Cervical

Spondylosis
dr. Yoga Karsenda, MH. Kes
PROGRAM STUDI FISIOTERAPI DIPLOMA III
POLITEKNIK KMC KUNINGAN
Summary
• Cervical Spondylosis represents the natural degenerative
process of the cervical motion segment which can lead to
cervical radiculopathy, cervical myelopathy, or axial neck pain.
• Diagnosis can be made with plain radiographs of the cervical
spine.
• Treatment can be observation, medical management, or surgical
management depending on the severity and chronicity of pain,
presence of instability or, presence of neurological deficits.
Epidemiology
• Incidence
• typically begins at age 40-50
• 85% of patients >65 years of age demonstrate spondylotic changes regardless of
symptomatology
• Demographics
• more common in men than women
• Anatomic location
• most common levels are C5-6 > C6-7 because they are associated with the most
flexion and extension in the subaxial spine
• Risk factors
• excessive driving
• smoking
• lifting
• professional athletes
Pathophysiology
• Mechanism of Neurologic Compression
• Nerve root compression
• leads to the clinical condition of radiculopathy
• foraminal spondylotic changes
• secondary to chondrosseous spurs of facet and uncovertebral joints
• posterolateral disc herniation or disc-osteophyte complex
• between posterior edge of uncinate and lateral edge of posterior longitudinal ligament (PLL)
• affects the exiting nerve root (C6/7 disease will affect the C7 nerve root)
• foraminal soft disc herniation
• affects the exiting nerve root (C6/7 disease will affect the C7 nerve root)s

• Central cord compression (central stenosis)

• leads to the clinical condition of myelopathy
• occurs with canal diameter is < 13mm (normal is 17mm)
• worse during neck extension where the central cord is pinched between
• degenerative disc (anterior)
• hypertrophic facets and infolded ligamentum (posterior)
Imaging
• Radiographs
• common radiographic findings include
• degenerative changes of uncovertebral and facet joints
• osteophyte formation
• disc space narrowing
• endplate sclerosis
• decreased sagittal diameter (cord compression occurs with canal diameter is < 13mm)
• incidence
• radiographic findings often do not correlate with symptoms
• lateral
• important to look for sagittal alignment and size of spinal canal
• oblique
• important to look for foraminal stenosis which often caused by uncovertebral joint
arthrosis
• flexion and extension views
• important to look for angular or translational instability
• look for compensatory subluxation above or below the spondylotic/stiff segment
Imaging
• MRI
• axial imaging is the modality of choice and gives needed
information on the status of the soft tissues. It may show
• disc degeneration
• spinal cord changes (myelomalacia)
• preoperative planning
• has high rate of false positive (28% greater than 40 will have
findings of HNP or foraminal stenosis)
Imaging
• CT myelography
• can give useful information on bony anatomy
• most useful when combined with intrathecal injection of
contrast (myelography) to see status of neural elements
• contrast is given via C1-C2 puncture and allowed to diffuse
caudally or given via a lumbar puncture and allowed to
diffuse proximally by putting the patient in Trendelenburg
position.
• particularly useful in patients that can not have an MRI
(pacemaker) or has artifact from hardware
Imaging

• Discography
• controversial and rarely indicated in cervical spondylosis
• approach is similar to that used with ACDF
• risks include esophageal puncture and disc infection
Clinical Presentation

• Axial neck pain

• Cervical Radiculopathy
• Cervical Myelopathy
Summary
• Cervical Spondylosis represents the natural degenerative
process of the cervical motion segment which can lead to
cervical radiculopathy, cervical myelopathy, or axial neck pain.
• Diagnosis can be made with plain radiographs of the cervical
spine.
• Treatment can be observation, medical management, or surgical
management depending on the severity and chronicity of pain,
presence of instability or, presence of neurological deficits.
Summary
• Cervical Spondylosis represents the natural degenerative
process of the cervical motion segment which can lead to
cervical radiculopathy, cervical myelopathy, or axial neck pain.
• Diagnosis can be made with plain radiographs of the cervical
spine.
• Treatment can be observation, medical management, or surgical
management depending on the severity and chronicity of pain,
presence of instability or, presence of neurological deficits.
Summary
• Cervical Spondylosis represents the natural degenerative
process of the cervical motion segment which can lead to
cervical radiculopathy, cervical myelopathy, or axial neck pain.
• Diagnosis can be made with plain radiographs of the cervical
spine.
• Treatment can be observation, medical management, or surgical
management depending on the severity and chronicity of pain,
presence of instability or, presence of neurological deficits.
Summary
• Cervical Spondylosis represents the natural degenerative
process of the cervical motion segment which can lead to
cervical radiculopathy, cervical myelopathy, or axial neck pain.
• Diagnosis can be made with plain radiographs of the cervical
spine.
• Treatment can be observation, medical management, or surgical
management depending on the severity and chronicity of pain,
presence of instability or, presence of neurological deficits.
Summary
• Cervical Spondylosis represents the natural degenerative
process of the cervical motion segment which can lead to
cervical radiculopathy, cervical myelopathy, or axial neck pain.
• Diagnosis can be made with plain radiographs of the cervical
spine.
• Treatment can be observation, medical management, or surgical
management depending on the severity and chronicity of pain,
presence of instability or, presence of neurological deficits.
Summary
• Cervical Spondylosis represents the natural degenerative
process of the cervical motion segment which can lead to
cervical radiculopathy, cervical myelopathy, or axial neck pain.
• Diagnosis can be made with plain radiographs of the cervical
spine.
• Treatment can be observation, medical management, or surgical
management depending on the severity and chronicity of pain,
presence of instability or, presence of neurological deficits.
Summary
• Cervical Spondylosis represents the natural degenerative
process of the cervical motion segment which can lead to
cervical radiculopathy, cervical myelopathy, or axial neck pain.
• Diagnosis can be made with plain radiographs of the cervical
spine.
• Treatment can be observation, medical management, or surgical
management depending on the severity and chronicity of pain,
presence of instability or, presence of neurological deficits.
Summary
• Cervical Spondylosis represents the natural degenerative
process of the cervical motion segment which can lead to
cervical radiculopathy, cervical myelopathy, or axial neck pain.
• Diagnosis can be made with plain radiographs of the cervical
spine.
• Treatment can be observation, medical management, or surgical
management depending on the severity and chronicity of pain,
presence of instability or, presence of neurological deficits.
Summary
• Cervical Spondylosis represents the natural degenerative
process of the cervical motion segment which can lead to
cervical radiculopathy, cervical myelopathy, or axial neck pain.
• Diagnosis can be made with plain radiographs of the cervical
spine.
• Treatment can be observation, medical management, or surgical
management depending on the severity and chronicity of pain,
presence of instability or, presence of neurological deficits.
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