Cervical spondylosis

Cervical spondylosis
Harrygouvas at Greek Wikipedia · CC BY-SA 3.0 · source
Name	Cervical spondylosis
Field	Neurology, Orthopedics
Symptoms	Neck pain, stiffness, radiculopathy, myelopathy
Onset	Gradual, age-related
Risks	Ageing, smoking, occupational health
Diagnosis	Clinical examination, magnetic resonance imaging, computed tomography
Treatment	Conservative therapy, surgery

Cervical spondylosis is a degenerative condition affecting the cervical portion of the spine associated with age-related changes in the intervertebral disc, facet joints and osteophyte formation. It commonly manifests with neck pain, radicular symptoms and, in severe cases, spinal cord compression leading to myelopathy, and is managed across specialties including neurology, orthopedics, rheumatology, physical therapy and sports medicine.

Signs and symptoms

Patients typically present with chronic neck pain and stiffness, often reported to clinicians in settings such as Mayo Clinic, Johns Hopkins Hospital, Cleveland Clinic, Massachusetts General Hospital and Royal National Orthopaedic Hospital; associated features may include unilateral or bilateral radicular pain, paresthesia and sensory loss that refer to upper limb distributions described in textbooks from Oxford University Press, Elsevier, Springer Nature, Wiley and Cambridge University Press. Neurological deficits such as weakness, hyperreflexia, gait disturbance and sphincter dysfunction indicate cervical myelopathy, prompting referral to centers like Stanford Health Care, UCLA Health, Mount Sinai Health System, Karolinska University Hospital and Charité – Universitätsmedizin Berlin for advanced assessment. Exacerbating signs include pain with neck movement, occipital referral, and headaches that overlap with presentations seen at Guy's Hospital, Addenbrooke's Hospital, Royal London Hospital, Toronto General Hospital and Monash Medical Centre.

Causes and risk factors

The primary cause is degenerative wear consistent with senescence observed across populations studied by institutions including World Health Organization, Centers for Disease Control and Prevention, National Institutes of Health, European Spine Journal cohorts and Global Burden of Disease collaborations. Risk factors include advancing age, prior cervical trauma such as injuries treated at Royal Victoria Hospital, repetitive occupational loading documented in cohorts from ILO, tobacco exposure seen in studies from American Cancer Society, systemic inflammatory conditions like rheumatoid arthritis evaluated in registries at London School of Hygiene and Tropical Medicine and metabolic contributors such as diabetes mellitus reported by American Diabetes Association. Genetic predisposition and lifestyle elements have been explored in research from Johns Hopkins University, Harvard Medical School, University of Oxford, University of Cambridge and Imperial College London.

Pathophysiology

Degeneration begins in the intervertebral disc with decreased hydration and proteoglycan loss, progressing to annular fissures, disc height loss and osteophyte formation at discovertebral junctions—mechanisms detailed in reviews from The Lancet, Nature Reviews Neuroscience, New England Journal of Medicine, BMJ and JAMA. Mechanical compression from herniated nucleus pulposus or hypertrophic ligamentum flavum can impinge on nerve roots or the spinal cord, producing radiculopathy or myelopathy described in monographs from Surgery of the Spine publishers such as Elsevier and Springer. Vascular insufficiency due to foraminal narrowing and microvascular compromise implicates small vessel pathology referenced in studies at Mayo Clinic and Cleveland Clinic. Cellular pathways involve matrix metalloproteinases and inflammatory mediators investigated by teams at National Institutes of Health, Cold Spring Harbor Laboratory, Salk Institute and Max Planck Society.

Diagnosis

Diagnosis is clinical supported by imaging modalities: plain radiography for alignment and osteophytes, computed tomography for osseous detail and magnetic resonance imaging for soft tissue and cord changes, used routinely at radiology services such as Mayo Clinic Radiology, Massachusetts General Hospital Radiology, Johns Hopkins Radiology, Karolinska Institutet and Royal College of Radiologists guidelines. Electrophysiological studies including nerve conduction studies and electromyography are performed in neurophysiology laboratories at Addenbrooke's Hospital, UCLH, Sheffield Teaching Hospitals and Bellevue Hospital to localize radiculopathy. Differential diagnosis requires exclusion of conditions managed by oncology centers (metastatic disease), infectious disease units (discitis), and rheumatology clinics (inflammatory spondyloarthropathies) in institutions like MD Anderson Cancer Center, CDC Emerging Infections Program, Hospital for Special Surgery and Brigham and Women's Hospital.

Treatment

Initial management emphasizes conservative care: analgesia (NSAIDs, acetaminophen), muscle relaxants, cervical physical therapy and structured exercise programs developed by teams at Cleveland Clinic, UCSF Health, Johns Hopkins Physical Medicine and Rehabilitation, Karolinska University Hospital and Peter MacCallum Cancer Centre. Interventional options include cervical epidural steroid injections and selective nerve root blocks performed in pain clinics at Mayo Clinic, Stanford Health Care and Toronto Western Hospital. Surgical indications—progressive myelopathy, intractable pain, or severe radiculopathy—lead to procedures such as anterior cervical discectomy and fusion, posterior decompression and cervical disc arthroplasty, offered by spine centers at Rothman Orthopaedic Institute, Hospital for Special Surgery, Neurosurgery Department at Johns Hopkins, UCLA Neurosurgery and Karolinska. Multidisciplinary rehabilitation involves physiotherapy units affiliated with Oxford University Hospitals, Cambridge University Hospitals, Monash Health and Singapore General Hospital.

Prognosis and complications

Many patients experience symptom stabilization or improvement with conservative therapy, as reported in longitudinal cohorts from Framingham Heart Study, Rotterdam Study, EPIC-Norfolk and Baltimore Longitudinal Study of Aging. Complications include chronic pain syndromes, progressive neurological deficit and rare cases of respiratory compromise managed in tertiary centers like Royal Brompton Hospital, John Radcliffe Hospital, St Thomas' Hospital and Guy's and St Thomas' NHS Foundation Trust. Surgical outcomes vary by procedure and comorbidity profiles reported in series from Cochrane Collaboration, American Academy of Orthopaedic Surgeons and Society of British Neurological Surgeons.

Epidemiology

Prevalence increases with age, with radiographic changes common in cohorts from Framingham Heart Study, NHANES, Rotterdam Study, Dunedin Multidisciplinary Health and Development Study and Baltimore Longitudinal Study of Aging; symptomatic disease predominates in middle-aged and elderly adults studied at WHO and national health surveys such as CDC National Health Interview Survey. Incidence and burden vary geographically and are reported by collaborations including Global Burden of Disease, European Spine Journal, Asia-Pacific Spine Journal and national registries in United Kingdom, United States, Australia, Japan and Germany.

Category:Spine disorders