Cervical spondylosis

It is degeneration of the spin from wear and tear , it is spinal arthritis

It becomes increasingly more common as people age. More than 85% of people over age 60 are affected.

Predisposing factors:

    a-Genetics – if your family has a history of neck pain

    b-Smoking – clearly linked to increased neck pain

    c-Occupation – jobs with lots of neck motion and overhead work

    d-Mental health issues – depression/anxiety

    e-Injuries/trauma – car wreck or on-the-job injury

.Diagnosis

1-X-rays

These pictures are traditionally ordered as a first step in imaging the spine. X-rays will show aging changes, like loss of disk height or bone spurs.

2-Magnetic resonance imaging (MRI)

This study can create better images of soft tissues, such as muscles, disks, nerves, and the spinal cord.

3-Computed tomography (CT) scans

This specialized x-ray study allows careful evaluation of the bone and spinal canal.

4-Myelography

This specific x-ray study involves injecting dye or contrast material into the spinal canal. It allows for careful evaluation of the spinal canal and nerve roots.

5-Electromyography (EMG)

6-Nerve conduction studies and electromyography may be performed by another doctor to look for nerve damage or pinching.

7-Neck flexibility assessment. Cervical spondylosis limits the range of motion in your neck. To observe this effect, your doctor may have you tilt your head toward each of your shoulders and rotate your neck from side to side.

Clinical picture:

Problemes result from compression on the spinal cord or nerve root or both

If the spinal cord is compressed, a change in walking is usually the first sign. Leg movements may become jerky (spastic), and walking becomes unsteady. Sensation may be decreased in the feet and hands. The neck may be painful and become less flexible. Reflexes may be increased, sometimes causing muscle spasms, particularly in the legs. Coughing, sneezing, and other movements of the neck may worsen symptoms. Sometimes the hands are affected more than the legs and feet. If severe, compression may impair bladder and bowel function.

If spinal nerve roots are compressed, the neck is usually painful, and the pain often radiates to the head, shoulders, or arms. Muscles in one or both arms may become weak and waste away, making the arms limp. Reflexes in the arms may be decreased

Treatment:

1-Analgesics:

    Paracetamol at full strength is often sufficient. For an adult this is two 500 mg tablets, four times a day.

    Anti-inflammatory painkillers. Some people find that these work better than paracetamol. They can be used alone or in combination with paracetamol. They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac or naproxen need a prescription. Some people with stomach ulcers, asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers.

    A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. Constipation is a common side-effect from codeine. To prevent constipation, have lots to drink and eat foods with plenty of fibre.

    A low dose tricyclic antidepressant, such as amitriptyline, is sometimes used for chronic (persistent) neck pain. The dose of amitriptyline used for pain is 10-30 mg at night. At higher doses, tricyclic antidepressants are used to treat depression. However, at lower doses they have been found to help relieve certain types of pain including neck pain.

2-Role of physiotherapy:

Your physical therapist may give you passive treatments such as:

    Deep Tissue Massage: This technique targets spasms and chronic muscle tension that perhaps builds up through daily life stress. You could also have spasms or muscle tension because of strains or sprains. The therapist uses direct pressure and friction to try to release the tension in your soft tissues )ligaments, tendons, muscles.)

    Hot and Cold Therapies: Your physical therapist will alternate between hot and cold therapies. By using heat, the physical therapist seeks to get more blood to the target area because an increased blood flow brings more oxygen and nutrients to that area. Blood is also needed to remove waste byproducts created by muscle spasms, and it also helps healing.Cold therapy, also called cryotherapy, slows circulation, helping to reduce inflammation, muscle spasms, and pain. You may have a cold pack placed upon the target area, or even be given an ice massage. Another cryotherapy option is a spray called fluorometh

    ane that cools the tissues. After cold therapy, your therapist may work with you to stretch the affected muscles.

    Electrical stimulation: This can be performed within the clinic and if extremely successful, a TENS unit can be issued to a patient for home use. E-stim stimulates your muscles through variable (but safe) intensities of electrical current. It helps reduce muscle spasms, and it may increase your body’s production of endorphins, your natural pain killers. It may also drive out inflammation, bring in healing properties, relax, and re-educate the muscles involved. The e-stim unit in the clinic is of a professional standard; the equipment is relatively large. However, a smaller machine for at “at home” use is also available. Electrical stimulation is a helpful therapy.

, your therapist will teach you various exercises to improve your flexibility, strength, core stability, and range of motion (how easily your joints move). Your physical therapy program is individualized, taking into consideration your health and history. Because your PT program is so individualized, we can’t say what should and shouldn’t be in your plan; again, your physical therapist will decide that. But we can generally say that you may learn about body mechanics—how to move your body so that you don’t increase your pain. You’ll learn how to avoid positions that exacerbate your pain. You may also learn about correcting your posture and how to use good ergonomics at work.

Wearing a neck brace (cervical collar) off and on throughout the day to help limit neck motion and reduce nerve irritation

3-Surgical treatment:

.Anterior approach is an incision in the front of the neck and moves aside the windpipe (trachea) and swallowing tube (esophagus) to expose the cervical spine. Your surgeon can then remove a herniated disk or bone spurs, depending on the underlying problem. Sometimes, with disk removal, your surgeon will fill the gap With agraft of bone or implant.

.Posterior approach Your surgeon may opt to remove or rearrange bone from the back of your neck, especially if several portions of the channel that houses the cord have narrowed. The operation, called a laminectomy, removes the back part of the bone over the spinal canal through an incision in the back of your neck.

Complication of surgry:

It may include infection, a tear in the membrane that covers the spinal cord at the site of the surgery, bleeding, a blood clot in a leg vein and neurological deterioration. In addition, the surgery may not eliminate all the problems associated with your condition.