Degenerative cervical spine disease (cervical spondylosis) is osteoarthritis of the spine, which 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. 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 (degenerative cervical myelopathy). 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.
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 (degenerative cervical myelopathy, formerly known as cervical spondylotic myelopathy) and/or cervical nerve roots (cervical spondylotic radiculopathy).
History and exam
Key diagnostic factors
- spontaneous onset of neck pain
- cervical muscle pain and spasm
- headaches or occipital pain
- weakness or numbness
- presence of radiating arm pain
- reflex changes
- proximal arm weakness
- distal hand weakness
- gait ataxia
Other diagnostic factors
- cervical muscle spasm
- decreased cervical range of motion
- sensory changes
- age >40 years
- head or neck trauma
- previous cervical spine surgery
- previous cervical myofascial strain
- genetic predisposition
1st investigations to order
- cervical MRI
- cervical x-ray
Investigations to consider
- cervical CT scan
- cervical CT myelogram
- cervical/upper extremity electromyography or nerve conduction velocity
- cervical nerve root block
axial neck pain
cervical spondylotic radiculopathy (CSR)
degenerative cervical myelopathy (DCM)
- Whiplash injury (cervical myofascial strain)
- Acute disk herniation
- Metastatic malignancy
- ACR appropriateness criteria: cervical neck pain or cervical radiculopathy
- A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression
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