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Cervical spondylosis is a degenerative disorder at the level of the cervical spine. It can be described as the result of degeneration of the intervertebral discs or the vertebral bodies in the cervical region.

Cervical spondylosis is characterised by: Formation of osteophytes on the vertebral bodies; Facet joint arthritis; Ossification of the posterior longitudinal ligament; Hypertrophy of the ligamentum flavum causing posterior compression of the cord especially as it buckles in extension; Spinal stenosis; Degenerative subluxation of cervical vertebra; Dislocated fragment of annular cartilage compressing the spinal cord or nerve root.

Aetiology

Spondylotic changes in the cervical spine occur at solitary disc space levels in 15-40% of patients and at multiple levels in 60-85%. The discs between the third and seventh cervical vertebrae are most commonly affected.

Repeated occupational trauma may contribute to the development of cervical spondylosis.

 An increased incidence has been noted in patients who carried heavy loads on their heads or shoulders, dancers, gymnasts, and in patients with spasmodic torticollis.

Signs and symptoms

Most of the time cervical spondylosis is diagnosed on clinical signs and symptoms alone.

Signs

Poorly localised tenderness; Limited range of motion of forward flexion, backward extension, lateral flexion, and rotation to both sides; Minor neurological changes, Like inverted supinator jerks unless complicated by myelopathy or radiculopathy.

Symptoms

Cervical pain aggravated by movement; referred pain; retro-orbital or temporal pain; cervical stiffness; vague numbness, tingling or weakness in upper limbs; dizziness or vertigo; poor balance; rarely syncope triggers migraine.

Medical Management

There are different medications to treat cervical spondylosis: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Opioid Analgesics, Muscle Relaxations, Corticosteroids.

Surgical Management

Poor prognostic indicators and, therefore, absolute indications for surgery are: Progression of signs and symptoms; Presence of myelopathy for six months or longer; Compression ratio approaching 0,4 or transverse area of the spinal cord of 40 square millimeters or less.

The goals of surgical treatment of cervical spondylosis are the following: Improvement or preservation of neurological function; Prevention or correction of spinal deformity; Maintenance of spinal stability.

Physiotherapy

Mobilization and/or manipulations in combination with exercises are effective for pain reduction and improvement in daily functioning in sub-acute or chronic mechanical neck pain with or without headache.

Typically the therapy regime requires 15–20 sessions over a 3-month period. The treatment should be tailored to individual patients but includes supervised isometric exercises, proprioceptive reeducation, manual therapy and posture education.

Manual Therapy of the thoracic spine will be used for reduction of pain, improving function, to increase the range of motion and to address the thoracic hypomobility.

Soft Tissue Mobilization is performed on the muscles of the upper quarter with the involved upper extremity positioned in abduction and external rotation to preload the neural structures of the upper limb.

Source

Rachael Lowe, cervical vertebrae, Physiopedia, http://www.physio-pedia.com/Cervical_Vertebrae assessed 26/08/18.

Faldini, D. Leonetti, Cervical disc herniation and cervical spondylosis surgically treated by Cloward procedure: a 10-year-minimum follow- up study, Journal of Orthopaedics and Traumatology, June 2010 (Level of evidence 1B)

Muhukumar, Surgical management of cervical spondylotic myelopathy, Neurol. India 60(2):201-209, Mar-Apr 2012. (Level of evidence 2A)

Gross AR, Hoving JL, Haines TA, Goldsmith CH, Kay T, Aker P, Bronfort G. A Cochrane review of manipulation and mobilization for mechanical neck disorders. Spine (Phila Pa 1976). 2004 Jul 15;29(14):1541-8. (Level of evidence 1A)

Kieran Michael Hirpara, Joseph S. Butler, Roisin T. Dolan, John M. O’Byrne, and Ashley R. Poynton , Non  operative Modalities to Treat Symptomatic Cervical Spondylosis, Advances in Orthopedics, 2011 (Level of evidence 1A)

Ippei Takagi, Cervical Spondylosis: An Update on Pathophysiology, Clinical Manifestation, and Management Strategies. DM, October 2011 (level of evidence 5)

Michale Costello, Treatment of a Patient with Cervical Radiculopathy Using Thoracic Spine Thrust Manipulation, Soft Tissue Mobilization, and Exercise, the Journal of Manual and manipulative therapy

 Young-Tae Kim and Young-Baeg Kim, Cervical Radiculopathy due to Cervical Degenerative Diseases : Anatomy, Diagnosis and Treatment, The Korean Neurosurgical Society, 2010 (Level of Evidence 1A)

Ibrahim M. Moustafa and Aliaa A. Diab, Multimodal Treatment Program Comparing 2 Different Traction Approaches for Patients With Discogenic Cervical Radiculopathy: A Randomized Controlled Trial, Journal of Chiropractic Medicine (2014) 13, 157–167

https://www.qispine.com/wp-content/uploads/2016/11/4.jpg assessed on 25/08/2018.