CERVICAL SPONDYLOSIS

Understanding Spinal Stenosis and Its Role in Spondylosis Pain

Spinal stenosis is a condition where the spaces within your spine narrow. This narrowing can put pressure on the nerves that travel through the spine. Typically, it occurs in the lower back and neck. The most common cause is wear and tear related to osteoarthritis, which can lead to the development of bone spurs.

How Does Spinal Stenosis Cause Spondylosis Pain?

When spinal stenosis occurs, it often leads to the compression of spinal nerve roots. Here’s a breakdown of how this causes pain associated with spondylosis:

• Bone Spur Formation: Osteoarthritis can lead to bone spurs, which are bony projections that develop along the edges of bones.
• Nerve Compression: These bone spurs can invade the foramina, the openings on the sides of each vertebra through which nerves pass.
• Pain Generation: As these bone spurs encroach upon the foraminal area, they compress the nerve roots, causing inflammation and pain.

This nerve compression is a primary contributor to the pain felt in spondylosis, manifesting as discomfort radiating through the back, neck, or limbs, depending on which nerves are affected.

To summarize, spinal stenosis is the narrowing of spinal spaces that can lead to nerve compression, particularly due to bone spur formation. This compression is what often triggers the pain experienced in spondylosis.

Cervical Spondylosis Causes

Spondylosis symptoms are primarily caused by the degeneration of the spine, a natural result of aging. The most common culprit behind these symptoms is spinal osteoarthritis. Over time, the cartilage that cushions the joints in your spine starts to wear down, leading to pain and stiffness.

However, spinal osteoarthritis isn’t the only cause. Other factors can also contribute to the development of spondylosis symptoms:

• Degenerative Disc Disease: As the discs between the vertebrae lose hydration and elasticity, they can shrink or tear, causing discomfort and mobility issues.
• Bone Spurs: These bony projections can develop along the edges of the spine, pressing on nerves and triggering pain.
• Herniated Discs: When the soft interior of a spinal disc pushes through its tougher exterior, it can irritate nearby nerves.

Understanding these underlying causes can help in managing and treating spondylosis effectively.

Disc Degeneration

As people get older, degenerative disc disease affects the discs in their spine and they lose height and discs begin to protrude. The discs also lose water content, dry up, and become feeble. Accordingly, the disc spaces settle or collapse as a result of this situation, and the disc gaps decrease. Then the discs’ cushioning properties begin to deteriorate with time. As the strain on the facet joints increases, they deteriorate and develop arthritis, similar to what happens in the hip or knee joint. Therefore, articular cartilage, which covers and protects the joints, wears away. If the cartilage wears away, bone-on-bone occurs.

Here are a few examples of potential causes:

Bone spurs

Bone spurs result as the body attempts to strengthen the spine by growing more bone. The excess bone, however, can put pressure on sensitive regions of the spine, such as the spinal cord and nerves, causing discomfort. Your body may respond by creating new bone in your facet joints to assist in supporting the vertebrae in order to compensate for the missing cartilage. Bone spurs, or expansion of bone, can reduce the area available for nerves and spinal cord passage over time (stenosis). Bone spurs can also cause a reduction in the spinal range of motion. Cervical spondylosis develops when the bones and protecting cartilage in your neck deteriorate.

Dehydrated spinal discs

Discs, which are thick, pad-like cushions between your spinal bones, buffer the impact of lifting, twisting, and other movements. In addition, these discs’ gel-like substance might dry up over time. This causes your bones (spinal vertebrae) to rub against each other more, causing pain. This procedure might start in your 30s.

Herniated discs

Spinal discs can develop fractures, allowing the interior cushioning substance to seep out. This substance can put pressure on the spinal cord and nerves, causing symptoms including arm numbness and discomfort radiating down an arm.

Injury

If you’ve suffered a neck injury (for example, from a fall or a vehicle accident), it might hasten the aging process.

Ligament stiffness

The thick cords that link your spinal bones to one another might stiffen over time, limiting your neck movement and making it feel tight.

