1. CERVICAL SPONDYLOSIS DR T.P MOJA STEVE BIKO ACADEMIC HOSPITAL

3. Pathophysiology Disc degeneration
-nucleus pulposus loses water content, fissuring, loss of height and bulging annulus.
-acute rupture and herniation may occur
Secondary changes due to increased and uneven loading of forces
- Vertebral osteophytes
- Facet and uncovertebral joint osteoarthritis and hypertrophy
- Ligamentum flavum becomes thickened and may ossify
- Spine deformity due to segmental instability
Degenerative spondylolistheses
Degenerative kyphosis or scoliosis
Narrowing of the central canal, lateral recesses and foramina with subsequent neural and vascular compression

4. CERVICAL SPINE XRAY

5. MRI CERVICAL SPINE

6. Clinical Presentation
Asymptomtic with incidental radiographic findings
Symptomatic - in most cases: onset is slow and insidious . However some cases may be acute eg hyperextension injury in minor trauma or acute disc herniation
Neck pain
Myelopathy
Radiculopathy

7. Neck pain Occurs if there is a disc extrusion Nerve root compression
Facet joint arthritis
Segmental instability
Often poorly localized
May radiate to the occipital region, shoulders, interscapular.
There may be associated stiffness of the neck from muscle spasm

8. Myelopathy May be complex and variable
Most cases seem to present with a central cord syndrome, rarely brown squard, or complete myelopathy
Motor
-upper limbs: LMN Weakness
Clumsiness of the hands. Muscle wasting. Absent biceps reflex, inverted reflex, Triceps reflex may be brisk. Positive Hoffman reflex
-Lower limbs: Spasticity, difficulty walking. No or slight weakness.
Sphincters: usually no symptoms. Rarely mild bladder symptoms. ? Prostate

9. Sensory
- No involvement
- Patchy sensory loss
- Paraesthesia in the hands, sometimes the feet and legs
- May be asymmetrical or symmetrical
- Different from radiculopathy in that it is not in a specific dermatomes
- Lhermittes’s sign

10. Radiculopathy May be acute if due to a disc protrusion
Slow and insidious if due to an osteophyte
Most common nerve root is C6
Neck pain and shoulder pain. Pain radiates down the biceps, then the lateral aspect of the forearm then the thumb and index finger.
Head may be tilted to the affected side due to muscle spasm. Pain made worse by neck extension, relieved by neck flexion and shoulder abduction.
Often numbness, more often hand and fingers

11. Chronic cases – wasting and fasciculations of biceps and brachioradialis muscle.
Weakness of elbow flexion (Thumb-nose), and wrist extension.
Absent biceps and brachioradialis reflex

12. C5 nerve root radiculopathy
- Neck pain
- Shoulder pain, pain over the lateral aspect of the upper arm.
- Numbness or paraesthesia over the lateral aspect of the upper arm.
- Weakness of deltoid and biceps muscles, with absent biceps reflex
In severe cases, wasting of the deltoid and biceps muscles

13. Treatment Neck Pain Myelopathy Acute radiculopathy
-Conservative
-Rarely, surgery
Myelopathy
-Surgery in most cases
-Some may stabilize on conservative
Acute radiculopathy
-Surgery if indicated
Chronic radiculopathy
-Most cases, surgery

14. Conservative treatment
Medication: Analgesia
NSAIDS
Diazepam
Baclofen
Carbamazepine, Gabapentin, Lyrica
Physiotherapy: Range of motion exercises
Isometric exercises
Heat and massage
Traction: Continuous or intermittent halter traction
Neck collar Soft neck collar < 1 week
Facet and Medial branch block – Cortisone, L.A, Radiofrequency

15. SURGERY Anterior decompression Posterior decompression
Anterior cervical discectomy and fusion
Corpectomy and fusion
Posterior decompression
Laminaplasty
Laminectomy