Cochin Cardiac Club

Health Blog by Dr.Uday Nair


Cervical spondylosis is a degenerative disease in which there is abnormal wear on the cartilage and bones of the neck (cervical vertebrae).It becomes increasingly more common as people age. More than 85% of people over age 60 are affected.

Understanding the Neck

The back of the neck includes the cervical spine and the muscles and ligaments that surround and support it. The cervical spine is made up of seven bones called vertebrae. The first two are slightly different to the rest as they attach the spine to the skull and allow the head to turn from side to side. The lower five cervical vertebrae are roughly cylindrical in shape - a bit like small tin cans - with bony projections. The sides of the vertebrae are linked by small facet joints. Between each of the vertebrae is a 'disc'. The discs are made of a tough fibrous outer layer and a softer gel-like inner part. The discs act like 'shock absorbers' and allow the spine to be flexible.

Strong ligaments attach to adjacent vertebrae to give extra support and strength. Various muscles attached to the spine enable the spine to bend and move in various ways.

The spinal cord which contains nervous tissue carrying messages to and from the brain, is protected by the spine. Nerves from the spinal cord come out from between the vertebrae in the neck to take and receive messages to the neck and arms. A major blood vessel called the vertebral artery also runs alongside the vertebrae to carry blood to the rear (posterior) part of the brain.


As you age, the bones and cartilage that make up your backbone and neck gradually develop wear and tear. These changes may include:
  • Dehydrated disks. Disks act like cushions between the vertebrae of your spine. By the age of 40, most people's spinal disks begin drying out and shrinking, which allows more bone-on-bone contact between the vertebrae.
  • Herniated disks. Age also affects the exterior of your spinal disks. Cracks often appear, leading to bulging or herniated disks — which sometimes can press on the spinal cord and nerve roots.
  • Bone spurs. Disk degeneration often results in the spine producing extra amounts of bone, sometimes called bone spurs, in a misguided effort to shore up the spine's strength. These bone spurs can sometimes pinch the spinal cord and nerve roots.
  • Stiff ligaments. Ligaments are cords of tissue that connect bone to bone. Increasing age can make spinal ligaments stiffen and calcify, making your neck less flexible.
Risk Factors

There are several factors that increase your risk for cervical spondylosis. The following have all been linked to higher risks of neck pain and spondylosis:

  • Genetics - if your family has a history of neck pain
  • Smoking - clearly linked to increased neck pain
  • Occupation - jobs with lots of neck motion and overhead work
  • Mental health issues - depression/anxiety
  • Injuries/trauma - car wreck or on-the-job injury


Symptoms often develop slowly over time, but they may start or get worse suddenly. The pain may be mild, or it can be deep and so severe that you are unable to move.
You may feel the pain over the shoulder blade or it may spread to the upper arm, forearm, or (rarely) fingers.
The pain may get worse:
  • After standing or sitting
  • At night
  • When you sneeze, cough, or laugh
  • When you bend the neck backwards or walk more than a few yards
You may also have weakness in certain muscles. Sometimes, you may not notice it until your doctor examines you. In other cases, you will notice that you have a hard time lifting your arm, squeezing tightly with one of your hands, or other problems.
Other common symptoms are:
  • Neck stiffness that gets worse over time
  • Numbness or abnormal sensations in the shoulders, arms, or (rarely) legs
  • Headaches, especially in the back of the head
Less common symptoms are:
  • Loss of balance
  • Loss of control over the bladder or bowels (if there is pressure on the spinal cord)


The doctor will generally begin by asking you about symptoms and taking a medical history. This will be followed by a physical exam of the body, with a focus on the neck, back, and shoulders. The doctor is also likely to test reflexes and the strength of hands and arms, check for loss of sensation, and watch you walk. 

Other tests that might be done include imaging exams such as X-rays, computed tomography (CT), and magnetic resonance imaging (MRI). MRI scans use large magnets, radio waves, and a computer to produce the best images of the body. You might also be referred to a neurologist.


After the doctor has conducted the necessary tests to identify the problem in the cervical spine, a treatment plan will then be developed. Various treatment options are available:

*Non operative treatment.
*Operative treatment. 
*Natural remedies

Nonoperative Treatment 

Nonoperative treatment of cervical degenerative disease provides good to excellent results in over 75% of patients. 

Analgesics and muscle relaxants are advised. In more severe cases the orthopedic doctor may suggest cortisone injections near the joints of the vertebral bodies to ease the swelling of the nerves and relieve pain.


The goal of physiotherapy treatment is to relieve pain and enhance movements of the neck.

