Overview
Cervical spondylosis is caused by degenerative changes in the bones and intervertebral disks of the neck. A less technical name for this condition is osteoarthritis of the neck, or degenerative disk disease of the neck.
Cervical spondylosis is primarily due to aging. The condition usually first starts after the age of 40 and continues to progress as you age. Men tend to develop cervical spondylosis at an earlier age than women. The condition often leads to myelopathy. Cervical spondylosis is the most common condition of the neck that can affect the spinal cord.
With widely varying signs and symptoms and no single pathognomonic finding, cervical spondylotic myelopathy presents a diagnostic challenge. Yet making the correct diagnosis is critical because appropriate surgical intervention is associated with improved outcomes.
Cervical spondylotic myelopathy, the result of narrowing of the cervical spinal canal by degenerative and congenital changes, is the most common type of spinal cord dysfunction in patients older than 55 years and the most common cause of acquired spastic paresis in the middle and later years of life.
Pathologic Mechanisms
Both static and dynamic mechanisms are involved in the pathogenesis of cervical spondylotic myelopathy. Static factors include congenital spinal canal stenosis (<13 mm anterior-posterior diameter); disc herniation; osteophyte formation in the vertebral bodies; degenerative osteophytosis of uncovertebral and facet joints; hypertrophy ligamentum flavum posterior longitudinal ligaments.
Dynamic factors are abnormal forces placed on the spinal column and spinal cord during flexion and extension of the cervical spine under normal physiologic loads. Trauma caused to the spinal cord by repetitive compression against an osteophytic bar during normal flexion and extension of the cervical spine is an example.
C5 through C7, the region of the spine with the highest frequency of cervical spondylotic changes, also is the area in which the vascular supply is the most tenuous.
Cervical spondylotic myelopathy can also be caused by spinal cord ischemia. Pathologic findings that
Symptoms
- Pain in the neck, subscapular area or shoulder.
- Numbness or paresthesia in the upper extremities, usually nonspecific.
- Sensory changes in the lower extremities.
- Motor weakness in the extremities.
- Gait difficulties (“spastic gait,” hesitant and jerky).
- Myelopathic or “upper motor neuron” findings such as spasticity, hyperreflexia, clonus, Babinski and Hoffman signs, and bowel and bladder dysfunction.
- Lower motor neuron” findings such as upper extremity hyporeflexia and atrophy.
Diagnosis
The differential diagnosis of cervical spondylotic myelopathy is quite broad. It is important to rule out multiple sclerosis and amyotrophic lateral sclerosis. Cervical spondylotic myelopathy does not affect the cranial nerves or the normal jaw jerk reflex, whereas the other disorders may. In addition, amyotrophic lateral sclerosis is a pure motor disease, therefore, sensation is unaffected. Cervical spondylotic myelopathy may have motor findings similar to those of amyotrophic lateral sclerosis, in addition to sensory findings such as numbness or paresthesia in the upper extremities.
Other disorders in the differential diagnosis include spinal cord tumors, syringomyelia, subacute combined degeneration, cerebral hemisphere disease, and peripheral neuropathy. Normal pressure hydrocephalus, which may have gait and bladder involvement, should also be considered.
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