Cervical spondylosis is a chronic degenerative disorder of the cervical spine that typically affects individuals over 40 years old, resulting from normal aging processes, including the deterioration of vertebrae, discs, and ligaments. Common symptoms include chronic neck pain, radiculopathy, and potentially severe cervical spondylotic myelopathy, which can lead to significant neurological deficits. Treatment options range from conservative management, such as immobilization and physical therapy, to surgical interventions for severe cases.

1. Cervical Spondylosis
Dr Aakash Nandu
M.S. Orthopaedics
Smit Hospital, Anand

2. Cervical Spondylosis
Definition
It is chronic degenerative disorder of cervical spine which affects
vertebrae, inter vertebral discs and ligaments of cervical spine.
Anatomy
Cervical spine consists of 7 vertebrae beginning from the base of the skull.
There are 8 pairs of nerve roots exiting posteriorly from spinal cord
through foramen in between the vertebrae.

5. Introduction
• Commonly seen in individuals after the age of 40 years
• Believed to be a part of normal ageing process of vertebral
column.
• Includes degenerative changes in facet joints, longitudinal
ligaments and ligamentum flavum.

6. 2 main components
1. Spinal canal stenosis leading to MYELOPATHY
2. Lateral canal stenosis leading to RADICULOPATHY.

7. Morbidity ranges from
1. Chronic neck pain
2. Radicular pain
3. Diminished cervical ROM
4. Suboccipital headache
5. Myelopathy leading to weakness and impaired fine motor functions, incoordination,
quadriparesis, sphincter dysfunction, etc
The course of cervical spondylopathy may be slow and prolonged, may either remain asymptomatic
or have mild cervical pain.

8. Pathophysiology
• IVD loses hydration with age
• Loss of elasticity
• Cracks and fissures in annulus fibrosus
• Nucleus pulposus bulges out
• Cross sectional area of Spinal Canal is
narrowed

9. • Facet joint and ligamentum
flavum hypertrophy occurs
• Decreases the dorso-lateral
space of the foramen
• Contributes to radiculopathy
• Marginal osteophytes develop
and end plate destruction
occurs.

10. Clinical features
1. Cervical Pain
• Chronic suboccipital headache
• May radiate to shoulder, scapula or arm
• Pain increases with certain movements
2. Radiculopathy
• Compression of cervical roots leads to radicular pain or muscle weakness
• Mostly resolves with conservative management, rarely surgery is required.

11. 3. CSM (Cervical Spondylotic Myelopathy)
• Most serious consequence of CS
• Occurs due to narrowed vertebral canal
• Quadriparesis, sphinchter involvement occurs
• Complete reversal is rare once CSM occurs

12. Etiology
1. Age (>40)
2. Trauma
3. Work activity (carrying load on head)
4. Genetics

13. Physical examination
• Decreased ROM
• Hand clumsiness
• Sensory Deficits
• Exaggerated reflexes or absent reflexes
• Spastic gait
• Extensor plantar reflex in severe
myelopathy

14. • Spurling sign – exacerbation of radicular pain by
lateral flexion towards affected side (due to
foraminal narrowing)
• Lhermitte sign – generalized electric shock like
sensation due to neck flexion
• Hoffman sign – reflex contraction of thumb and
index finger in response to nipping of middle
finger ( sign of UMN lesion )

15. Diagnosis
• 1. Clinical
• 2. Xray
• 3. MRI

16. Treatment
1. Immobilisation
• Reduces irritation of nerves
• Daytime soft cervical collar
• More rigid orthosis (Philadelphia collar, minerva
jacket)
2. Moulded Pillows
• For better alignment of spine during sleep

17. 3. Exercises
• Isotonic isometric cervical spine exercises to maintain
the strength of neck muscles
4 Heat therapy
• Superficial – moist heat packs
• Deep – Diathermy, local US
5 Manual or Mechanical traction
• foraminal widening leads to pain relief

18. 6 Occupational therapy
• Ergonomic adjustment of workplace,
postural correction and vocational therapy.
7 Pharmacological
• NSAIDS
• Opioids
• Pregabalin, Nortryptiline

19. Surgery
• Indications
1. Progressive neurological deficit
2. Intractable pain
3. Documented compression of nerve root or spinal cord

20. Types of surgeries
1. Discectomy
2. Decompressive laminectomy and foraminotomy
3. Hemilaminectomy
4. Laminoplasty