Cervical Spondylosis Treatment in Delhi, India

Cervical spondylosis, often referred to as neck arthritis or cervical osteoarthritis, is a degenerative condition affecting the cervical spine, which encompasses the vertebrae in the neck region. This condition typically emerges with age due to the natural wear and tear that occurs in the cervical spine over time. It involves the deterioration of the intervertebral discs, as well as changes in the bones, ligaments and joints of the neck. These changes can lead to various symptoms, ranging from mild discomfort to significant pain and functional impairment.

The primary cause of cervical spondylosis is the ageing process, which results in structural changes within the cervical spine. As individuals age, the intervertebral discs lose moisture and elasticity, becoming less effective at cushioning the vertebrae. Additionally, the formation of osteophytes, or bone spurs, ossification of ligaments may occur along the edges of the vertebrae, contributing to the development of cervical spondylosis. Other factors that may contribute to the condition include:

• Repetitive Neck Movements: Activities or occupations that involve repetitive neck movements or prolonged neck postures can accelerate the degenerative changes in the cervical spine.
• Poor Posture: Maintaining poor posture, such as slouching or holding the neck in an awkward position for extended periods, can place excessive stress on the cervical spine and contribute to the development of spondylosis.
• Neck Injuries: Trauma or injury to the neck, such as whiplash from a car accident or a sports-related injury, can damage the structures of the cervical spine and increase the risk of developing cervical spondylosis.
• Genetic Factors: Certain genetic factors may predispose individuals to developing cervical spondylosis, although the specific genes involved are not yet fully understood.

While ageing is the primary risk factor for cervical spondylosis, several other factors can increase an individual's likelihood of developing the condition. These include:

• Age: The risk of cervical spondylosis increases with age, with most individuals experiencing some degree of degenerative changes in the cervical spine by the age of 50.
• Occupational Factors: Jobs or activities that involve repetitive neck movements, heavy lifting, or prolonged sitting can increase the risk of developing cervical spondylosis.
• Smoking: Smoking has been linked to an increased risk of developing cervical spondylosis, as it can accelerate the degenerative process in the spine by impairing blood flow and nutrient delivery to the spinal discs.
• Obesity: Excess weight places additional strain on the cervical spine, which can accelerate degenerative changes and increase the risk of developing cervical spondylosis.
• Gender: Studies have suggested that men may be at a slightly higher risk of developing cervical spondylosis compared to women, although the reasons for this are not entirely clear.

The symptoms of cervical spondylosis can vary widely depending on the severity of the degenerative changes and the structures affected. Common symptoms include:

• Neck Pain: Persistent or intermittent pain in the neck, which may radiate to the shoulders, arms, or hands. The pain may be dull, aching, or sharp, and it may worsen with movement or certain positions.
• Stiffness: Stiffness in the neck, particularly upon waking in the morning or after prolonged periods of inactivity. This stiffness may improve with movement but can worsen with prolonged sitting or standing.
• Reduced Range of Motion: Difficulty turning the head from side to side or tilting the head backward or forward due to stiffness and pain in the neck.
• Headaches: Some individuals with cervical spondylosis may experience headaches, particularly those originating from the base of the skull or the back of the head.
• Numbness or Tingling: Numbness, tingling, or weakness in the arms, hands, or fingers, which may occur due to nerve compression in the cervical spine.
• Muscle Weakness: Weakness in the arms or hands, which may affect grip strength or fine motor skills and performing daily living activities. 
• Difficulty Walking: In severe cases where cervical spondylosis leads to spinal cord compression, individuals may experience difficulty walking, loss of balance, or coordination problems.

It's important to note that not everyone with cervical spondylosis will experience symptoms, and the severity of symptoms can vary from person to person. Additionally, symptoms may come and go or worsen over time, depending on various factors such as activity level, posture, and overall health. If an individual experiences persistent or severe neck pain or other symptoms suggestive of cervical spondylosis, it's essential for them to seek medical evaluation for proper diagnosis and management.

