Degenerative cervical spine disease

Osteoarthritis of the spine includes the spontaneous degeneration of either disk or facet joints.

Presenting symptoms include axial neck pain and neurologic complications.

The most common neurologic complication is cervical spondylotic radiculopathy (CSR). This results in a pattern of arm pain (specific to the nerve root involved) along with mild weakness and sensory loss in muscles and skin innervated by that nerve root.

The next most common neurologic complication is loss of neurologic function from pressure on the spinal cord in the cervical region (cervical spondylotic myelopathy, CSM). Although this loss of function can be painful, there is usually a painless reduction of upper extremity (and sometimes lower extremity) function, which is particularly noticeable as hand clumsiness or loss of fine motor function.

Treatments differ radically depending on patient presentation, specific symptoms, and which arthritis-related or neurologic complications predominate.

Neurologic complications may respond to surgical decompression if symptoms do not abate after treatment with conservative measures, depending on their longevity and severity.

Cervical spondylosis is the specific term for osteoarthritis of the spine, which includes the spontaneous degeneration of either disk or facet joints. Alternative terms include degenerative disk disease and degenerative joint disease (DJD). This spontaneous degeneration is commonly asymptomatic. It can lead to either arthritis-specific symptoms referable to the neck (i.e., loss of joint motion, pain on motion, joint incompetency) or neurologic complications of the joint degeneration, including pressure on the spinal cord (cervical spondylotic myelopathy) and/or cervical nerve roots (cervical spondylotic radiculopathy).[Figure caption and citation for the preceding image starts]: Severe, multilevel degenerative disk 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].[Figure caption and citation for the preceding image starts]: Cervical MRI (sagittal T2) with mild degenerative joint disease and disk bulgingDennis A. Turner, MA, MD [Citation ends].[Figure caption and citation for the preceding image starts]: Cervical MRI (sagittal T2) with moderate degenerative joint disease but no significant spinal cord compressionDennis A. Turner, MA, MD [Citation ends].