Degenerative Arthritis in your Neck
What is Cervical Spondylosis?
Your spine is made up of 24 bones, called vertebrae, that are stacked on top of one another. These bones connect to create a canal that protects the spinal cord. The seven small vertebrae that begin at the base of the skull and form the neck comprise the cervical spine.
Your spinal cord has nerve roots that branch off from the cord carrying sensory and motor signals to and from your body. Flexible disks act as cushions between the vertebrae. As you age, these disks collapse and bulge. Your body also forms bone spurs around these collapsing disks. These degenerative changes to the intervertebral disks and formation of bone spurs are called cervical spondylosis.
How does it occur?
Cervical spondylosis occurs from wear and tear as you age.
As the disks in the spine age, they lose height and begin to bulge. They also lose water content, begin to dry out and weaken. This problem causes settling, or collapse, of the disk spaces and loss of disk space height. Eventually, the cushioning qualities of the disks begins to decrease.
As the facet joints experience increased pressure, they also begin to degenerate and develop arthritis, similar to what may occur in the hip or knee joint. The smooth, slippery articular cartilage that covers and protects the joints wears away.
If the cartilage wears away completely, it can result in bone rubbing on bone. To make up for the lost cartilage, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth — called bone spurs — may narrow the space for the nerves and spinal cord to pass through (stenosis). Bone spurs may also lead to decreased range of motion in the spine.
These changes are normal and occur in everyone. Many older people have worn disks that do not cause painful symptoms.
Risk factors associated with arthritis of the neck include genetics, smoking, occupation (repetitive neck motion and overhead work), depression/anxiety, prior injury to the neck.
What are the symptoms?
Many people with arthritis in the neck are asymptomatic, but the most common complaints are pain and stiffness in the neck. Aggravating factors are looking up or down for long periods of time and activities such as driving or reading a book.
Other symptoms can be headaches, grinding/popping as you move you neck, numbness/weakness/tingling in your arms and hands. You may also have trouble walking and keeping you balance or muscle spasms in your neck and shoulders.
How is it diagnosed?
Diagnosis starts with a thorough history and physical exam. You will be evaluated for range of motion, strength, and sensation in your neck and upper extremities. An X-ray will be taken to evaluate bony structures and alignment of the vertebrae. CT or MRI can give a greater detail image and provide 3D reconstruction of the bony and soft tissues. An EMG or nerve conduction test can test the function of the cervical nerves.
How is it treated?
Most cases of cervical spondylosis can be treated conservatively. Physical therapy to improve strength and flexibility in the neck can help. Cervical traction can help stretch the joints in your neck. Tylenol with an NSAID (Advil/ibuprofen, Aleve/naproxen, or a prescription arthritis medication are usually tried first to relieve pain and inflammation. A stronger, short course of an oral steroid can be used to reduce inflammation in more severe cases. Muscle relaxers can be prescribed to relieve painful muscle spasms. Ice can be used for inflammation, and heat can be used for muscle spasms or soreness.
If these more conservative measures fail, the next step may be a steroid injection around the spine called an epidural block.
Rarely, in the most severe cases, surgery may be required. A cervical laminectomy is a procedure where bone is removed to relieve pressure on the spinal cord and nerves. A foraminotomy is a procedure which removes bone around the cervical nerve root, relieving pressure on that nerve root. Cervical fusion eliminates movement between two vertebrae, relieving any associated pain and symptoms.
If you experience severe pain, weakness or numbness in your arms, loss of coordination or balance in your lower extremities, you may need surgery.
What is the recovery time?
Conservative treatment of milder cases may take 6-8 weeks with medications and physical therapy.
Epidural blocks may be given in a series of up to 3 injections, spaced out a few weeks apart and can give weeks to months of relief.
Surgery may be done same day or require up to 2 days in the hospital, with lighter duty activity for 4-6 weeks, and a full recovery in 2-3 months.
We are here to help. If you believe you are suffering from one of these conditions, we would love to deliver a diagnosis, get you treated and get you moving again.