Overuse

Repetitive actions or heavy lifting puts more tension on the spine, causing premature wear and tear.

How Do Degenerative Changes in Spinal Discs Cause Pain?

Degenerative changes in spinal discs often referred to as degenerative disc disease, can lead to a range of painful symptoms. Let’s break down the process:

The Process of Degeneration

• Thinning of Discs: Over time, spinal discs can begin to thin. This loss of disc height reduces the cushioning between vertebrae, leading to increased friction and discomfort.
• Loss of Moisture: Healthy discs maintain a high water content, which helps them absorb shock. As discs dry out, they become less flexible and more prone to damage.
• Breakdown of Disc Structure: With age or injury, the tough outer layer of the disc, called the annulus, can develop small tears. These tears may cause the disc’s inner gel-like core to bulge out or even rupture.

Origins of Pain

• Discogenic Pain: Pain can originate directly from the damaged disc itself. The inner disc, or nucleus pulposus, contains inflammatory proteins that can irritate the surrounding nerves when the disc is torn or ruptured.
• Biomechanical Changes: As the structures of the spine deteriorate, the biomechanics—or the way the spine moves and bears weight—can change. This misalignment can put additional strain on muscles, ligaments, and joints, resulting in pain.

Consequences of Degenerative Disc Disease

• Radiating Pain: If a degenerating disc presses on nearby nerves, it can cause radiating pain, numbness, or weakness in the arms or legs, depending on the location of the affected disc.
• Chronic Discomfort: Persistent pain can develop, fluctuating with activities and positions, often worsening with prolonged sitting or standing.

By understanding these mechanisms, one can better appreciate how degenerative changes in spinal discs contribute to the often debilitating pain associated with this condition.

Risk Factors

Old age causes the majority of cervical spondylosis cases.  Unfortunately, patients in their middle and later years become more susceptible. Other variables that might put you at risk for cervical spondylosis and neck discomfort include:

• Genetics — a family history of spondylosis and neck discomfort
• Smoking increases neck discomfort.
• Labor – occupations that require a lot of repeated neck motion and overhead work
• Anxiety or depression
• Neck injury or trauma in the past

Cervical Spondylosis Symptoms

Spondylosis encompasses a range of degenerative conditions affecting the spine, and its symptoms can vary widely. Here’s an overview of the most common symptoms you might experience:

Spinal Osteoarthritis Symptoms

• Facet Joint Pain: Pain primarily emanates from the facet joints, which are pairs of joints located at the back of each vertebra. As the cartilage within these joints deteriorates, it can lead to:
• Bone Grinding: Without the cushioning cartilage, bones grind against one another, causing significant friction and loss of mobility.
• Bone Spurs: The friction may result in the formation of osteophytes (bone spurs), which can impinge on surrounding nerves, muscles, or ligaments, causing pain.

Nerve Compression Symptoms

• Sciatica: When a vertebra in the lower back slips forward over the one beneath it—a condition known as spondylolisthesis—it can compress the sciatic nerve. This compression often results in radiating pain down the back, buttocks, and legs.
• Spinal Stenosis: Narrowing of the spinal canal can compress spinal nerves, leading to pain. If a bone spur intrudes upon the foraminal area (an opening in the side of each vertebra), it can exacerbate this condition.

Degenerative Disc Disease Symptoms

• Disc Thinning: Over time, spinal discs may thin, lose moisture, and deteriorate.
• Disc-Originated Pain: Pain can originate within the disc itself due to its degeneration.
• Altered Biomechanics: Changes in the spine’s mechanics due to disc degeneration can lead to additional pain and discomfort.

Each of these conditions contributes to an overarching picture of spondylosis, presenting a variety of symptoms that can significantly impact daily life. Whether the pain stems from joint degradation, nerve compression, or disc issues, recognizing these symptoms can lead to better diagnosis and management.

