Cervical spondylosis is a degenerative condition affecting the bones and joints in the neck. It causes pain, stiffness, and weakness and can compress nerves leading to sensory and motor problems. Symptoms range from mild neck pain to major dysfunction. While it mainly affects older adults, injuries or occupations involving heavy lifting or straining of the neck can also trigger it. Treatment focuses on relieving pain and addressing weakness, sensory loss, and other symptoms through analgesics, cervical collars, physiotherapy, surgery if needed, and encouraging patients to seek medical help. Healthcare assistants should explain cervical spondylosis to patients and ensure any problems are referred to doctors.

1. British Journal of Healthcare Assistants April 2007 Vol 01 No 01 81
Clinical
Cervical spondylosis part 1:
osteoarthritis of the cervical
spine
C
ervical spondylosis is also called degenerative
arthritis. It affects the intervertebral discs and
the vertebrae in the cervical spine (Figure 1) and
causes pain, stiffness and weakness. Changes within the
structure of bones or joints in the neck can compress
nerves and nearby blood vessels, causing symptoms
such as sensory problems in hands and legs, a loss of co-
ordination and, less commonly, a loss of bladder control
(NHS Choices, 2007).
It is estimated that by the age of 70, nearly 100% of
men, and 96% of women, will have some degree of
cervical spondylosis (NHS Choices, 2007). Cervical
spondylosis is considered to be a natural consequence
of the widespread degenerative changes that occur
with ageing. However, not all older people experience
problems, and this condition is not confined to the older
population.
Younger people can be affected by cervical spondylosis,
particularly if there has been a previous injury to the
neck such as a serious whiplash injury. Occupations
involving heavy lifting (such as hod-carriers, solid-fuel
carriers, and weight-lifters) or excessive neck strain
during exercise can trigger or exacerbate this condition.
An illustration of excessive use of the spine is provided
by Jumah and Nyame (1994). They studied 355 African
patients to ascertain the relationship between load-
carrying on the head and cervical spondylosis. Two-
hundred and fifty-five patients had carried loads on their
head with 63.6% suffering from cervical spondylosis, but
36% of the people who did not carry loads suffered from
cervical spondylosis. They concluded:
‘cervical spondylosis is not exclusively an ageing
phenomenon, but that regular heavy load carrying
on the head plays an aetiological (causative) role’.
Knowledge of the spinal column and how degeneration
occurs is useful in helping to understand the symptoms
of cervical spondylosis.
The spinal column
The vertebrae of the spinal column are cushioned by
Julie Swann is an Independent Occupational Therapist
Abstract
Degenerative changes are common within bones and joints, owing
to excessive wear and tear, resulting in osteoarthritis. When these
symptoms appear in the cervical region of the spinal vertebrae,
this degenerative process is termed ‘cervical spondylosis’.
A multitude of problems can occur, ranging from mild localized
pain and discomfort to a major dysfunction of the nervous system.
This article explains cervical spondylosis and outlines the main
forms of treatment.
Key words
n Cervical spondylosis n OA n Degenerative condition
n Symptoms n Clinical investigations n Spinal column
Figure 1: An X-ray of the cervical spine
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2. 82 British Journal of Healthcare Assistants April 2007 Vol 01 No 01
Clinical
intervertebral discs of cartilage and form part of the rigid
skeletal framework of the body. Eriksen (2003) describes the
three primary functions of the spinal column as; protecting
the nervous system, supporting the body and keeping it
upright, and providing motion. The spinal column helps
to protect vital organs, namely the heart and lungs, and
provides anchorage points for muscle attachment.
The centre of the spinal column, the spinal cord, is
housed in an enclosed cavity surrounded by a thick,
strong, elastic, fibrous covering called the dura mater.
There are two other layers namely, the ‘arachnoid’ and
the pia mater. The pia mater also encases the spinal nerve
roots and covers the spinal blood vessels. The spinal
cord’s tubular bundle of nerve fibres transmits neural
impulses between the peripheral parts of the body and
the brain.
Pathology of cervical spondylosis
As we age, the intervertebral discs shrink and become
tough and unyielding. This results in a loss of height and
a reduction in spinal stability. This process is accelerated
in cervical spondylosis. Wear and tear erodes the joint
surfaces and degeneration of the spinal discs can occur
To counteract degeneration, abnormal bone growth
(osteophyte formation) occurs in unstable joints to attempt
to stabilize the spine and protect the spinal cord. Small
bony spurs can form at the edges of the vertebral joints
near the spinal column and can impinge on the nerves.
