Arthritis in the Neck — Cervical Spondylosis

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Overview of Cervical Spondylosis and Arthritis of the Neck

Xray image of arthritic spine.
Arthritis is one cause of cervical radiculopathy. CNRI/Science Photo Library/Getty Images

Aging is inevitable and with it comes wear and tear on the joints of the spine. While you can't stop wear and tear from happening, you can slow down the rate at which it develops. This article describes cervical spondylosis, a condition that can arise from degenerative changes in the bones and discs in your neck.

Less technical names for this condition is osteoarthritis of the neck, or degenerative disc disease of the neck.

Typically, neck arthritis starts to show up at about 40 years of age, and progresses as the years pile on. That said, men tend to develop cervical spondylosis at a younger age than women. Cervical spondylosis can lead to myelopathy; in fact, it is the most common condition of the neck that can affect the spinal cord.

Arthritis — The Neck and Its Changes

Arthritis in the neck starts with osteophytes — aka bone spurs — that form on vertebral bodies.

Bone spurs are the body’s response to wear and tear. In the spine they serve a purpose, helping to increase the joint's surface area and distribute the weight on it more evenly.

Problem is, bone spurs they may also lead to pain when they put pressure on spinal nerves, and/or the spinal cord. The pressure can also cause numbness, weakness and even incontinence of either the bowels or the bladder (the latter of which is considered a medical emergency.)

See above for an image of neck arthritis, and below, as well as the pages that follow, for more detailed information on symptoms and treatments.

 

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Risk Factors for Arthritis in the Neck

A senior couple is shown in close up.
Taking Advil or ibuprofen raises your risk for a stroke. Westend61/Getty Images

Age

The Amercian Academy of Orthopaedic Surgerons says the biggest risk factor for cervical spondylosis is, first and foremost, age. Starting in middle-age (and continuing on,) they say, arthritis in the neck is a very common condition.

Genetics

After age, the next biggest risk factor is genetics. Arthritis in the neck (like some other types of spine problems), may run in families.  If your spinal canal and/or intervertebral foramen are naturally small in diameter, your risk for complications of degenerative changes may be higher. With a narrow spinal canal, the spinal cord — a very sensitive structure that relays feelings to the brain and movement commands from the brain to the muscles — has less space to fit inside the column of bone that it occupies.  Contact between the cord and the column could irritate the column and cause symptoms.

Smoking

Smoking contributes to degenerative disc disease, as well, and is another risk factor for neck arthritis. 

Psychological Risk Factors

Depression and anxiety are psychological risk factors for arthritis in the neck.

Your Daily Work

Next, let's talk about your occupation.  The AAOS says that if your job involves a lot of repeated neck motion and/or work that takes place above your head, your risk may again be higher.  Depression and/or anxiety are psychological risk factors.

Trauma

And finally, trauma, especially repeated trauma, increases your risk for cervical spondylosis. That said, most neck arthritis is not preceded by trauma.

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Symptoms that Come with Arthritis in the Neck

A man attempts to treat his own neck.
A man attempts to treat his own neck. Shelby Ross/The Image Bank/Getty Images

Generally speaking, the source of neck arthritis pain is not well understood by the medical community. In fact, it's even possible to not have symptoms at all!

Neck and Head Symptoms

When symptoms do occur, intermittent neck pain (called cervicalgia) and stiffness tend to be the most common. And about 1/3 of people with neck arthritis also have headaches, usually located in the lower skull (called sub-occiptial) area. Even though neck pain and stiffness are very prevalent in people who have arthritis of the neck, sometimes headaches will trump the other symptoms.

Radiculopathy and Myelopathy Symptoms

Plus, radiuclopathy, a collection of symptoms caused by an irritated or compressed spinal nerve root, may accompany cervical spondylosis. These include pins and needles, pain, numbness and/or weakness going down one arm (and hand.) Electrical sensations may occur, as well.

Similarly, myelopathy, which is caused by irritation of your spinal cord tissue, is another potential source of neck arthritis symptoms.

But unlike to radiculopathy, myelopathy tends to come on slowly over time, and may express itself in a wide variety of symptom types. It is a common cause of pins and needles. Further, if symptoms arise from higher up in your neck (C-3 through 5), you may experience a syndrome called “numb, clumsy hands," where writing and similar activities become problematic. Your legs may be affected, as well.