Other Conservative Methods

Shortwave Diathermy
- A disc or heating pad is placed over the back of the neck. The warmth obtained from the shortwave diathermy current relaxes the muscle and the pain is relieved. 

Cervical Traction- Traction is a mechanical device, which supports the head and chin. It is used to relieve the nerve compression by a bone. 

Posture correction - Simple postural exercises can be taught to correct the faulty position of the neck. Motivation is given to maintain the erect posture.

Use of collars- Two types of collars can be prescribed- Soft collar is used during night times to prevent awkward position of the neck during sleep. Firm collar steadies the neck and relieves pain, especially during traveling or work. It is removed when the pain subsides.

Operative Treatment(Surgery)

A surgeon is likely to consider a surgical treatment of a cervical degenerative problem if one or more of the following criteria are met:
• Non operative treatments have been tried and failed 
• The disorder is causing spinal cord dysfunction 
• The disorder is causing prolonged arm pain or weakness 

The surgical procedure proposed for these patients is removing the bone spur and possible fusion of two or more cervical vertebrae. In most instances, the preferred approach is an anterior (i.e. from the front) Inter body fusion. Using the anterior approach, a surgeon can perform a complete discectomy (i.e. removal of the disc between two vertebrae), and then seek to restore the normal disc space height and normal lordosis (i.e. the concave curve in the cervical spine) by implanting a carefully sculpted graft. A titanium plate may be utilized to improve the rate of fusion and avoid a neck brace. 

A posterior approach (from the back of the spine) is often considered when a cervical disc has herniated laterally (i.e. sideways). 

Motion preservation surgery - Cervical Disc Replacement ,is a new newer concept.


Any external massage is not of much use. Violent massage with deep pressure is very harmful for the patient. Only gentle massage over the muscles of the neck and shoulder joints should be applied and for this purpose Mahanarayan taila is best suited. This gentle massage can be given 2-3 times a day .In winter season; this medicated oil should be gently warmed before application. 
Guggulu, gum resin extracted from the plant is the best medicine for the treatment of this condition. Ayurvedic physicians for the treatment of this condition popularly use a compound preparation named as simhanada guggulu. It is given in a dose of 2-4 tablets, 4 times a day. Usually hot water or hot milk id given to the patient after the administration of this medicines. This medicine has slightly laxative effects. For the patient to recover from this ailment, it is necessary that this bowel should move clearly and regularly. This medicine is very much helpful for this purpose. For patients having clear motions, this medicines should be given in a dose of 2 tablets and constipated patients the dose should be 4 tablets. If the constipation is not relieved even by taking 4 tablets the dose can be further increased to 6 tablets. 
At night some medicines should be given to the patients, which will act as a purgative. Triphala powder is the best medicine for this purpose. One teaspoonful of triphala should be given to the patient, mixed with a cup of warm milk and one spoon of sugar. In the motions become regular by the intake of simbanada guggulu, then triphala powder should be given only twice a week otherwise it can be given every day. 
Hot fomentation on the vertebrae of the neck is very useful for this condition. In a big handkerchief about 500gms of salt should be kept over a frying pan till it becomes tolerably hot. Then this should be applied over the neck. Care should be taken to see that it not too hot. In that case, it may cause burns. Sometime patients suffering from cervical Spondylosis develop some anesthetic patches in the back, neck, shoulders and arms because of the pressure from nervous systems .the patient is therefore not able to feel the quantum of heat applied during fomentation. It should therefore be the responsibility  of the attendant to examine the heat of the bolus before applying it it on the affected parts .This fomentation should be continued about ½ an hour every day .After fomentation the affected part should not be exposed to cold wind. In winter season therefore immediately after fomentation, the affected part should be covered with some woolen garment. In other seasons also the affected part should be kept covered with some cotton garments after fomentation. It is very convenient to take the fomentation before bedtime. After the fomentation the patient should go to sleep so that he does not run the risk of exposure.


Yoga exercises cure by profuse blood circulation and nourishment of veins and nerves with fresh oxygenated blood that repairs the damaged muscles, tissues and bone joints.Repeated stretching and rotation lubricates joints, improves range of motion and strengthens back, shoulder and neck muscles. It helps with natural traction that reduces the pain caused by compression of the nerve roots.
Some postures (Asanas) you can try out with a trained yoga instructor are-
Bhujangasana Strengthens different parts of the body and works wonders for the spine and back. We prescribe variations according to the problem. 
Bakrasana Stretches the upper back and strengthens the arms and wrists. Very effective in spondylosis. 
Ardhamatsyendrasana From the base of the spine through the neck, this asana enhances the flexibility in each vertebrae. 
Abhyasana for Neck Pain Strengthening the arm and shoulder muscles and relieves cervical pain. 
Suryaved Pranayam Increases the energy level and relieves physical and mental stress. 
Sabasana A calm and carefree yoga posture for relaxing the mind and body. 