Diagnosis of cervical spondylosis typically involves a combination of medical history review, physical examination, and diagnostic tests. Here's how it's typically done:

• Medical History: The healthcare provider will start by asking the individual about their symptoms, including the location, duration, and severity of pain, as well as any other symptoms such as numbness, tingling, weakness, or changes in bowel or bladder function. They may also inquire about any previous neck injuries or surgeries.
• Physical Examination: A physical examination is conducted to assess the range of motion in the neck, muscle strength, reflexes, and sensation in the arms and hands. The healthcare provider may also perform specific manoeuvres to assess for signs of nerve compression or spinal cord involvement.
• Imaging Studies: Imaging tests such as X-rays, CT scans, or MRI scans may be ordered to visualise the structures of the cervical spine and confirm the diagnosis. X-rays can show bony changes, such as bone spurs or narrowing of the spinal canal, while CT scans and MRI scans provide more detailed images of the bones, discs, nerves, and surrounding soft tissues.
• Electromyography (EMG) and Nerve Conduction Studies: In some cases, electromyography (EMG) and nerve conduction studies may be performed to evaluate the function of the nerves and muscles in the arms and hands. These tests can help determine if there is nerve compression or damage.
• Other Tests: Depending on the individual's symptoms and medical history, additional tests such as blood tests or other imaging studies may be ordered to rule out other conditions that could be causing similar symptoms.

Once a diagnosis of cervical spondylosis is confirmed, the healthcare provider will work with the individual to develop a treatment plan tailored to their specific needs and symptoms.

Treatment for cervical spondylosis aims to manage symptoms, improve function, and prevent further progression that is primary to the condition. Here are some common treatment options:

Medications

• Pain relievers: Over-the-counter pain medications such as acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve) can help alleviate pain and reduce inflammation, opioids. 
• Muscle relaxants: These medications may be prescribed to relieve muscle spasms and improve mobility.
• Corticosteroid injections: Injections of corticosteroids directly into the affected nerve area of the spine can help reduce inflammation and alleviate pain, especially if other medications are ineffective.

Physical Therapy

A physical therapist can design a personalised exercise program to improve strength, flexibility, and posture, as well as to alleviate symptoms. This may include stretching exercises, strengthening exercises, and posture training. Similarly, manual therapy techniques such as massage, mobilisation, or manipulation may also be used to relieve muscle tension and improve mobility.

Activity Modification

• Avoiding activities that worsen symptoms, such as repetitive neck movements or heavy lifting, can help prevent exacerbation of symptoms.
• Using ergonomic equipment and maintaining good posture while sitting, standing, and sleeping can help alleviate strain on the neck and spine.

Heat or Cold Therapy

Applying heat or cold packs to the affected area can help reduce pain and inflammation. Heat therapy, such as warm showers or heating pads, can help relax muscles and improve blood flow. Cold therapy, such as ice packs, can help numb the area and reduce inflammation.

Bracing

In some cases, wearing a cervical collar or neck brace for a short period of time may help stabilise the neck and relieve symptoms. However, prolonged use of a collar or brace is generally not recommended as it can lead to muscle weakness and stiffness.

Surgery

Surgery may be considered for individuals who have severe symptoms that do not respond to conservative treatments or who have progressive neurological deficits (such as weakness or loss of coordination). Surgical options may include:

• Decompression surgery: Removing bone spurs, herniated discs, or other structures that are compressing the spinal cord or nerves.
• Spinal fusion: Joining two or more vertebrae together to stabilise the spine and prevent further movement.
• The combination of decompression (Deco) with fusion and bone grafting is a common surgical approach used to address spinal instability or deformity while also providing structural support and promoting bone healing. This technique involves removing pressure from compressed nerves or spinal cord (decompression) and stabilising the spine through fusion, often using bone grafts to facilitate bone growth and fusion between vertebrae. 

The choice of treatment depends on the severity of symptoms, the individual's overall health, and their preferences. It's important for individuals with cervical spondylosis to work closely with their healthcare provider to develop a comprehensive treatment plan that addresses their specific needs and goals. Regular follow-up appointments may be necessary to monitor progress and make adjustments to the treatment plan as needed.

While cervical spondylosis itself isn't life-threatening, it can lead to some serious complications if left untreated. Here's a list of potential complications:

• Chronic Pain: The most common complication is chronic neck pain. This pain can sometimes radiate to the shoulders and arms and may be accompanied by stiffness and muscle spasms.
• Nerve Compression: As the discs and vertebrae degenerate, they can compress the nerves in the cervical spine. This compression can lead to symptoms such as numbness, tingling, weakness, and possibly loss of coordination in the arms and hands. In severe cases, it can lead to cervical radiculopathy or myelopathy.
• Cervical Radiculopathy: This occurs when a nerve root in the cervical spine becomes irritated or compressed, leading to symptoms such as pain, numbness, tingling, or weakness that radiates along the nerve pathway into the shoulder, arm, or hand.
• Cervical Myelopathy: This is a more serious complication that occurs when the spinal cord itself is compressed. Symptoms may include difficulty walking, loss of coordination, weakness in the hands and legs, and even bladder or bowel dysfunction.
• Degenerative Disc Disease: Over time, cervical spondylosis can lead to degenerative changes in the intervertebral discs, causing them to lose height and hydration. This can contribute to further instability and compression of the spinal nerves, deformity or cord.