Symptoms
NHS Choices (2007) note:
‘Around 90% of people with cervical spondylosis
will only experience episodes of stiffness and neck
pain.’
In some cases, there may be mild discomfort with a
gradual, virtually unnoticeable, limitation of the outer
ranges of neck and shoulder movements. Some older
people may construe symptoms as simply relating to
ageing rather than abnormal degenerative changes in
the joints and discs. Healthcare assistants (HCAs) and
assistant practitioners (APs) may need to encourage
sufferers to seek medical advice.
The symptoms depend on how the cervical spine is
affected. A combination of mechanical changes, caused
by osteophytic outgrowths and disc protrusion, can
narrow the disc spaces. Osteophytes encroaching upon
the spinal cord can cause inflammation and oedema
(swelling).
Symptoms of nerve root or spinal cord compression
may arise and produce secondary symptoms, depending
on the section of the spine that is involved. If the nerve
root (the part of the nerve from the spinal column
to the muscles) is compressed, ‘lower motor-neurone’
(peripheral) symptoms can arise. There will be weakness,
Spinal roots Dermatome Movement tested Reflex
C1 Top of head Contributes to cervical flexion None
C2 Temporal andoccipital regions Cervical flexion None
of the head
C3 Posterior cheek and neck Lateral neck flexion None
C4 Superior shoulder and clavicle Shoulder shrug None
area
C5 Deltoid patch and lateral aspect Shoulder abduction and elbow Biceps (brachioradialis)
of upper arm flexion
C6 Lateral forearm, radial side of Elbow flexion and wrist Brachioradialis (biceps)
hand, thumb and index finger extension
C7 Posterior lateral aspect of arm Elbow extension and wrist Triceps
and forearm, middle finger flexion
C8 Medial forearm, ulnar border Ulnar deviation, thumb , None
of hand, ring and little finger extension finger flexion and
abduction
Adapted from http://tinyurl.com/bbu4tf
Table 1. Spinal roots, dermatomes, movement and reflex impairments
in the cervical spine
‘healthcare staff should
encourage their patients to
seek help rather than suffer’
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3. British Journal of Healthcare Assistants April 2007 Vol 01 No 01 83
Clinical
and perhaps wasting, in the appropriate myotome (muscle
function) (Table 1), together with diminished reflexes
that will affect a person’s level of abilities. Incontinence
can occur, as can mobility problems, causing difficulties
with walking, and the onset of balance impairment will
increase the risk of falling.
If ascending sensory tracts are compressed, there can
be paraesthesia (numbness, tingling, pins and needles,
pain, prickly or burning sensation) in the dermatome
(area of skin innervated by a single sensory nerve)
(Table 1). Abnormal sensations can be very debilitating.
If the descending motor tracts are involved, an upper
motor-neurone (central cord) deficit below the level of
the compression of the spinal cord will arise and can
result in increased muscle tone, clonus and extensor
plantar responses.
A mixture of upper and lower motor problems can
arise to add to diagnostic problems.
Cervical spondylosis is usually recognized by the
symptoms; these may be exacerbated owing to strain or
repetitive movements. The main symptoms of cervical
spondylosis are listed in Table 2.
Clinical investigation
It is important for investigations to be carried out to
eliminate any other causes of nerve involvement that
can present with similar symptoms such as a prolapsed
intervertebral disc or a spinal tumour. To rule out other
possibilities and confirm the diagnosis, various tests can
be undertaken including a physical examination and
clinical tests.
Physical examination
A physical examination assesses the symptoms and any
restrictions on level of abilities. It includes examining
the range of movement, co-ordination, muscle power,
sensation, reflexes, and general mobility. The damaged
area can be located by the symptoms of pain, numbness,
pattern of weakness and changes in reflex responses.
The neck may be slightly kyphotic (curved forwards or
hunched).
Clinical tests
An X-ray identifies osteophytes, narrowing of disc spaces
and any other abnormalities. It will reveal the extent
of the damage or misalignment of the cervical spine. A
myleogram is when radio-opaque dye is injected into
the spinal column and can be used in conjunction with
computerized tomography (CT) to outline any blockages,
and identify the extent of the injury. CT scans provide
detailed 3-dimensional images of the affected area(s).
Magnetic resonance imaging (MRI) also creates images of
areas from various angles and can detect disc and spinal
cord problems. The MRI may not show enough detail
of the vertebrae themselves. EMGs (electromyogram)
provide the nerve-conductivity rate of skeletal muscles.