Nature Remedies

*Turn your neck slowly from side to side, then rotate clockwise, anticlockwise for 10 times. Practise this in the morning, at lunch time and evening everyday.

*Do not sit with the chair and table in front constantly for more than one hour and use a table lamp so that the neck is not bent for longer durations. Relax with both hands clenched with thumb under the chin for every one to two hours of work on the table.

*Lie on your abdomen folding hands behind your back and raise your head slowly for 15-20 times. Do this every morning and evening.

*Shoulders should be rotated slowly in the clockwise and anticlockwise direction.

*Use hard bed without any pillows.

*Avoid driving on rough and bumpy roads and go slow if it cannot be avoided.

*Do not carry heavy objects, shopping bags or brief cases etc.

Precautionary measures to prevent.

1. If your work long hours in front of the computer, you must relax the muscles of your neck and shoulders by taking frequent breaks from work.
2. While at work, avoid keeping your neck straight and stiff
3. Do neck exercises. Look towards the left side and then slowly drop the chin to your chest and again look to the right hand side. Then repeat this exercise from the right hand side to the left hand side. Repeat it slowly for around five times.
4. Roll your shoulders in a circular motion (clockwise) with your hands straight along your body. Repeat this in anti-clockwise direction. Repeat it five times.
5. Place your arms straight in front of you, with the palms facing each other. Lift your arms and bring them near your ears and while doing so, inhale.
6. Take 10 cloves of garlic and add them in 60 gm vegetable oil after crushing them. Heat the mixture till it gets hot, remove the utensil from the burner and allow the oil to cool down. Later strain the oil and massage the affected area with it. In case of severe pain, massage the area twice and bath with warm water.
7. Drink a teaspoon of lemon juice after adding a pinch of salt to it two to three times a day.


Most patients with cervical spondylosis will have some long-term symptoms. These symptoms will often get worse and then improve. However, symptoms should improve with treatment and do not need surgery.
Many people with this problem are able to maintain active lives. However, some patients will have to live with chronic pain.


One of the most important glands in our body is the thyroid gland. It is shaped like a butterfly. The thyroid is one of the largest endocrine glands in the body. This gland is found in the neck, inferior to (below) the thyroid cartilage (also known as the Adam's apple) and at approximately the same level as the cricoid cartilage.It has two cone-like lobes or wings, lobus dexter (right lobe) and lobus sinister (left lobe), and the two lobes are connected together by the isthmus.
The gland is situated on the anterior side of the neck, lying against and around the larynx and trachea, reaching posteriorly over the oesophagus and carotid sheath. It starts cranially at the oblique line on the thyroid cartilage (just below the laryngeal prominence or Adam's apple) and extends inferiorly to the fifth or sixth tracheal ring. 

Hormones and Iodine

The thyroid gland produces two primary hormones - thyroxine (also referred to as T4) and tri-iodothyronine (also referred to as T3). The numbers 3 and 4 refer to the number of atoms of iodine in the hormones. Iodine is essential for the production of thyroid hormones and humans need about 150 mcg (millionths of a gram) each day. Iodine is found in most foods, especially seafood.  Iodised salt is the best way to supplement dietary iodine, but taking too much iodine canalso be a problem.

Of the two hormones produced, T3 is more active than T4, but is produced in much smaller quantities. T4 has a lesser effect, but most is converted to T3 by enzymes that remove one iodine atom. The greater the amount of T3 and T4 circulating in the blood, the faster the metabolism. Lower amounts of T3 and T4 result in a reduced metabolism.

Pituitary Gland

The thyroid gland is controlled by the pituitary, which is considered the ‘master gland’ of the endocrine system. The pituitary is located at the base of the brain. Its principal function is to monitor and regulate the activity of the other glands. The pituitary affects the thyroid gland by producing a hormone called thyroid-stimulating hormone (TSH), which prompts the thyroid to release more T4 and T3. If there is too much T4 circulating in the blood, the pituitary reduces the amount of TSH produced, which then causes thyroid activity to slow. If there is too little T4, the pituitary increases the amount of TSH. In this way, T4 and T3 levels in the blood are kept relatively constant. The pituitary gland, in turn, is overseen by a part of the brain called the hypothalamus.