Prevention of cervical spondylosis primarily focuses on minimising factors that contribute to its development and progression. Here are some strategies that may help prevent or slow down the progression of cervical spondylosis:

• Maintain good posture: The individual should practise good posture while sitting, standing, and sleeping. They should invest in ergonomic chairs and keep their monitor at eye level to avoid neck strain.
• Strengthen neck muscles: Engage in regular neck exercises targeting both strength and flexibility to improve neck stability and support.
• Stay active: Regular exercise keeps joints healthy and promotes blood flow to the spine. Low-impact options like swimming or walking are recommended.
• Maintain a healthy weight: Excess weight puts stress on the spine, so losing weight, if necessary, can significantly reduce the individual's risk.
• Quit smoking: Smoking reduces blood flow to the discs, accelerating degeneration. Quitting smoking is crucial for overall spine health.
• Use proper lifting techniques: Always bend the knees and lift with the legs to avoid straining the neck during lifting tasks.
• Manage stress: Stress can exacerbate pain perception, so individuals should incorporate relaxation techniques like yoga or meditation into their routine.
• Get enough sleep: Adequate sleep is essential for healing and allows the body to repair itself effectively.

How does cervical spondylosis affect daily activities and quality of life?

Cervical spondylosis can limit neck movement, causing discomfort and affecting activities like driving or working. Quality of life may decline due to chronic pain and restricted mobility.

Are there any specific exercises or lifestyle modifications to manage cervical spondylosis symptoms?

Yes, exercises targeting neck muscle strength and joint flexibility, along with maintaining good posture and avoiding activities that strain the neck, can alleviate symptoms.

Can cervical spondylosis lead to other spine-related conditions or issues?

Yes, it may lead to conditions like cervical radiculopathy or myelopathy, causing symptoms such as arm numbness, weakness, or even coordination problems, paralysis. 

What are the potential long-term effects of cervical spondylosis, and how can they be mitigated?

Long-term effects may include chronic pain, nerve damage, or spinal cord compression. Regular exercise, proper posture, and medical intervention can help manage these effects.

Are there any alternative or complementary therapies that may be beneficial for cervical spondylosis management?

Yes, therapies such as acupuncture, chiropractic care, or massage therapy may offer relief from symptoms, though results can vary from person to person.

How does age impact the progression and management of cervical spondylosis?

Age-related degeneration contributes to cervical spondylosis progression. Management focuses on symptom relief, lifestyle adjustments, and sometimes surgical intervention for severe cases that affect daily living activities.

What role does posture play in the development and progression of cervical spondylosis, and how can it be optimised?

Poor posture can exacerbate cervical spondylosis by adding strain to the neck. Optimising posture through ergonomic adjustments and regular posture checks can help alleviate symptoms.

Are there any specific ergonomic considerations for individuals with cervical spondylosis in their workplace or home environment?

Yes, ergonomic considerations include using supportive chairs, adjusting computer monitor height, and avoiding prolonged positions that strain the neck.

Can cervical spondylosis be hereditary, and are there any genetic factors that may influence its development?

There may be genetic predispositions to cervical spondylosis, though environmental factors also play a significant role in its development.

How does weight management and overall physical fitness affect cervical spondylosis symptoms and progression?

Maintaining a healthy weight and engaging in regular exercise can reduce strain on the neck and spine, potentially alleviating symptoms and slowing down the progression of cervical spondylosis.

Is cervical spondylosis the same as spinal stenosis?

No, cervical spondylosis and spinal stenosis are not the same conditions. Cervical spondylosis involves degenerative changes in the neck vertebrae and discs, while spinal stenosis is a narrowing of the spinal canal, which can occur in various parts of the spine.

Reviewed By Dr. Abhishek Srivastava, Senior Consultant – Spine Surgery on 17 May 2024.