Categories: Neurosurgery

Cervical Degenerative Spine

Interesting facts about Cervical Spondylosis

The cervical spine is a highly mobile segment of the spine. The facet orientation enables movements in all three primary planes – flexion/extension, lateral bending, and rotation. Some of these movements can be purely in one direction and others are compound movements in which there is spinal movement in more than one plane simultaneously. The stability of cervical spine motion segments is primarily dependent upon the ligamentous structures and paraspinal musculatures.

Degeneration of the cervical spine motion segments results from repeated movement, stress, and strain on the osseoligamentous structures over a long time. Genetic and developmental factors may also influence this. Current concepts suggest that changes in the disc initiate the cascade of changes in cervical spondylosis. Degeneration of the facet joints and reactive bony changes follow the primary discogenic pathology. In addition to this typical form of spondylosis, two other unique forms – Ossification of Posterior Longitudinal Ligament (OPLL) and Diffuse Idiopathic Skeletal Hyperostosis (DISH) occur.

Clinical manifestations

The consequences of the spondylotic process include:

  • Diminished range of motion of neck – Due to osteophytes and change in consistency of the ligamentous and capsular structures.
  • Pain – Ongoing cervical nerve root compression results in radiating pain in distal aspects of the arm.
  • Neurological deficit in the form of radiculopathy or myelopathy or a combination of the two. Limb weakness, atrophy of muscles, difficulty in walking, and urinary disturbances can disturb daily activities.
  • Headaches are also a possible manifestation of spondylosis

Investigations

A variety of imaging techniques are available to study the anatomy and pathology of the cervical spine.

  • X-Ray – Lateral view in dynamic and static views outlines the alignment and stability of the cervical spine. Bony changes associated with spondylosis can be identified.
  • MRI – Multiplanar imaging of high-resolution directly visualize the spinal cord and its relation to surrounding osseoligamentous tissues. The extent of disc desiccation, the presence of reactive changes in the endplates, and the accumulation of fluid in the facet joints can be seen.
  • CT – Sclerosing of the vertebral body endplates, osteophytes at the disc space, and facet joint changes can be seen well.
  • ENMG – This can sometimes be effective in identifying the origin of arm pain identifying the precise nerve root involved in radicular pain or deficit.

Treatment

The goals of treating patients with the symptomatic cervical spondylotic disease include diminishing pain, restoring neurological function, and re-establishing spinal stability.

Non-operative treatment:

Isometric cervical spine exercises augment paraspinal muscle tone and improve the stability of the cervical spine to some extent. Anti-inflammatory and analgesic use would represent the mainstay of preliminary treatment. In the presence of true muscle spasms, which are episodic, intense, cramp-like pains, muscle relaxants can be of value. The medication frequently has a sedating effect, which can be beneficial for rest but can impair one’s ability to function throughout the day. The role of steroid injections is controversial.

Surgical treatment:

This is considered for those patients with spinal instability or neurologic deficits from spondylosis, or in those patients who present with pain and have failed non-operative treatment. A variety of surgical techniques have been developed. Many factors and considerations have to be taken into account to determine the type and extent of surgery required in a given case. Bony decompression is accomplished by removing the compressive pathology, expanding the channel through which the neural element is passing or by reduction of a deformity which is causing encroachment upon the spinal cord or nerve roots. The patient’s age, bone quality, spinal curvature, and general health can influence the approach and extent of surgery required. Laminoforaminotomy, laminectomy with or without lateral mass fusion, anterior cervical discectomy with fusion, corpectomy with autologous graft or titanium cage fixation are few types of surgery for cervical spondylosis.

Dr. Kiran M, Neurosurgery, Mazumdar Shaw Medical Center, Bommasandra

Narayana Health

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