What is Cervical Spondylosis: Anatomy, Etiopathogenesis, Types, and Treatment

Cervical spondylosis, also known as cervical disc degenerative disease, is a common age-related condition affecting the cervical spine, which is the upper portion of the spine encompassing the neck area. This condition often manifests as neck pain, stiffness, and other neurological symptoms due to degenerative changes in the spinal discs, vertebrae, and surrounding structures.

Understanding the anatomy of the cervical spine is fundamental in comprehending cervical spondylosis. The cervical spine comprises seven vertebrae, denoted as C1 to C7, and is divided into two main regions: the upper cervical spine (C1 and C2) and the lower cervical spine (C3 to C7).

1. Upper Cervical Spine (C1 and C2) : The first cervical vertebra, known as the atlas (C1), supports the skull’s weight and allows for nodding or “yes” motion. The second cervical vertebra, called the axis (C2), possesses a unique bony projection, the odontoid process (also known as the dens), which articulates with the atlas. This pivotal joint permits the rotation or “no” motion of the head.
2. Lower Cervical Spine (C3 to C7) : The lower cervical vertebrae have more typical vertebral bodies, and their functions include providing stability, flexibility, and support to the neck. The cervical discs, fibrous structures situated between these vertebrae, act as shock absorbers and facilitate movement.

Surrounding the cervical spine are crucial structures such as the spinal cord, nerve roots, intervertebral discs, facet joints, and various ligaments and muscles. These components work in harmony to maintain spinal stability while allowing for a range of neck movements.

Cervical spondylosis is primarily an age-related condition, and its etiology is multifactorial. Several key factors contribute to the development and progression of this condition:

1. Degeneration of Intervertebral Discs : Over time, the intervertebral discs in the cervical spine undergo wear and tear. This degeneration can lead to the loss of disc height and hydration, resulting in reduced shock-absorbing capacity and increased susceptibility to injury.
2. Formation of Osteophytes : Osteophytes, also known as bone spurs, often develop as a response to disc degeneration. These bony growths can impinge on surrounding structures, including nerves, leading to pain and other symptoms.
3. Herniated Discs : Disc herniation occurs when the inner core of a disc protrudes through its outer layer. This can compress nearby nerves or the spinal cord, causing radiculopathy or myelopathy, respectively.
4. Facet Joint Arthritis : Facet joints, located at the back of the spine, can undergo degeneration and arthritis. Inflammation and pain can result from facet joint dysfunction.
5. Ligament Thickening : Ligaments in the cervical spine may thicken and stiffen, reducing neck mobility and potentially contributing to symptoms.
6. Spinal Stenosis : The narrowing of the spinal canal, known as spinal stenosis, can occur with age, compressing the spinal cord and nerve roots. This condition is associated with myelopathy.
7. Genetic Factors : Genetics can play a role in the development of cervical spondylosis. Some individuals may have a genetic predisposition to disc degeneration or other structural abnormalities.
8. Occupational and Lifestyle Factors : Certain occupations or activities that involve repetitive neck movements or heavy lifting may increase the risk of cervical spondylosis.
9. Smoking : Smoking has been linked to accelerated disc degeneration and may contribute to the development of cervical spondylosis.
10. Trauma : Previous neck injuries or trauma, even if they occurred years earlier, can accelerate the degenerative process.

Understanding these underlying factors is crucial for both prevention and management of cervical spondylosis.

MRI scans of a male patient with cervical spondylosis at 2 noncontiguous levels with spinal cord compression at C3–C4 and C5–C6 due to disk herniation, and a normal C4–C5 disk. B, C, Transverse sections showing severe spinal cord compression due to disk herniation at C3–C4 and C5–C6. MRI indicates magnetic resonance imaging.

Cervical spondylosis can manifest in various forms, each with its unique clinical presentation and implications. The four main types are as follows:

1. Cervical Spondylosis with Radiculopathy : This type involves compression or irritation of cervical nerve roots, typically due to herniated discs or osteophytes. Common symptoms include neck pain, radiating arm pain, tingling, and weakness along the affected nerve’s pathway.
2. Cervical Spondylosis with Myelopathy : Myelopathy refers to spinal cord dysfunction caused by spinal compression. In cervical spondylosis with myelopathy, patients may experience gait disturbances, loss of fine motor skills, balance problems, and bladder or bowel dysfunction.
3. Cervical Spondylosis without Myelopathy : In cases where spinal cord compression is absent, patients can still experience neck pain, stiffness, and radiculopathy symptoms, but without the more severe neurological deficits seen in myelopathy.
4. Multilevel Cervical Spondylosis : This type involves degenerative changes affecting multiple levels of the cervical spine. Multilevel spondylosis can lead to a combination of symptoms depending on the location and severity of degeneration.

The management of cervical spondylosis is tailored to the type and severity of the condition. Several treatment modalities are available, ranging from conservative measures to surgical interventions:

Conservative approaches often form the initial treatment strategy and may include:

1. Physical Therapy : Physical therapy focuses on improving neck strength, flexibility, and posture. It can also include modalities such as heat or cold therapy.
2. Medications : Non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and pain medications may be prescribed to manage pain and inflammation.
3. Neck Braces or Collars : These devices provide support and restrict neck movement to facilitate healing.
4. Lifestyle Modifications : Lifestyle changes like ergonomic adjustments at work, weight management, and smoking cessation can help manage symptoms and prevent progression.

For patients with persistent pain, image-guided injections can be beneficial:

1. Cervical Epidural Steroid Injections: These injections deliver anti-inflammatory medication directly to the epidural space around the spinal cord, reducing pain and inflammation.
2. Cervical Facet Joint Injections: Targeting the facet joints, these injections can alleviate pain associated with facet joint arthritis.
3. Selective Nerve Root Blocks: These injections target specific nerve roots to relieve radicular pain.

Surgery is considered when conservative measures fail or in severe cases. Surgical options include:

1. Discectomy : Removal of herniated disc material pressing on nerves.
2. Cervical Fusion : Joining two or more vertebrae to stabilize the spine.
3. Artificial Disc Replacement : Replacing a damaged disc with an artificial one.
4. Laminectomy : Removing part of the vertebra to relieve spinal cord compression.

Cervical spondylosis, a degenerative condition of the cervical spine, presents with various clinical manifestations, often resulting in neck pain, radiculopathy, or myelopathy. Understanding the anatomy, etiopathogenesis, and types of cervical spondylosis is crucial for accurate diagnosis and appropriate management. While conservative treatments and image-guided injections provide relief for many patients, surgical interventions may be necessary in severe cases. AT ALLEVIATE we practice a  multidisciplinary approach, involving healthcare professionals from various specialties combining their expertise to ensure comprehensive care and improved patient outcomes.