Cervical spondylosis

By
Chukwu Chidera
Victoria
20/09/2023.
Outline
Introduction
Anatomy
Epidemiology
Pathophysiology.
Clinical features.
Risk factors.
Diagnosis .
Medical management.
Physiotherapy management.
Red flags
Conclusion.
Reference.
Introduction

Cervical Spondylosis refers to the age related chronic

degenerative process that's affects the intervertebral discs
and joints, which may progress to disc herniation,
osteophyte formation, vertebral body degeneration and
compression of the nerve roots or spinal cord (Xiong etal ,
2020).
This mainly lead to increasing pain and weakness in the
neck and upper limbs.
It is the most common disorder of cervical spine in adults
and accounts for about 2% of all hospital visitations.
In extreme cases, it is accompanied by Cervical
Spondylotic Radiculopathy (CSR) or Cervical
Spondylotic Myelopathy (CSM) to form the Cervical
Spondylosis Syndrome.
(Rana, 2015).
Anatomy of the cervical spinal

The cervical spine is the most superior portion of the

vertebral column, lying between the cranium and the
thoracic vertebrae. it's major functions include
supporting and cushioning loads to the head/neck
while allowing for rotation of the head and protecting
the spinal cord extending from the brain. With the first
and second cervical vertebrae being Atlas and Axis
respectively. The intervertebral disc which provides a
cushion effect and is found between the vertebrae . It
is made up of the nucleus propous and annual fibrous .
 Joints.
There are two different joints present throughout the vertebral
column:
1.The disc joint (determines how much vertebral motion is
possible at a particular segmental level. This joint is found
between adjacent vertebral bodies. And it's major function is to
bears the weight of the body above it.
2.Facet joint or zygapophyseal joints (Z joints) : formed by the
articulation of superior and inferior articular processes from
adjacent vertebrae (synovial joints). Facet joints determine and
guide the type of motion (i.e., the direction of motion) that occur
at the segment.
Ligament: There are six major ligaments to consider in the cervical spine.
1 Anterior and posterior longitudinal ligaments – long ligaments that run
the length of the vertebral column, covering the vertebral bodies and
intervertebral discs.
3.Ligamentum flavum – connects the laminae of adjacent vertebrae.
4. Interspinous ligament – connects the spinous processes of adjacent
vertebrae.
5. Nuchal ligament – a continuation of the supraspinous ligament. It
attaches to the tips of the spinous processes from C1-C7.
6.Transverse ligament of the atlas – connects the lateral masses of the
atlas, and in doing so anchors the dens in place.
Epidemiology
Evidence of spondylotic change is frequently found in
many asymptomatic adults, with 25% of adults under the
age of 40, 50 and 85% of adults over the age of 60
showing evidence of disc degeneration.
(Kelly et al., 2011)
Study on asymptomatic adults showed significant
degenerative changes at 1 or more levels in 70% of
women and 95% of men at age of 65 and 60.
Also study carried out in 2014 at Ogun state found 36
symptomatic Cervical Spondylosis pts with male to
female ratio of 8:2 (Oguntona, 2014).
Pathophysiology
Clinical Features.

1.Neck and/or shoulder pain that may radiate down the

upper extremity which may worsen with neck movement.
2. Tingling sensation or numbness felt at the upper limb of
affected side.
3.Muscle weakness along the distribution of the nerve roots
affected.
4.Headache, stiffness and tenderness and/or spasm of neck
and paraspinal muscles,
5.limitation of ROM at the neck and the affected limbs Kelly
et al, 2011).
Risk factors

Risk Factors include;

1.Age
2.Sex
3. Previous injury
4.Genetics
5.Work activity e.g. Load carrying on the head.
(Singh et al, 2014)
DIAGNOSIS.
• Thorough Medical History
• Physical Examination
• Imaging Studies e.g. X-rays, MRI, CT scan, etc.
(Binder, 2007).

MEDICAL MANAGEMENT.
1.Pain relievers,
2.muscle relaxants
3. steroid injections.
Physiotherapy management
Subjective assessment.
Presenting complain.
History.
Past medical history ( THREADS).
Objective assessment.
Segmental assessment
Palpation
Range of motion.
Special tests .
a. The spurling test: The Spurling's test (also known as Maximal Cervical Compression Test
and Foraminal Compression Test) .
b.Distraction test.
c.Cervical flexion test.
d.Cervical extensor endurance test.
e.Cervical isometric test.
Physiotherapy management

Aim
1. To relieve pain
'2.To improve the strength of weak neck muscle.
3 .To improve ROM & optimize function.
4. To provide neck support.
Physiotherapy means of management.

*TENS
*Cryotherapy
* Heat therapy.
* Soft tissue manipulation.
*Traction
* Immobilization by use of neck collar
*Neck resisted exercises.
* Lifestyle modification and postural education.
(Kieran et al, 2011)
Red flags
5Ds
Dizziness
Diplopia, blurred vision or transient hemianopia
Drop attacks (loss of consciousness)
Dysphagia (problems swallowing)
Dysarthria (problems speaking)

3 N's
Nystagmus
Nausea or vomitting
Other neurological symptoms eg the cauda equina syndrome

Bladder dysfunction (usually urinary retention),

Faecal incontinence,
Global / progressive upper or lower limb weakness, and
Gait disturbance.
History of malignancy, infection (tuberculosis)
Sudden onset in a young patient .
Other
History of severe osteoporosis
History of neck surgery.
Fracture.
Conclusion

It important to know that the symptoms of cervical spondylosis

can depend on the stage of the pathologic process and the site of
neural compression.
The treatment approach should be in a stepwise fashion.
Patients experiencing axial neck pain without neurologic
symptoms will typically have a resolution of symptoms within days
to weeks.If symptoms persist, conservative therapy including
NSAIDs and physical therapy should be initiated .Patients with
axial neck pain, cervical radiculopathy, or mild cervical myelopathy
should work formally with a physical therapist on neck-specific
strengthening and range of motion exercises, general exercises,
and pain coping strategies before undergoing surgical treatment.
Reference

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Radiculopathy: A Randomized Controlled Trial, Journal of Chiropractic Medicine.
Kelly, Unrecognized Shoulder Disorders in Treatment of Cervical Spondylosis
Presenting Neck and Shoulder Pain, The Korean Spinal Neurosurgery Society

Kieran et al, Cervical Radiculopathy due to Cervical Degenerative Diseases :

Anatomy, Diagnosis and Treatment, The Korean Neurosurgical Society, 2011.

Melvin D. Law et al Cervical Spondylotic Myelopathy: A Review of Surgical

Indications and Decision Making, Yale journal of biology and medicine,1993.
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Patients With Cervical Radiculopathy: A Randomized Clinical Trial, 2014.
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review.
Singh etal Physical Rehabilitation: Fifth Edition. Philadelphia: F.A.
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Xiong W, Li F, Guan H. Tetraplegia after thyroidectomy in a patient
with cervical spondylosis: a case report and literature review. Medicine
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Thank you.