• Cervical spondylosis can cause the following symptoms:
• Neck pain that may spread to your arms or shoulders
• Headaches
• When you move your neck, you get a grinding sensation.
• Your arms and legs are weak.
• Arms, hands, or shoulders that are numb.
• The neck is stiff.
• You’re having trouble holding your footing.
• Problems with your bladder or bowels

Lumbar Spondylosis Symptoms

Lumbar spondylosis manifests through various symptoms, primarily involving back and leg pain. The most common sign is low back discomfort, which can range from a persistent ache to sharp pain. Additional symptoms include:

• Leg Pain: Often felt as a radiating or sharp sensation, leg pain may extend from the lower back down to one or both legs.
• Nerve Compression: This can lead to pain or tingling that shoots down the hip, thigh, and even to the knee.
• Lumbar Radiculopathy: Pain that radiates outward, often mistaken for issues in other parts of the body, such as knee pain due to nerve compression.
• Sciatica: This specific type of pain occurs when the sciatic nerve is irritated or compressed, resulting in tingling, numbness, or shooting pain down the leg.

Understanding these symptoms can help in identifying lumbar spondylosis early and seeking appropriate treatment.

Diagnosis Spondylosis

Accurately diagnosing spondylosis usually requires a multi-faceted approach.

Patient History and Symptoms

The diagnostic process begins with a thorough review of the patient’s medical history and a detailed discussion about symptoms. Patients often report neck pain, numbness in the limbs, and difficulties with coordination and balance. Understanding the longevity and severity of these symptoms helps in forming an initial diagnosis.

Physical Examination

A physical examination focuses on neurological and mechanical function. Doctors assess reflexes, muscle strength, sensory response, and gait to identify any signs of spinal cord compression.

Key Aspects Examined:

• Reflex reactions
• Muscle strength in upper and lower limbs
• Sensory perception
• Balance and coordination

Imaging Studies

X-rays

• These are primarily used to see changes to the bones. X-rays can also observe the skeleton in motion, such as when the spine and neck bend backward or forward, helping the orthopedist understand the impact of spondylosis on the patient’s range of motion.
• They provide an initial view of the spinal structure, helping to identify bone spurs or vertebral misalignments. However, for a more detailed evaluation, additional imaging tests are often required:

MRI (Magnetic Resonance Imaging):

• Offers a detailed image of soft tissues including discs, spinal cord, and nerve roots.
• Can highlight areas of compression and degeneration.

CT Scan (Computed Tomography):

• Provides a more comprehensive view of the spinal structure.
• Useful for identifying bone abnormalities and complex fractures.

Myelography:

• Involves injecting contrast dye into the spinal canal before a CT scan.
• Helps to pinpoint areas of pressure on the spinal cord or nerves.

Electromyography (EMG) and nerve conduction studies (NCS)

• This test can assess the electrical activity of muscles and the efficacy of nerve signal transmission. These tests help to determine whether symptoms are due to nerve compression from spondylosis or other conditions.

Differential Diagnosis

• To rule out other potential causes of the symptoms, doctors often perform a differential diagnosis. Conditions like multiple sclerosis or peripheral neuropathy can mimic the signs of cervical myelopathy, necessitating a careful and detailed analysis.

Clinical Criteria

Different clinical criteria may also be employed to assess the severity and specific characteristics of cervical myelopathy. These criteria help guide treatment decisions and provide a standardized measure for evaluating patient progress. In conclusion, diagnosing spondylosis with cervical myelopathy requires an integrated approach that includes medical history evaluation, physical examination, advanced imaging, and electrophysiological studies. Accurate diagnosis is crucial for developing an effective treatment plan and improving patient outcomes.

Facts About Cervical Spondylosis

As previously mentioned, when people get older they can get this condition and recognize it because of the pain. Many others, on the other hand, don’t have any symptoms, and they might not even know that their neck is changing. In most cases, cervical spondylosis does not result in impairment. However, these alterations in the spine might occasionally compress the spinal cord or its nerve roots. Your legs or hands may feel weak or clumsy as a result of this.

Is Spondylosis Serious?

