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.
The consequences of the spondylotic process include:
A variety of imaging techniques are available to study the anatomy and pathology of the cervical spine.
The goals of treating patients with the symptomatic cervical spondylotic disease include diminishing pain, restoring neurological function, and re-establishing spinal stability.
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.
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.
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