Symptom Details
Pain This may be a vague, localized pain or a constant,
deep ache that radiates across the shoulders
and down into the arms, hands and fingers.
Intermittent stabbing or shooting pains can
occur in the neck, arms, and shoulders, or upper
back owing to pressure on the nerve roots,
perhaps after coughing or some other sudden
movement.
Headaches Headaches that often start at the back of the
head.
Stiffness Neck stiffness, often with an audible grating on
moving the neck.
Limited range Limited movement in the neck can be owing to
of movement pain, or the avoidance of pain, or restriction
imposed by the development of bony
outgrowths. This can affect head turning and
looking up or down.
Sensory Paraesthesia, owing to nerve involvement that
problems follows a dermatomal distribution, may be
present in the shoulders, arms, hands and fingers.
It can affect the lower limbs.
Wasting and This is related to the part of the spinal cord
weakness that is affected. Muscle weakness is common and
of muscles grip or dexterity can be affected.
Loss of reflexes Impairment or loss of reflexes of the relevant
(Table 1) nerve root can occur.
Trophic In long-standing root compression, the skin will
changes become dry, scaly, inelastic, blue and cold.
Spinal cord Compression of the spinal cord produces
compression symptoms of upper motor-nerve damage below
the level of the lesion.
General There can be undue fatigue, irritability, and a
symptoms disturbed sleep pattern.
Dizziness, loss The top six cervical vertebrae have a foramen
of balance (hole) that gives passage to interconnecting
and blackouts sympathetic nerves [plexus], the vertebral artery
and vein. Symptoms arise if osteophytes impinge
on the blood supply of the basilar or vertebral
arteries by reducing the blood flow; but this is a
rare occurrence.
Table 2. Main symptoms of cervical spondylosis
Role of HCAs and APs
HCAs and APs may work with patients who have
cervical neuropathy and who have not mentioned their
symptoms to medical staff. There is a considerable
amount of treatment that can be provided to relieve
symptoms, and healthcare staff should encourage their
patients to seek help rather than suffer.
Patients may ask questions about treatment and
procedures, so it is important for healthcare staff to be
able to explain the procedures, and to know when they
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4. 84 British Journal of Healthcare Assistants April 2007 Vol 01 No 01
Clinical
need to refer to other staff if the questions are beyond
their level of knowledge.
General management
The symptoms of cervical spondylosis, whether acute or
chronic, usually respond to non-invasive conservative
measures such as analgesics or a cervical collar.
Analgesics
Initially, treatment is aimed at reducing inflammation
and relieving pain. Analgesia is the main form of pain-
relief, and HCAs and APs can make patients aware of any
possible side-effects and encourage them to report any.
Collars
It is important to ensure that collars fit correctly and
provide adequate support. Initially, a small, soft collar
Key Points
n Cervical spondylosis is a degenerative condition of the spine.
n Young people can be affected.
n Aetiology includes a previous injury to the spinal vertebrae or discs.
n Treatment addresses the symptoms of pain, weakness and sensory
loss.
n Patients may require encouragement to seek medical advice.
may be provided or a hard collar may be needed. It is
essential that a patient is shown how to put the collar on
the right way and to fasten and unfasten, it particularly
if dexterity is a problem or there is a limited range of
shoulder girdle movement.
Conclusion
HCAs and APs can help patients with cervical
spondylosis in many ways. As cervical spondylosis can
be part of ageing, the problems can often be mistaken for
concurrent medical complaints and not addressed.
HCAs and APs can explain the symptoms of cervical
spondylosis to patients and can ensure that problems are
referred to medical practitioners by encouraging patients
to go to their GPs for relief of symptoms. Surgery may
be needed if there is severe nerve compression. There
are many practical ways that functional problems can be
overcome. Surgery, physiotherapy, occupational therapy,
alternative techniques, assistive devices and adaptations
will be outlined in the next article. BJHCA
Eriksen E (2003) Upper Cervical Anatomy/Biomechanics in Upper
Cervical Subluxation Complex: A Review of the Chiropractic and
Medical Literature. Lippincott Williams & Wilkins, Philadelphia
Jumah KB, Nyame PK (1994) Relationship between load carrying
on the head and cervical spondylosis in Ghanaians. West African
Journal of Medicine Jul-Sep 13(3):181–2
NHS Choices (2007) Cervical spondylosis. http://tinyurl.com/bnlg2r
(Accessed 4 February 2009)
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