When the thyroid gland malfunctions, it either produces too much thyroid hormone leading to hyperthyroidism or too little thyroid hormone, leading to hypothyroidism.It can make you feel nervous or tired and you may experience muscular weakness. Sudden weight gain or loss, dry skin patches, memory loss, and irregularities in your menstrual flow are all part of a thyroid disorder. It can even cause miscarriage and infertility. Not just that, women are 4 times more prone to thyroid disorders than men.And while diagnosis of the condition is pretty straightforward once symptoms are linked to it, the problem is that some patients and doctors don’t first consider the thyroid as a possible cause of their symptoms.

Causes and of Thyroid problems.

All types of hyperthyroidism are due to an overproduction of thyroid hormones, but the condition can occur in several ways:
  • Graves' disease : The production of too much thyroid hormone
  • Toxic adenomas: Nodules develop in the thyroid gland and begin to secrete thyroid hormones, upsetting the body's chemical balance; some goiters may contain several of these nodules. 
  • Subacute thyroiditis: Inflammation of the thyroid that causes the gland to "leak" excess hormones, resulting in temporary hyperthyroidism that generally lasts a few weeks but may persist for months 
  • Pituitary gland malfunctions or cancerous growths in the thyroid gland: Although rare, hyperthyroidism can also develop from these causes.
Hypothyroidism, by contrast, stems from an underproduction of thyroid hormones. Since your body's energy production requires certain amounts of thyroid hormones, a drop in hormone production leads to lower energy levels. Causes of hypothyroidism include:
  • Hashimoto's thyroiditis: In this autoimmune disorder, the body attacks thyroid tissue. The tissue eventually dies and stops producing hormones.  
  • Removal of the thyroid gland: The thyroid may have been surgically removed or chemically destroyed. 
  • Exposure to excessive amounts of iodide: Cold and sinus medicines, the heart medicine amiodarone, or certain contrast dyes given before some X-rays may expose you to too much iodine.You may be at greater risk for developing hypothyroidism if you have had thyroid problems in the past. 
  • Lithium: This drug has also been implicated as a cause of hypothyroidism. 
Untreated for long periods of time, hypothyroidism can bring on a myxedema coma, a rare but potentially fatal condition that requires immediate hormone injections.

Hypothyroidism poses a special danger to newborns and infants.

A lack of thyroid hormones in the system at an early age can lead to the development of cretinism (mental retardation) and dwarfism (stunted growth). Most infants now have their thyroid levels checked routinely soon after birth. If they are hypothyroid, treatment begins immediately. In infants, as in adults, hypothyroidism can be due to these causes:
  • A pituitary disorder
  • A defective thyroid
  • Lack of the gland entirely
A hypothyroid infant is unusually inactive and quiet, has a poor appetite, and sleeps for excessively long periods of time.

Cancer of the thyroid gland is quite rare and occurs in less than 10% of thyroid nodules. You might have one or more thyroid nodules for several years before they are determined to be cancerous. 
People who have received radiation treatment to the head and neck earlier in life, possibly as a remedy foracne, tend to have a higher-than-normal risk of developing thyroid cancer

Symptoms and Complications of Thyroid Diseases

Hypothyroidism results in low levels of T4 and T3 in the blood. Not having enough T4 and T3 in the blood causes your metabolism to slow down.

Common symptoms include:
  • coarse and dry hair
  • confusion or forgetfulness (often mistaken for dementia in seniors)
  • constipation
  • depression
  • dry, scaly skin
  • fatigue or a feeling of sluggishness
  • hair loss
  • increased menstrual flow (women)
  • intolerance to cold temperatures
  • irritability
  • muscle cramps
  • slower heart rate
  • weakness
  • weight gain
If hypothyroidism isn't treated, the symptoms will progress. Rarely, a severe form of hypothyroidism, called myxedema, can develop. 

Symptoms of myxedema include:
  • low body temperature
  • dulled mental processes
  • congestive heart failure, a condition where the heart cannot pump enough blood to meet the body's needs
Myxedema coma occurs in people with severe hypothyroidism who have been exposed to additional physical stresses such as infections, cold temperatures, trauma, or the use of sedatives. Symptoms include loss of consciousness, seizures, and slowed breathing.

Hyperthyroidism results in high levels of T4 and T3 circulating in the blood. These hormones speed up your metabolism.

Some of the most common symptoms include:
  • increased heart rate with abnormal rhythm or pounding (palpitations)
  • high blood pressure
  • increased body temperature (feeling unusually warm)
  • increased sweating
  • clamminess
  • feeling agitated or nervous
  • tremors in the hands
  • feeling of restlessness even though the person is tired or weak
  • increased appetite accompanied by weight loss
  • interrupted sleep
  • frequent bowel movements, sometimes with diarrhoea
  • puffiness around the eyes, increased tears, sensitivity to light, or an intense stare
  • bone loss (osteoporosis)
  • stopped menstrual cycles
Graves' disease, in addition to the common symptoms of hyperthyroidism, may cause a bulge in the neck (goiter) at the location of the enlarged thyroid gland. It also might cause the eyes to bulge out, which may result in double vision. Sometimes, the skin over the shins becomes raised.

