Fast Five Quiz: Back and Neck Pain

Stephen Kishner, MD, MHA


June 11, 2020

Cervical spondylosis is a chronic degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral disks of the neck (in the form of, for example, disk herniation and spur formation), as well as the contents of the spinal canal (nerve roots and/or spinal cord).

Common clinical syndromes associated with cervical spondylosis include:

  • Cervical pain: Chronic suboccipital headache may be present. 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.

  • Cervical radiculopathy: Compression of the cervical nerve roots leads to ischemic changes that cause sensory dysfunction (eg, radicular pain) and/or motor dysfunction (eg, weakness). Radiculopathy most commonly occurs in persons aged 40-50 years.

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

Usually, no specific laboratory findings are present in patients with cervical spondylosis. Other findings may include those related to an underlying etiologic or pathogenetic disorder that initiates the spondylotic changes. Plain cervical radiography is routine in every patient with suspected cervical spondylosis. Myelography, with CT scanning, was previously considered the imaging test of choice for assessing spinal and foraminal stenosis. With advances in MRI and CT scanning technology, however, myelography is now performed only in selected patients. Because myelography method is invasive, most physicians depend on MRI in diagnosing cervical spondylosis.

Immobilization of the cervical spine is the mainstay of conservative treatment for patients with severe cervical spondylosis with evidence of myelopathy. Mechanical traction is a widely used technique. This form of treatment may be useful because it widens the foraminal openings.

Manual therapy, such as massage, mobilization, and manipulation, may provide further relief for patients with cervical spondylosis without myelopathy. Mobilization is performed by a physical therapist and is characterized by the application of gentle pressure within or at the limits of normal motion, with the goal of increasing the range of motion. Manual traction may be better tolerated than mechanical traction in some patients. Manipulation is characterized by a high-velocity thrust, which is often delivered at or near the limit of the range of motion. The intention is to increase articular mobility or to realign the spine. Contraindications to manipulative therapy include myelopathy, severe degenerative changes, fracture or dislocation, infection, malignancy, ligamentous instability, and vertebrobasilar insufficiency.

Read more about cervical spondylosis.


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