Cervical spondylosis incidence varies with age. Population-based MRI studies show nearly 100% of adults aged >40 years have severe degeneration of at least 1 cervical level (commonly C5/6). [1] [2] [3] [4] [5] [6] However, only a subset of patients present with axial neck pain, and patients are usually asymptomatic even though cervical radiographs and MRI may show severe, spontaneous degenerative disease. [4] [7] com.bmj.content.model.Caption@5f59cb25 [Figure caption and citation for the preceding image starts]: Severe, multi-level degenerative disc disease changes but without significant spinal cord compression (i.e., neither deformation nor intrinsic T2 changes) on cervical MRI (sagittal T2) Dennis A. Turner, MA, MD [Citation ends].

The incidence of radiculopathy and myelopathy is much lower, although few population-based studies exist, except for the rate of surgical treatment of cervical spondylosis. [8] However, only 1% to 2% of patients with cervical spondylosis proceed to surgical intervention, as non-operative treatments suffice in most patients. [9] [10] [11] [12] [13]

The relatively high rate of obtaining cervical MRI studies for symptoms of axial neck pain in the US is likely to influence both the rate of aggressive interventions and the overall awareness of this common problem. For example, it is likely that disc degeneration (i.e., desiccation of a normally hydrated disc joint with subsequent joint narrowing) is ubiquitous after 30 years of age due to intrinsic loss of the disc cells, which maintain hydration. Facet joints follow the more usual pattern of synovial joint degeneration.

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