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Diagnosing Cervical Spondylosis with Flexibility Tests and X-Rays

Neck x-ray for diagnosing arthritis or other conditions.
Neck x-ray for diagnosing arthritis or other conditions. plepraisaeng

As with most neck and back diagnostic processes, your doctor will gather information about your neck arthritis by taking a history and doing a physical exam. 

MRI for Neck Arthritis

And when it comes to imaging (i.e., x-rays, MRI, CT scans and the like) the gold standard is an MRI, especially for determining the source of nerve symptoms such as pain, pins and needles, numbness or weakness going down one arm. The reason is, an MRI may help your doctor to see not only your bones, but your soft tissues and nerves as well. It may help her to accurately estimate how much unimpeded space is left in the areas that house nerves, namely your spinal canal and intervertebral foramen. 

X-Rays for Neck Arthritis

X-rays are also used when diagnosing arthritis in the neck, as they allow your doctor to visualize how your spinal alignment, including any spondylolisthesis, or forward slippage of a vertebra, contributes to central canal stenosis. (Spinal stenosis is a progressed form of osteoarthritis.)

If you don’t have nerve symptoms, you may only need an x-ray. The strength of an x-ray is its ability to show what’s going on with bones, so in lieu of pain or other symptoms, having one may alert your doctor to things like narrowing in your disc space, bone spurs, loss of neck curve, facet joint hypertrophy, and any decrease in your spinal canal diameter (as mentioned above.)  It can also help her classify cervical spondylosis in elderly people as mild, moderate or severe.

CT Scans for Neck Arthritis

A CT scan (CAT scan) is another diagnostic imaging test commonly given to people with cervical spondylosis. A CT scan is like an x-ray except that it takes multiple images of the inside of the body, and puts them together to display a cross section of the area. The quality of the image is better than that of an x-ray, which may allow your doctor to better study your spinal canal, neural foramen, and any changes in your bones that have occurred since the last CT scan.

Myelography is used to visualize your nerve roots; this is where the spinal cord branches out to become spinal nerves. There’s also CT myelography which some practitioners prefer because it is thought to have lower false-positive results (compared to myelography.) CT myelography is most often used when surgery is involved, as opposed to first time or asymptomatic diagnosis.

Nerve Conduction Study

And finally, another type of test that doctors use to diagnose (or confirm a diagnosis of) radiculopathy is a nerve conduction study.

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Arthritis in the Neck - Treatment

Pain relievers
Pain relievers. Peter Dazeley/Photographer's Choice/Getty Images

Your primary care doctor or general internist may be able to provide treatment for your cervical spondylosis. That said, many a referral to a specialist is made for neck arthritis. Referrals to rheumatologists, neurologists, and orthopedic or neuro-surgeons are common.

But surgery is not generally given for neck arthritis. Instead, conservative care (see below for more information) may help you control pain and slow the progression of the disease.

Signs you may need surgery include pain that's difficult or impossible to control, and/or nerve problems, for example, pins and needles or other electrical sensations, numbness and/or weakness down one arm) that over time continue to worsen.

If you do need surgery, you may be looking at a laminectomy, also known as decompression surgery. 

Physical Therapy for Arthritis in the Neck

If your symptoms are mild or moderate, and if you do not have progressive nerve problems, you may only need conservative care. This may involve one or more of the following:

  • ·Nonsteroidal anti–inflammatory drugs (NSAIDs) including aspirin, naproxen or ibuprofen to help reduce inflammation and relieve pain.
  •  Analgesics, such as acetaminophen (Tylenol) for pain relief only.
  •  Corticosteroid injections to treat radiating pain and to reduce inflammation.
  • ·Nerve blocks for temporary pain relief.
  • ·Restricting but not eliminating physical activity.
  • ·Cervical collar for support and stabilization during the healing period.
  • ·Exercise and, as mentioned above physical therapy.

Referrals to physical therapists are made for conservative care that can be tailored to your symptoms and condition.

Source:

AAOS. Cervical Spondylosis (Arthritis of the Neck.) OrthInfo. American Academy of Orthopaedic Surgeons website. August 2015.
Rana, S., M.D., et. al. Diagnosis and Management of Cervical Spondylosis Clinical Presentation. Medscape website. Last Updated: Aug 2015.

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