjacent structures such as spinal cord and nerve roots to cause CSM.
• Stiff ligaments: the bones are held together by strong tissue called ligaments. Due to continuous wear and tear or stress, the spinal ligament may get stiffened which may, in turn, result in decreased flexibility of the neck. This may again predispose the neck to more stress.
Changes in cervical spondylosis are considered a normal part of the aging process. The process is believed to begin in the age of 30s and found to affect more than 85% of the people above the age of 60 years. Women are believed to develop spondylosis more than men.
In about 8% of people above the age of 50 years, it is found to cause compression of the spinal cord.
With the increasing age, people are more likely to develop cervical spondylosis. However, there are several other factors that predispose a person to develop this condition such as:
• Occupation: working in jobs that put repetitive strain on the neck such as looking up or down a lot or keeping head in one position for prolonged hours such as working on a computer for long hours.
• Neck injuries: a history of injuries to the neck such as car accident or sports injury.
• Poor posture: maintaining poor posture while standing, sitting, or lying on bed van put more stress on the spine predisposing it to injury.
• Smoking: has been found to be associated with increased degenerated spine-related issues.
• Genetic factors: more common in people with a positive family history.
The diagnosis will start with clinical history where the doctor would ask about the following:
Location, severity, type, radiation to arm or shoulder, or an aggravating factor.
Duration of symptoms
The treatment of cervical spondylosis depends upon the severity of the signs and symptoms and stage of the disease. Most of the cases respond to non-surgical methods such as medicines and physical therapy. Only a few cases where other treatment fails or nerve compression gets worsen are considered for surgery.
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