Subarna Shrestha: CERVICAL SPONDYLOSIS

INTRODUCTION :

‘SPONDYLO’ is a Greek word- meaning vertebra. Spondylosis generally means changes in the vertebral joint characterized by increasing degeneration of I.V.D (Intervertebral Disc) with subsequent changes in the bones and soft tissues. Hence, cervical spondylosis is a condition in which there is progressive degeneration of the I.V.D as an expression of two factors which may be acute or chronic. The radiculopathy and the myelopathy in this vertebra may lead to permanent disability.

DEFINITION :

Cervical spondylosis refers to the degenerative condition of the cervical spine including the intervertebral joints in between the vertebral bodies and the vertebral disc. In simple words, it is a condition of neck region (cervical spine) where the disc degenerates, later resulting in reduced space between the vertebra and formation of osteophytes.

EPIDEMIOLOGY:

AGE: Cervical spondylosis is very common in persons above 50years of age. About half of the population develops cervical spondylosis by the age of 50, with this figure rising to 70% by the age of 60.

SEX: Cervical spondylosis affects both sexes, but men usually develop it at an earlier stage than women.

SITES: The segments commonly affected in cervical regions are C4 to T1.Along with these sites; other parts of spine are also affected due to compensatory adjustments.

CLINICAL FEATURES:

1) ONSET: The condition gets precipitated by fatigue, mental tension, worries or depression. It occurs gradually due to faulty posture.

2) PAIN: Neck movement worsens the pain. The complain of neck stiffness is commonly seen after a night’s rest.The region of the pain depends on the site where the cervical spine is affected by the pathology.

Upper cervical spine	Headache
Mid-cervical spine	Neck pain
Region from C4-T2	Radiating pain shoulder & arm, either unilateral or bilateral

3) DISTURBED SLEEP.

4) MUSCULOSKELETAL DISORDERS:

i. Muscle weakness

ii. Muscle spasm

5) NEUROLOGICAL SIGNS AND SYMPTOMS:

a. There occurs paraesthesia that means numbness, pins and needles sensation or altered sensation of the particular dermatome which is supplied by the impinged nerve root. It may occur in part of the arm or hand, shoulder, fingers & sometimes in the leg.

b. Vertigo, dizziness & blackouts (if there is a pressure on the vertebral artery) fatigue and irritability.

c. Loss of bladder and bowel control if spinal cord is compressed.

d. Abnormal reflexes-weak biceps and triceps jerks.

e. Lack of coordination, fear of falling, difficulty in walking.

INVESTIGATION

On the first visit, if the problem is short-lived and there are no major signs or symptoms, it may not need any further investigation. However, if the problem has been present for sometime, or if there is some history of trauma, fever, any other major illness, or any notable findings on clinical examinations like-

1. X-RAY (SIDE VIEW OF NECK):

2. MRI SCAN:

3. MYELOGRAM:

MANAGEMENTS:

Medical management:

Treatment is usually conservative in nature the most commonly used treatments are no steroidal anti-inflammatory drugs (NSAIDs), physical modalities and lifestyle modifications. Surgery is occasionally performed.

The treatment would depend on the duration of the problem, presence of similar episode in the past, neurological function, response to previous non-operative treatment and lastly the subjective severity of the pain. Various non-operative means of treatment include painkillers, muscle relaxants, various modalities such as heat and electrical stimulation, cervical traction, activity restrictions etc.

Painkillers will be prescribed to allow a smoother and easier return to normal function. In addition, based on individual merit, he may be prescribed muscle relaxants so as to relax and soothe the neck and back muscle. This is so because whenever there is neck or back pain, the muscle lend to go into spasm and hence, leading to pain. It is essential to break this spasm with a muscle relaxant so as to give effective pain relief.

PHYSIOTHERAPY MANAGEMENT:

ELECTROTHERAPY:

During acute pain, only passive physiotherapy would be used in the form of heat or electrical stimulation in various forms such as-

· SWD (short-wave diathermy)

· TENS(transcutaneous electrical nerve stimulation)

· IFT (interferential therapy)

Cervical traction too, aids in relaxing the aching neck. After pain relief, the patient would be prescribed active physiotherapy i.e. spinal exercises. Based on the complains, exercise protocol is decided.

EXERCISE THERAPY-

1) A cervical traction, hot and cold therapy (cry therapy), or active exercise program may help relieve symptoms.

Exercises may include:

Ø Neck strengthening,

Ø PNF techniques.

Ø Neck and shoulder stretching, and

Ø Aerobic exercises.

Ø Patients may also receive gentle massage and perform activities to improve posture

2)Manipulation

3) Cervical collar.

Neck Exercises:

Do an isometric push against your hand to strengthen the neck. Hold your left palm against the left side of your head (fig.4). Push your left hand against your head while also pushing your head toward your left hand at about half strength. Hold for 30 seconds. Repeat with your right hand on the right side of the head. Do the same exercise, using either hand, with the back of the head (fig.5) and the forehead (fig.6).