Because spondylosis can affect people in many different ways, there is no single answer to this question. Many cases of spondylosis are effectively treated with physical therapy and pain relief measures. However, orthopedists advise seeking more immediate care if the following symptoms, which are associated with pressure on the nerves, are present:

• Weakness, including foot drop (difficulty lifting the toes and forefoot off the floor)
• Bladder or bowel dysfunction, especially incontinence
• Changes in balance that cannot be attributed to other factors
• Numbness either in a stripe-like pattern or involving the fingers
• Severe pain, especially electrical or shock-like pain
• Pain in the arms and/or legs that has not responded after attempting other nonsurgical measures like physical therapy, oral pain medications, and/or spinal injections

It is important to pay attention to these symptoms, as they may indicate a more serious issue that requires immediate medical attention. While spondylosis can often be managed effectively, recognizing when it becomes serious can help you seek the care you need promptly.

Treatments

Nonsurgical Treatment

Most of the time, doctors do not consider surgery as a treatment for Cervical spondylosis, and therefore, physical therapy becomes the primary treatment. Furthermore, your doctor will most likely prescribe physical therapy as the initial nonsurgical treatment option. Exercises that strengthen and stretch damaged or strained muscles might help reduce pain. Physical treatment may involve posture therapy or the use of traction to extend your neck’s joints and muscles. Physical therapy programs span anywhere from six to eight weeks. Sessions usually occur every two to three weeks.

Medications

Your doctor may prescribe a combination of drugs to relieve both pain and inflammation during the first phase of therapy.

• Acetaminophen is commonly used to treat mild discomfort.
• Anti-inflammatory medications (NSAIDs). NSAIDs like aspirin, ibuprofen, and naproxen are often recommended alongside acetaminophen and are considered first-line treatments for neck discomfort. They alleviate pain and swelling and depending on your symptoms, the doctor may recommend them for a few weeks. If you have major contraindications to NSAIDs or if your pain does not go away, you may want to try other pain medications.
• Corticosteroids are used orally. By lowering inflammation, a brief course of oral corticosteroids can help reduce pain.
• Muscle relaxants are drugs that relax the muscles. Doctors treat painful muscular spasms with medications like cyclobenzaprine or carisoprodol.

A comfortable cervical collar

This is a cushioned ring that is wrapped around the neck and secured with Velcro. Doctors often recommend wearing a soft cervical collar to reduce neck mobility and relax the muscles in your neck. Because long-term use of a soft collar might weaken the muscles in your neck, doctors recommend wearing it for a short time.

Ice, heat, and other treatments are available

To assist in reducing symptoms, your doctor may consider using cold, heat, massage, and other local treatments.

Injections of steroids

Steroid injections provide temporary pain relief for many people. The following are the most popular neck pain procedures:

• Epidural block in the cervical region. A steroid and an anesthetic drug are injected into the area close to the spinal cord’s covering in this treatment (epidural space). This surgery is commonly performed to treat neck and arm pain caused by a herniated cervical disc, also known as radiculopathy or a pinched nerve.
• Block of the cervical facet joint. A steroid and an anesthetic drug are administered into the facet joint capsule during this surgery. Facet joints offer stability and mobility in the rear of the neck. These joints are prone to arthritic changes, which can cause neck pain.
• Radiofrequency ablation and medial branch block. In some situations of persistent neck discomfort, this technique is used. It can diagnose as well as treat a troublesome joint. A local anesthetic is used to block the nerve that feeds the facet joint during the diagnostic stage of the surgery. If the pain goes away, your doctor may have found the root of your neck discomfort. The next step might use a more permanent pain blocker. This is accomplished by burning the nerves that feed the joint, a treatment known as radiofrequency ablation. An ablation usually provides pain relief for several months. However, if the nerve regenerates, pain may return.

Although less intrusive than surgery, your doctor will only recommend steroid-based injections after a thorough examination. Additionally, your doctor will discuss the risks and advantages of steroid-based injections for your particular disease with you.