If hyperthyroidism is left untreated or is not treated properly, a life-threatening complication called thyroid storm (extreme overactivity of the thyroid gland) can occur.

Symptoms include:
  • confusion
  • coma
  • fever
  • high blood pressure
  • irregular heartbeat, which can be fatal
  • jaundice associated with liver enlargement
  • mood swings
  • muscle wasting
  • restlessness
  • shock
  • weakness
Thyroid storm, considered a medical emergency, can also be triggered by trauma, infection, surgery, uncontrolled diabetes, pregnancy or labour, or taking too much thyroid medication.


Thyroid disease can be difficult to diagnose because symptoms are easily confused with other conditions. Fortunately, there is a test, called the thyroid stimulating hormone (TSH) test, that can identify thyroid disorders even before the onset of symptoms.Screening for mild thyroid failure in women and men over age 35 is as cost-effective as screening for more common problems such as high cholesterol or high blood pressure.
When thyroid disease is caught early, treatment can control the disorder even before the onset of symptoms.


Hypothyroidism is treated by replacing the missing hormone, a hormone that is essential to the body’s key functions. This is accomplished by taking thyroid hormone replacement drugs prescribed by a physician.

Treatment of Hashimoto’s disease, the autoimmune condition that often results in hypothyroidism, is more controversial. Some practitioners believe that Hashimoto’s requires no treatment, and will only treat a patient with thyroid hormone replacement drugs when the Hashimoto’s has resulted in hypothyroidism that can be verified through laboratory testing. 
Some practitioners believe that Hashimoto’s, which can be confirmed by testing for thyroid antibodies, warrants treatment in some patients. There is some evidence that treating Hashimoto’s disease with thyroid hormone replacement drugs before the thyroid stimulating hormone (TSH) level rises may alleviate some symptoms. Some research suggests that treating someone with Hashimoto’s but a normal TSH may help prevent elevation of the TSH level and progression to full hypothyroidism. 
On the integrative medicine front, some holistic practitioners recommend iodine supplementation, other nutritional supplements, dietary changes, particular yoga poses, mind-body medicine, and other complementary approaches to help the thyroid.

Hyperthyroidism is treated by reducing the excess hormone levels, which is accomplished in several different ways:
  • antithyroid drugs
  • radioactive iodine treatment (RAI) also known as radioiodine ablation
  • surgical removal of all or part of the thyroid, known as thyroidectomy
Some controversial, cutting-edge therapies for treatment include block/replace therapy (BRT), and thyroid arterial embolization.
Generally, the approach used for treatment depends on the severity of the condition, whether or not the patient is a child or a pregnant woman, and in some cases, the preference or perspective of the treating physician. 
Interest is also growing in thyroid arterial embolization, a new approach for Graves' disease treatment.
In some cases, key hyperthyroidism symptoms such as rapid heart rate or elevated blood pressure are also treated with drugs known as beta-blockers.
Most thyroid patients who receive RAI treatment or have surgery eventually end up hypothyroid, and are treated with thyroid hormone replacement drugs.
Some integrative practitioners recommend stress reduction programs, antithyroid dietary and nutritional changes, traditional Chinese medicine, and other holistic approaches to help an overactive thyroid.

Thyroid storm is a rare but potentially life-threatening complication of hyperthyroidism. When this condition is suspected, immediate treatment needs to be obtained at an emergency room.

Hashimoto’s thyroiditis is treated with thyroid hormone replacement drugs. For cases of thyroiditis that are painful, doctors typically recommend a pain-reliever with anti-inflammatory properties, such as aspirin, ibuprofen (Advil/Motrin), or naproxen (Aleve).
If the thyroiditis is especially acute, doctors occasionally recommend steroid drugs to reduce inflammation, along with thyroid hormone replacement drugs, to allow the thyroid to rest from its job of hormone production.
On the nutritional front, there is some evidence that supplementing with the mineral seleniummay help thyroiditis.

Please Note-

10 signs of Thyroid problems

2)Weight Changes
3)Depression and Anxiety
4)Family History
5)Cholesterol problems
6)Menstrual Irregularities and Fertility Problems
7)Bowel Problems
8)Hair and Skin Changes
9)Neck Discomfort and Enlargement
10)Muscle and Joint Pain