Arthritis of the neck, also known as cervical spondylosis, is common among older adults. It is a degenerative condition that affects the cervical spine (the neck region of the spine) and is often associated with aging. By the age of 60, most people show signs of cervical spondylosis on x-rays, and it is estimated that more than 85% of people over the age of 60 are affected by this condition.
Although many people with cervical spondylosis remain asymptomatic, it can cause symptoms such as neck pain, stiffness, and in some cases, neurological deficits due to nerve compression.
In this article, we’ll discuss everything you should know about this condition.
Overview
Cervical spondylosis is a disorder in which there is abnormal wear on the cartilage (disks) and bones of the neck (cervical vertebrae). It is a common cause of chronic neck pain, especially in older adults. The changes associated with cervical spondylosis include:
- Dehydrated disks: The disks between the vertebrae act as cushions, but they can dehydrate and shrink with age, leading to increased bone-on-bone contact.
- Herniated disks: Cracks may appear on the exterior of the spinal disks, allowing the soft interior to bulge out and press on the spinal cord or nerve roots.
- Bone spurs: As the disks break down, the body may produce extra bone in an attempt to strengthen the spine, resulting in bone spurs that can pinch the spinal cord or nerve roots.
- Stiff ligaments: The ligaments connecting the bones can stiffen with age, making the neck less flexible.
While cervical spondylosis is very common, especially after age 60, many people do not experience any symptoms. However, in some cases, it can lead to compression of the spinal cord or nerve roots, causing various symptoms.
Symptoms
The most common symptoms of cervical spondylosis include:
- Neck pain: This is often the primary symptom, and the pain may radiate to the shoulders or arms.
- Stiffness and reduced range of motion: The neck may feel stiff, and it may be difficult to turn or move the neck freely.
- Headaches: Cervical spondylosis can cause headaches, particularly at the base of the skull.
- Grinding or crunching sensation: When moving the neck, there may be a grinding or crunching feeling due to bone-on-bone contact.
- Numbness or tingling: If nerve roots are compressed, it can cause numbness or tingling in the shoulders, arms, or hands.
- Weakness: Compression of the spinal cord or nerve roots can lead to weakness in the arms or legs.
- Balance problems: In severe cases, cervical spondylosis can affect balance and coordination.
- Bladder or bowel control issues: Rarely, severe compression of the spinal cord can cause loss of bladder or bowel control.
It’s important to note that many people with cervical spondylosis may not experience any symptoms, as the changes can be seen on imaging tests without causing discomfort. However, if symptoms do occur, they can range from mild to severe, depending on the extent of compression on the spinal cord or nerve roots.
Causes
Cervical spondylosis is primarily caused by age-related degeneration of the cervical spine. As people age, the structures in the neck, including the intervertebral discs, facet joints, and ligaments, undergo wear and tear. Other factors that can increase the risk of developing cervical spondylosis include:
- Genetics: A family history of neck pain and spondylosis.
- Occupation: Jobs that involve repetitive neck motions, heavy lifting, or awkward positioning.
- Previous Neck Injuries: Past trauma to the neck can accelerate degenerative changes.
- Smoking: Linked to increased neck pain and degeneration.
- Obesity and Lack of Exercise: These can contribute to the overall wear and tear on the spine.
Diagnosis and Tests
The diagnosis and testing for cervical spondylosis involve a combination of physical examinations and various imaging and nerve function tests.
Your doctor typically start with a physical examination to assess the your symptoms and physical condition. This includes:
- Checking the range of motion in the neck.
- Testing reflexes and muscle strength to identify any pressure on spinal nerves or the spinal cord.
- Observing gait to see if spinal compression affects walking.
- Examining the neck, shoulders, arms, and legs for any abnormalities, such as bumps or knots, and assessing muscle strength and touch sensation
To provide detailed views of the spine and identify structural changes, your doctor might recommend imaging tests, including:
- X-rays: These can show bone spurs and other changes in the spine, such as the alignment of bones and the presence of degenerative changes.
- Magnetic Resonance Imaging (MRI): MRI provides detailed images of soft tissues, including cartilage, nerve roots, muscles, spinal cord, and disks, helping to pinpoint areas where nerves might be pinched.