Surgical Treatment

Doctors rarely suggest surgery for cervical spondylosis and neck discomfort unless your doctor concludes that:

• A herniated disc or bone is pinching a spinal nerve (cervical radiculopathy), or
• Compression of your spinal cord (cervical spondylotic myelopathy)

Finally, surgery is more likely to benefit patients with progressive neurologic symptoms such as arm weakness, numbness, unsteadiness while walking, or falling. If you have significant neck discomfort (without nerve compression) that has not responded to nonsurgical therapy, the doctor may recommend surgery. Some individuals with significant neck discomfort, however, will not be surgical candidates. Consequently, there are many medical reasons including severe arthritis, other medical issues, or other sources of pain, such as fibromyalgia.

When conservative measures fail to alleviate the pain and debility caused by spondylosis, surgical treatment may be recommended. The specific procedure needed depends on the abnormalities present in the spine, but it will generally involve addressing the area of the spine that is pressing on a nerve.

Minimally Invasive Surgical Options

Some examples of minimally invasive surgical treatment for spondylosis include:

• Removal of a bone spur in cervical spondylosis
• Placement of spacers to recreate space lost by disc wear, allowing for no nerve compression
• Removal of soft tissues that can become thickened in spondylosis that press on nerves

Extensive Surgical Procedures

In some cases, a patient with spondylosis will require more extensive surgery to remove a portion of the spine that is causing pain, and a fusion of the vertebrae, a surgery that stabilizes the bone.

• Anterior Cervical Discectomy with Fusion (ACDF): This is one such procedure performed in the neck.
• Lumbar Laminectomy: For low back pain or other problems associated with lumbar spondylosis, this procedure, with or without fusion, or various other types of lumbar fusion surgery may be appropriate.

By understanding both the minimally invasive and more extensive surgical options, patients can better discuss their treatment plans with their doctors and make informed decisions about their health.

What is the Recovery Time for Spondylosis Surgery?

The recovery time for spondylosis surgery varies significantly based on the type of procedure performed. Minimally invasive surgeries typically allow for a quicker return to daily activities, often within a few weeks. In contrast, more extensive surgeries may require a longer recovery period, sometimes several months.

Key Factors Influencing Recovery Time

• Type of Surgery: Minimally invasive options, such as microdiscectomy, often result in faster recovery compared to traditional open surgeries.
• Individual Health: Overall health, age, and physical fitness greatly impact how quickly one can heal.
• Post-Operation Care: Adhering to prescribed rehabilitation programs is crucial. Many patients begin physical therapy about six weeks post-operation to strengthen supporting muscles and enhance flexibility.

Tips for a Speedy Recovery

• Physical Therapy: Engaging in a structured physical therapy regimen can help restore mobility and strength. This often includes exercises to keep the supporting muscles flexible and robust.
• Ergonomics: Adjusting your workstation can prevent strain on the spine. For instance, raising your computer monitor to eye level reduces the need to hunch forward.
• Weight Management: Maintaining a healthy weight can alleviate additional pressure on the spine, promoting faster healing and preventing future issues.

Long-Term Considerations

• Regular follow-up with healthcare providers is necessary to monitor recovery progress.
• Remaining active within the limits advised by your doctor can aid in long-term health benefits.

Every patient’s recovery journey is unique. Consulting with your healthcare provider for personalized advice is essential for the best outcomes.

Why Choose Southwest Scoliosis and Spine Specialists

Orthopedics is a specialty of our doctors and surgeons at Southwest Scoliosis and Spine Institute.  Furthermore, our Medical Practice with offices in Dallas, Plano, and Frisco, Texas has top-rated doctors with the experience and knowledge necessary to offer patients the best possible treatment for Cervical Spondylitis.

Our doctors understand your concerns, can answer your questions regarding your condition, and know how to use their specialized knowledge to assist you.  Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, have many years of training and experience in Spine and Back Pain for kids, adolescents, young adults, and seniors, and can help people of all ages get back to living the life they love.

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Ortho Info: Cervical Spondylosis