Arthritis in the Neck — Cervical Spondylosis

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Overview of Cervical Spondylosis and Arthritis of the Neck

Xray image of arthritic spine.
Arthritis is one cause of cervical radiculopathy. CNRI/Science Photo Library/Getty Images

Aging is inevitable; in fact, it's occurring in each one of us every day. With aging comes wear and tear on the body's joints, including those of the spine. 

Cervical spondylosis is a common neck condition often due to age related, plus other types, of degenerative changes that take place in spinal joints and discs.  

You may know cervical spondylosis as neck osteoarthritis or degenerative disc disease of the neck.

Osteoarthritis of the neck typically starts to make itself known at around the forty year mark, and it progresses as more years pile on. That said, men tend to develop it at a younger age than women.

Cervical spondylosis can lead to myelopathy, a condition in which the spinal cord become compressed by neighboring structures; in fact, cervicial spondylosis is the most common neck condition that causes myelopathy.

It may also lead to radiculopathy. Both are discussed in more depth below.

Neck Arthritis — How Changes Occur in the Cervical Spine

Arthritis in the neck starts with osteophytes — aka bone spurs — that form on vertebral bodies.

Bone spurs are the body’s response to joint wear and tear. In the spine they serve a purpose by helping to increase the joint's surface area and more evenly distribute weight that's placed on it during everyday activity.

The problem is, bone spurs may lead to pain, particularly when they put pressure on spinal nerves and/or the spinal cord. Such pressure can also cause numbness, weakness and even bowel incontinence, which is a medical emergency.

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Risk Factors for Arthritis in the Neck

A senior couple is shown in close up.
Taking Advil or ibuprofen raises your risk for a stroke. Westend61/Getty Images

Age

The biggest risk factor for cervical spondylosis is age. Once you reach middle age, the likeliness of being diagnosed with neck arthritis increases. The American Academy of Orthopedic Surgeons says the condition very common in this and older populations.

Genetics

After age, genetics poses the biggest risk. Along with a few other types of spine problems, cervical spondylosis may run in families.

If your spinal canal and/or intervertebral foramen are naturally small in diameter, your risk for complications of degenerative changes may be higher. With a narrow spinal canal, the spinal cord — a very sensitive structure that relays messages between the brain and the rest of the body — has less unimpeded space inside that passageway. Contact between the cord and the column may irritate the cord and cause myelopathy, which was defined above.

Smoking

No matter how you slice it, smoking may be really bad for your back. It is associated with increased risk for degenerative disc disease, failed back surgery and other conditions, including, of course, neck arthritis.

Psychological Risk Factors

Depression and anxiety are psychological risk factors for arthritis in the neck.

A 2009 study published in the journal BMC Musculoskeletal Disorders reported a strong link between psychosocial factors and neck pain in general. The authors conclude by saying "the higher the neck pain level, the more attention should be paid to psychosocial distress as a related burden."

More specifically, authors of a 2005 study published in the journal Neurosurgery estimate that greater than one third of patients with cervical spondylotic myelopathy, or CSM, are depressed or anxious. CSM is cervical spondylosis that affects the spinal cord and causes related symptoms.

The authors suggest these mood disorders are most strongly associated patients' decreased ability to move.

Daily Work

Next, let's talk about your occupation. The American Academy of Orthopedic Surgerons says that if your job involves a lot of repeated neck motion and/or work that takes place above your head, your risk may again be higher. Depression and/or anxiety, the psychological risk factors discussed above, also happen at work.

Trauma

And finally, trauma, especially repeated trauma, increases your risk for cervical spondylosis. That said, most neck arthritis is not preceded by trauma.

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Symptoms that Come with Arthritis in the Neck

A man attempts to treat his own neck.
A man attempts to treat his own neck. Shelby Ross/The Image Bank/Getty Images

Generally speaking, the source of neck arthritis pain is not well understood by the medical community, and it's possible to have this condition without symptoms.

Neck and Head Symptoms

When symptoms do occur, intermittent neck pain, called cervicalgia, plus stiffness are generally the most common. About one-third of people with neck arthritis also have headaches, which tend to be located in the lower skull area.

Headaches sometimes override pain and/or stiffness, and become the dominant symptom.

Radiculopathy and Myelopathy Symptoms

Two other types of symptoms that are common in people with cervical spondylosis are radiuclopathy and myelopathy.

Radiculopathy is a disease process that affects the spinal nerve root.

Spinal nerve root is the name given to the part of the nerve that branches off from the main spinal cord.

Most of the time some form of pressure on the spinal nerve root is what causes the symptoms. Symptoms may include pain, weakness, numbness and/or electrical sensations down an extremity. 

Similarly, myelopathy is a disease process affecting the spinal cord.

As mentioned above, the spinal cord is a long, tube-like nervous structure that runs the length of the spine. It is housed in the spinal canal, which is a passageway located in the center of the spinal column. It is one of the two main structures of the central nervous system. The other structure is the brain.

Similar to radiculopathy symptoms, most myelopathy symptoms are caused by compression, but in this case of the spinal cord.