- Computed Tomography (CT) Scan: CT scans offer detailed images of the spinal structures and can be enhanced with a myelogram, where a contrast dye is injected into the spinal canal to better visualize the spinal cord and nerve roots
Nerve function tests help determine if nerve signals are traveling properly to the muscles. They include:
- Electromyography (EMG): Measures the electrical activity in nerves as they transmit messages to muscles during contraction and at rest.
- Nerve Conduction Study: Involves attaching electrodes to the skin above the nerve and passing a small shock through the nerve to measure the strength and speed of nerve signals.
Treatment
In most cases, doctors start with simple, non-invasive treatments. Here are some common recommendations:
- Physical Therapy: Stretching and strengthening exercises for the neck and shoulders can reduce pain and improve flexibility.
- Traction: This can help create more space within the spine if nerve roots are being pinched.
- Heat and Ice: Applying heat or ice to the neck can relieve muscle soreness.
- Soft Neck Brace: Wearing a soft collar can limit neck motion and allow muscles to rest, but it should be used only for short periods to avoid muscle weakening.
- Chiropractic Adjustments: Spinal manipulation and massage can help relieve symptoms.
Your doctor might also prescribe the following medications:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Commonly used to reduce pain and inflammation. Examples include ibuprofen and naproxen.
- Acetaminophen: Used for mild pain relief.
- Corticosteroids: Oral prednisone or steroid injections can help reduce severe inflammation and pain.
- Muscle Relaxants: Medications like cyclobenzaprine can relieve muscle spasms.
- Anti-seizure Medications: Drugs such as gabapentin can help manage nerve pain.
- Antidepressants: Certain antidepressants can also help alleviate chronic pain
If your neck pain is severe, your doctor might suggest more advanced treatments such as:
- Steroid Injections: These can provide short-term pain relief by reducing inflammation.
- Epidural Steroid Injections: These are used for more severe cases involving nerve root compression.
Surgery is considered when conservative treatments fail or if there are significant neurological symptoms, such as weakness in the arms or legs. Surgical options include:
- Discectomy: Removal of a herniated disc.
- Laminectomy: Removal of part of the vertebra to relieve pressure on the spinal cord.
- Spinal Fusion: Fusing two or more vertebrae to stabilize the spine.
- Anterior Cervical Diskectomy and Fusion (ACDF): Removal of a disc and fusion of the vertebrae.
Living With
To live with your neck pain, you might incorporate some self-care measures into your daily routine:
- Regular exercises
- Maintain good posture
- Set up ergonomic workstation
- Avoid activities that exacerbate symptoms, such as heavy lifting or prolonged neck bending
- Use a soft neck brace for short periods
- Practice relaxation techniques
If you want to have some short-term relief, you might check out some over-the-counter pain relievers.
It’s also a good idea to do regular check-ups with your doctor to monitor the condition and adjust treatments as necessary.
When to See a Doctor
While most neck pains disappear in a few weeks, you might make an appointment with your doctor if you experience any of the following symptoms:
- Persistent or worsening neck pain
- Stiffness or reduced range of motion in the neck
- Numbness, tingling, or weakness in the arms or hands
- Headaches, especially at the base of the skull
- Grinding or crunching sensations when moving the neck
Though these symptoms may be mild initially, early evaluation and treatment can prevent deterioration.
There are some symptoms that might indicate a serious complication or compression of the spinal cord, such as:
- Sudden onset of numbness or weakness in the arms, legs, or torso
- Loss of bladder or bowel control
- Difficulty walking or maintaining balance
If you experience any of the above symptoms, you should seek immediate medical attention to prevent permanent nerve damage.
Sophia Anderson, PT, DPT is a physical therapist who offers online pain management consultations. She helps people with various types of pain, especially neck, back, and knee pain.
She graduated from the University of St. Augustine with a Doctor of Physical Therapy (DPT) degree. She has experience in orthopedic physical therapy, sports medicine, neurological rehabilitation, advanced assessment and treatment of running injuries, and advanced treatment of the pelvic complex, spine, and extremities.
If you’re experiencing any pain, let Sophia Anderson, PT, DPT help you out.