Fast Five Quiz: Spine Pain

Herbert S. Diamond, MD

Disclosures

May 16, 2019

Chronic suboccipital headache may be present in individuals with cervical spondylosis. Mechanisms include direct nerve compression; degenerative disk, joint, or ligamentous lesions; and segmental instability. Pain can be perceived locally, or it may radiate to the occiput, shoulder, scapula, or arm. The pain, which is worse when the patient is in certain positions, can interfere with sleep.

In patients with cervical radiculopathy, the C6 root is the most commonly affected because of the predominant degeneration at the C5-C6 interspace; the next most common sites are C7 and C5.

Cervical myelopathy has an insidious onset, which typically becomes apparent in persons aged 50-60 years. Complete reversal is rare once myelopathy occurs. Cervical spondylotic myelopathy is the most serious consequence of cervical intervertebral disk degeneration, especially when it is associated with a narrow cervical vertebral canal.

Less common manifestations associated with cervical spondylosis include:

  • Primary sensory loss may be present in a glovelike distribution.

  • Tandem spinal stenosis is a simultaneous cervical and lumbar stenosis resulting from spondylosis. It is a triad of findings: neurogenic claudication, complex gait abnormality, and a mixed pattern of upper and lower motor neuron signs.

  • Dysphagia may be present if the spurs are large enough to compress the esophagus.

  • Vertebrobasilar insufficiency and vertigo may be observed.

  • Elevated hemidiaphragm, caused by spondylotic compression of C3-4 (as noted in a case report), may be another finding.

Read more about the presentation of cervical spondylosis.

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