Myelopathy tends to come on slowly over time. It may express itself in a variety of ways, including, but not limited to symptoms associated with compressed spinal nerve roots, or radiculopathy. These symptoms include pain, weakness, numbness, and/or electrical sensations in an extremity.

But there are other types of myelopathy symptoms, too, for example, dizziness.

Also, if symptoms arise from higher up in your neck, which may result in a condition known as high cervical myelopathy, you may experience a syndrome called “numb, clumsy hands." With "numb, clumsy hands," writing and related activities can become problematic. These symptoms may arise when the spinal cord between C-5 and C-7 is pressured.

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Diagnosing Cervical Spondylosis

Neck x-ray for diagnosing arthritis or other conditions.
Neck x-ray for diagnosing arthritis or other conditions. plepraisaeng

As with most neck and back diagnostic processes, your doctor will likely gather information about your cervical spondylosis by taking a history and doing a physical exam. 

MRI for Neck Arthritis

When it comes to diagnostic imaging tests, the MRI is the gold standard. This is especially so when your doctor needs to determine the source of your nerve symptoms.

An MRI may help your doctor to see not only your bones, but your soft tissues and nerves, and it may help her to accurately estimate how much unimpeded space is left in the areas that house the cord and/or spinal nerve roots.

X-Rays for Neck Arthritis

X-rays are also used for diagnosing cervical spondylosis, as they allow visualization of the bony passageways that contain the spinal cord and the spinal nerve roots.

If you don’t have nerve symptoms, you may only need an X-ray. 

The value of an X-ray lies mainly in its ability to show what’s going on with bones. In lieu of pain or other symptoms, having one may alert your doctor to things like narrowing in your disc space, the presence of bone spurs and any decrease in your spinal canal diameter that could lead to myelopathy. 

An X-ray may also help your doctor classify cervical spondylosis as mild, moderate or severe.

CT Scans for Neck Arthritis

A CT scan (CAT scan) is another diagnostic imaging test commonly given to people with cervical spondylosis. A CT scan is like an X-ray except that it takes multiple images of the inside of the body, and puts them together to display a cross section of the area. The quality of the image is better than that of an X-ray, which may allow your doctor to better study your spinal canal, and any changes in your bones that have occurred since your last CT scan.

Myelography and CT Myelography

Myelography is used to visualize your spinal nerve roots as a way of hunting for those obstructions that could lead to radiculopathy symptoms discussed above. Beware, myelography involves needles and the injection of dye into your body.

There’s also a test called CT myelography which some practitioners prefer because it is thought to have lower false-positive results (compared to myelography.)

CT myelography is most often used when surgery is involved, as opposed to first time or asymptomatic diagnosis.

Nerve Conduction Study

And finally, another type of test that doctors use to diagnose (or confirm a diagnosis of) radiculopathy is a nerve conduction study.

A nerve conduction study measures the functioning of your nerves. It is sometimes given in conjunction with an EMG test which measures nerve to muscle functioning both during contraction and relaxation.

The nerve conduction test may give you some discomfort as an electrical stimulus will be introduced via electrodes on the skin. The EMG test does involve needles.

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Arthritis in the Neck — Treatment

Pain relievers
Pain relievers. Peter Dazeley/Photographer's Choice/Getty Images

Your primary care doctor or general internist may be able to provide treatment for your cervical spondylosis. That said, many a referral to a specialist is made for neck arthritis. Referrals to rheumatologists, neurologists, and orthopedic or neurosurgeons are common.

But surgery is not generally given for neck arthritis. Instead, conservative care may help you control pain and slow the progression of the disease.

Signs you may need surgery include pain that is difficult or impossible to control, and/or radiculopathy symptoms that worsen over time.

If you do happen to need surgery, you may be looking at a laminectomy, also known as decompression surgery. A 2018 study published in Bone and Joint Journal found that decompression surgery in the neck, known as anterior cervical decompression, is effective in relieving dizziness symptoms associated with cervical spondylosis.

Physical Therapy for Arthritis in the Neck

While you can't stop age related joint degeneration from occurring, it is possible to slow down its rate of development. 

If your symptoms are mild or moderate, and if you do not have progressive nerve problems, you may only need conservative care. This may involve one or more of the following:

  • ·Nonsteroidal anti–inflammatory drugs (NSAIDs) including aspirin, naproxen or ibuprofen to help reduce inflammation and relieve pain.
  •  Analgesics, such as acetaminophen (Tylenol) for pain relief only.
  •  Corticosteroid injections to treat radiating pain and to reduce inflammation.
  • ·Nerve blocks for temporary pain relief.
  • ·Restricting but not eliminating physical activity.
  • ·Cervical collar for support and stabilization during the healing period.
  • ·Exercise and, as mentioned above, physical therapy.

Generally, to see a physical therapist for conservative care, a referral has to be made by your primary care doctor. This is not the case in all states, so you may want to check yours specifically. In other words, some states allow patients to self-refer to physical therapy.

The beauty of physical therapy is that your conservative care will likely be tailored to your particular conditions and symptoms.

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