CERVICAL SPONDYLOSIS

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.

Causes

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

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)

Diagnosis

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.

Treatment

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. 

*Ayurveda

*Yoga

*Natural remedies

Nonoperative Treatment 

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

Medications

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.

Physiotherapy

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.

Ayurveda

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

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.

Prognosis

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.