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Spondylosis is a term referring to degenerative osteoarthritis of the joints between the center of the spinal vertebrae and/or neural foramina. If this condition occurs in the zygapophysial joints, it can be considered facet syndrome. If severe, it may cause pressure on nerve roots with subsequent sensory and/or motor disturbances, such as pain, paresthesia, or muscle weakness in the limbs.
When the space between two adjacent vertebrae narrows, compression of a nerve root emerging from the spinal cord may result in radiculopathy (sensory and motor disturbances, such as severe pain in the neck, shoulder, arm, back, and/or leg, accompanied by muscle weakness). Less commonly, direct pressure on the spinal cord (typically in the cervical spine) may result in myelopathy, characterized by global weakness, gait dysfunction, loss of balance, and loss of bowel and/or bladder control. The patient may experience a phenomenon of shocks (paresthesia) in hands and legs because of nerve compression and lack of blood flow. If vertebrae of the neck are involved it is labelled cervical spondylosis. Lower back spondylosis is labeled lumbar spondylosis.
Spondylosis can affect a person at any age; however, older people are more susceptible.
- Cervical Compression Test is performed by laterally flexing the patient's head and placing downward pressure on it. A positive sign is neck or shoulder pain on the ipsilateral side, that is, the side to which the head is laterally flexed. This is somewhat predictive of cervical spondylosis.
- Lhermitte sign: feeling of electrical shock with neck flexion;
- reduced range of motion of the neck, the most frequent objective finding on physical examination
- MRI testing. This test is non-invasive and provides the only definitive positive diagnosis.
Treatment is usually conservative in nature. Patient education on lifestyle modifications and nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy have been shown to manage such conditions. Other alternative therapies such as massage, trigger-point therapy, yoga and acupuncture may be of limited benefit. Surgery is occasionally performed.
Many of the treatments for cervical spondylosis have not been subjected to rigorous, controlled trials. Surgery is advocated for cervical radiculopathy in patients who have intractable pain, progressive symptoms, or weakness that fails to improve with conservative therapy. Surgical indications for cervical spondylosis with myelopathy (CSM) remain somewhat controversial, but "most clinicians recommend operative therapy over conservative therapy for moderate-to-severe myelopathy." (Baron, M.E.)
Physical therapy may be effective for restoring range of motion, flexibility, and core strengthening. Decompressive therapies (i.e. manual mobilization, mechanical traction) may also help alleviate pain. However, physical therapy and chiropractic cannot "cure" the degeneration, and some people view that strong compliance with postural modification is necessary to realize maximum benefit from decompression, adjustments, and flexibility rehabilitation.
It is often argued, however, that the cause of spondylosis is simply old age, and that posture modification treatment is often practiced by those who have a financial interest (such as Worker's Compensation) in proving that it is caused by work conditions and poor physical habits. Understanding anatomy is the key to conservative management of spondylosis.
Many surgical procedures have been developed to alleviate the signs and symptoms associated with spondylosis. The vertebral column can be approached by the surgeon from the front, side, or rear. Osteophytes and sometimes portions of an intervertebral disc are commonly removed in an effort to relieve pressure on adjacent nerve roots and/or the spinal cord.
Non surgical treatment modalities are also available. Though these therapies namely Cervical Epidural Steroid Injection, Cervical facet joint injection, Transforaminal injections can be given at a day care basis. These procedures may alleviate the symptoms of the patient and may give a long lasting benefit from the ongoing symptoms.
A major problem related to this disease is vertebrobasilar insufficiency. This is a result of the vertebral artery becoming occluded as it passes up in the transverse foramen. The spinal joints become stiff in cervical spondylosis. Thus the chondrocytes which maintain the disc become deprived of nutrition and die. The weakened disc bulges and grows out as a result of incoming osteophytes.
- Thomas, Clayton L. (1985). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, Pennsylvania. ISBN 0-8036-8309-X.
- Baron, M. E. (2007). Cervical Spondylosis: Diagnosis and Management. http://www.emedicine.com/neuro/topic564.htm
- Newman & Santiago, 2013
- Rana, Sandeep, "Cervical Spondylosis, Diagnosis and Management: eMedicine Neurology", "http://emedicine.medscape.com" (March 24, 2010).
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