Cervical spondylosis is a degenerative disease of the cervical spine, accompanied by a change in the intervertebral discs, ossification of the anterior longitudinal ligament, the appearance of bone growths on the anterior and lateral surfaces of the vertebrae. Usually occurs in old age. It can be asymptomatic for a long time. With a decrease in the height of the discs and the attachment of spondyloarthrosis, it is manifested by limited mobility of the neck, pain in the neck and neck. To clarify the diagnosis, radiography, MRI, CT, myelography, electromyography and other studies are used. Treatment is usually conservative: physical therapy, massage, manual therapy, physiotherapy.
ICD 10
M47 Spondylosis
General information
Cervical spondylosis is a degenerative–dystrophic lesion of the cervical spine (SHOP). It is usually a consequence of involutive processes, occurs in the elderly. The initial signs of spondylosis are often noticeable on radiographs of elderly and middle-aged patients. According to statistics, after 40 years, pathology is detected in 30-40%, after 65 years – in 90% of the population. Less often, the disease develops in young people.
Cervical spondylosis is the most common type of spondylosis. This is due to the anatomical and physiological features of the cervical spine. According to the observations of specialists in the field of vertebrology, traumatology and orthopedics, in most cases, clinically manifested cervical spondylosis is combined with other involutive lesions of the vertebral column – osteochondrosis and arthrosis of the joints of the spine.
Causes
As a rule, the main cause of cervical spondylosis is age-related changes in metabolism, natural aging of cells and tissues of the human body. Early development of spondylosis is promoted by:
- large single traumatic injuries, for example, a fracture of the cervical vertebrae;
- multiple minor spinal injuries in the cervical region;
- congenital anomalies of the spinal column;
- posture disorders, scoliosis and increased cervical lordosis;
- metabolic disorders, due to which calcium salts are strenuously deposited in the spinal column;
- hormonal disorders, hypothermia and chronic infections.
Risk factors
A separate group of reasons should include circumstances in which there is a prolonged non-physiological load on the cervical spine. Most often, the pathology develops in knowledge workers, people who perform professional duties in one static position, and people who lead a low-activity lifestyle. Often, patients with cervical spondylosis have a combination of these factors.
The forced position of the head when working on a computer, behind a microscope or a typewriter creates an excessive load on certain areas of the shop. The neck is very mobile, while the muscular corset in this area is less developed than in other parts of the spinal column. The muscles cannot cope with holding a non-physiological pose, there is an overload of the intervertebral discs, muscles and ligamentous apparatus of the spine.
Pathogenesis
The cervical spine is the most mobile part of the spinal column. It consists of seven vertebrae. Between all the cervical vertebrae, except the first and second, there are elastic intervertebral discs that perform the function of shock absorbers. The discs consist of a soft pulpous nucleus and a hard fibrous ring that holds the nucleus, preventing it from bulging out.
The spine is strengthened by ligaments and muscles. One of the large ligaments (anterior longitudinal ligament) is located on the anterior surface of the vertebral bodies. With the development of cervical spondylosis, the fibrous ring partially loses its rigidity, and the pulpous nucleus, which is under pressure, protrudes towards the anterior longitudinal ligament. Areas of ossification appear in the ligament area. Over time, bone growths form on the anterior and lateral surfaces of the vertebrae.
While maintaining the height of the intervertebral disc, cervical spondylosis can be asymptomatic for a long time. Pain syndrome is caused by increased tone of nearby muscles, joint blockages, inflammation in the ligaments and fascia. Over time, gross anatomical disorders are formed: a decrease in the height of the intervertebral discs, limited mobility and ankylosis of small joints. Compression of nerve roots and spinal canal stenosis with the development of neurological symptoms is possible.
Cervical spondylosis symptoms
Patients with an isolated form of the disease, not accompanied by a decrease in the height of the intervertebral discs, may not make any complaints for a long time. With the addition of other diseases of the spine and the progression of anatomical disorders, local dull aching or pulling pains occur, which increase after exertion and weaken or disappear after prolonged rest. The patient begins to spare the neck when moving, tries to turn not only the head, but also the body.
Pain occurs in the neck, gives in the hands. Sometimes patients complain only of pain in the hands, which are localized on the outer surface of the limb from the shoulder to the elbow joint. Sometimes the pain radiates to the scapula area. Possible cardialgia, pain in the area of the sternum and upper ribs.
As the pathology progresses, the pain syndrome becomes longer and more intense. Subsequently, the pain becomes permanent and does not disappear even after sleep. Due to pain and violation of the normal anatomical relationships between the individual elements of the spine, the neck muscles are in constant tension. The spasm of the cervical muscles contributes to the restriction of movements of the cervical region and over time itself becomes the cause of neck pain.
Complications
Some patients develop shoulder periarthritis, active shoulder abduction and rotation is limited due to pain. Due to compression of vertebral arteries by osteophytes, dizziness and headaches appear over time due to deterioration of blood supply to the brain. Combined compression of nerves and blood vessels can cause visual and hearing impairments. Patients are concerned about the inability to concentrate their eyes, the flickering of flies, tinnitus and hearing impairment.
Sometimes the syndrome of the ladder muscle is detected, due to compression of blood vessels and nerves in the area of the upper arm. Pathology is accompanied by pain in the arm and a weakening of the pulse. With further aggravation of pathological changes, neurological symptoms may occur due to compression of nerve roots (sciatica) and spinal canal stenosis (compression myelopathy). Muscle weakness, sensitivity disorders of the upper and lower extremities are possible.
Diagnostics
Examination of a patient suffering from cervical spondylosis is carried out by a vertebrologist or orthopedist with the participation of a neurologist, includes objective studies and visualization techniques. To clarify the diagnosis, the following are conducted:
- A survey, an external examination. The doctor specifies the time of occurrence and dynamics of the development of manifestations of the disease, signs of complications. The specialist determines the mobility of the neck, identifies characteristic symptoms (limiting the tilt of the head sideways in the standing position and increasing it in the lying position).
- Neurological examination. Includes checking reflexes, sensitivity and movements. When the roots are squeezed, reflexes may disappear from the biceps, triceps and shoulder muscles. With compression of the spinal cord, there is an increase in muscle tone and an increase in reflexes, a pathological Babinsky reflex appears.
- Spine x-ray. The height of the intervertebral discs is reduced. The images show common degenerative changes, osteophytes protruding towards the spinal canal are determined.
- CT of the spine. Allows you to refine the radiography data. It indicates a narrowing of the intervertebral openings, degenerative changes in the small joints of the spine. At a late stage, it confirms compression of the spinal cord by altered discs and osteophytes.
- MRI of the spine. It is used for a detailed assessment of the condition of soft-woven structures. It reveals stenosis or occlusion of the subarachnoid space, thickening of ligaments, compression of spinal cord areas, areas of edema, demyelination, contusion or myelomalacia of nerve tissues.
- Electromyography. The study of nerve conduction is carried out when signs of sciatica or compression myelopathy are detected. It makes it possible to clarify the severity and prevalence of damage to nerve fibers and muscles innervated by them.
Previously, to detect spinal canal stenosis, myelography was usually used – an X-ray contrast study in which contrast fluid or air was injected into the spinal canal by means of a lumbar puncture, and then a series of pictures were taken. Currently, this technique is gradually losing its importance due to the appearance of CT and MRI. These methods allow you to get the same data, but they have no side effects and are much easier for patients to tolerate.
Treatment
Treatment is usually conservative. The main goals are to eliminate pain syndrome, improve local blood circulation, preserve the mobility of the spine, restore normal relations between the individual structures of the spinal column and slow down degenerative-dystrophic processes in the tissue of the intervertebral discs.
Conservative therapy
It is carried out on an outpatient basis, includes a special regime, medications and physiotherapy procedures. The following therapeutic measures are carried out.
- Protective mode. It involves limiting loads (especially static) on the neck area. Patients who have to stay in a forced position for a long time are recommended to use an elastic collar.
- Drug therapy. Patients are prescribed chondroprotectors, angioprotectors and anti-inflammatory drugs. With intense pain syndrome, analgesics are used, with pronounced spasms of the cervical muscles – muscle relaxants.
- Physiotherapy. Ultrasound, diadynamic currents, and drug electrophoresis with novocaine are effective in cervical spondylosis. To strengthen the muscles and maintain mobility, regular exercise exercises are necessary without overextension and overstrain of the neck.
In the absence of contraindications, manual therapy and gentle massage are prescribed. Rough massage techniques and self-massage performed by a non-specialist are categorically contraindicated. With sharp pains caused by compression of nerve roots, blockades of the affected area (paravertebral blockades and blockades of facet joints) are performed.
Surgical treatment
Surgical interventions are required very rarely. Patients are referred for surgery with a combination of several pathological processes (for example, spondylosis and severe spondyloarthrosis), ineffectiveness of conservative treatment, as well as in the presence of progressive neurological symptoms indicating spinal canal stenosis and compression of spinal roots. Performed:
- Laminectomy. Removal of the arches and spinous processes of the vertebrae to eliminate compression of the spine.
- Foraminotomy. Expansion of the hole through which the root and vessels feeding the spinal cord pass.
- Microdiscectomy. It is indicated in case of complication of spondylosis by cervical hernia. It provides for partial excision of the disc using microsurgical techniques.
Operations are performed in the conditions of a neurosurgical or vertebrological department. In the postoperative period, anesthesia is carried out, physiotherapy, massage, physical therapy are prescribed.
Forecast
The prognosis is usually favorable. Pathology is not life-threatening. It is impossible to eliminate the degenerative changes that have already occurred in the spine, however, with the timely start of treatment in most patients, it is possible to eliminate the pain syndrome, preserve the mobility of the neck and prevent the development of neurological complications. In the later stages, the prognosis worsens somewhat due to the prevalence of pathological processes, concomitant changes in nerves, muscles and other structures.
Prevention
The list of preventive measures includes maintaining the physiological position of the neck during work that requires prolonged immobility, regular breaks to warm up the neck muscles, maintaining a sufficient level of physical activity, preventing injuries and diseases of the spine.
