In cervical spondylosis, the cervical spine, which is the spine of the neck, and the intervertebral disc, which is the cartilage between the spines, are deformed with age, and osteochondral tissue called “osteophytes” increases and the neck hurts. In this condition, numbness, pain, or movement disorders in the upper limbs are called “cervical myelopathy”.(1)
What Are The First Symptoms Of Cervical Spondylosis?
Cervical spondylosis is a condition in which disc bulges, ligament thickening, and osteophyte formation occur due to age-related degeneration of the cervical disc, hook joint (Luschka joint), facet joint, etc. When the nerve roots and spinal cord are pressed and damaged, neurological symptoms occur. It is the most common disease in patients with numbness in hands. Symptomatic cervical spondylosis is more likely to develop after the age of 50, and it is often reported that the incidence in men is about twice that in women.
When the spinal cord flattens due to compression, pathological changes occur in the gray matter. The anterior horn first flattens, and when it becomes more advanced, it forms a cystic cavity in the ventrolateral part of the posterior chord from the central gray matter such as the anterior horn, intermediary, and dorsal horn.(2)
Clinical Symptoms Of Cervical Spondylosis
Radiculopathy: Radiculopathy often begins with radiculopathy in the cervical, shoulder, and upper extremities on one side. This nerve root pain is exacerbated by cervical spine movement and is induced by cervical spine flexion and lateral flexion. Subjective numbness is often present in the upper extremity. Objective sensory deficits are generally C 6 for the thumb, C 7 for the middle finger, and C 8 are often present in the little finger. In the presence of anterior root disorders, the muscle strength of the dominant muscle is reduced. There is diminished or absent tendon reflexes at the disability level, and other tendon reflexes are normal.
Myelopathy: It is not accompanied by nerve root pain and often develops with unilateral or bilateral upper limb numbness. Myelopathy may develop acutely or subacutely or slowly due to dynamic injuries such as minor trauma and inappropriate posture. Neuralgia- like pain in the cervical and scapular regions is often not accompanied, and even when complaining of pain, it is about “muscle stiffness”. As myelopathy progresses, spastic paralysis of the lower limbs, sensory deficits in the lower limbs of the trunk, and dysuria are observed.
It is called cervical spondylotic muscular atrophy, with the main symptoms being spinal cord dysfunction and muscular weakness in the upper limbs and muscle atrophy, with or without sensory dysfunction. In this case, differentiation from amyotrophic lateral sclerosis becomes a problem.
How Do You Test For Cervical Spondylosis?
High-Level Diagnosis Of Spinal Cord Disorders: For the diagnosis of cervical spondylosis, it is important to diagnose a high-level disorder based on the symptom of the spinal cord and/or radiculopathy and to judge whether or not the high level generally matches the spinal cord compression seen on the image. is there. The cervical vertebra and cervical spinal cord have a discrepancy of approximately 1.5 medullary segments, the C 5 medullary segment at the C 3/4 intervertebral, the C 6 medullary at the C 4/5 intervertebral, and the C 7 medullary at the C 5/6 intervertebral. Node, C 6/7 intervertebral C 8It roughly corresponds to the medullary segment. The nerve root runs about one vertebral body downward from the medullary segment and exits the spinal canal through the foramina. For example, C 5/6 in the intervertebral high, C as spinal clause symptom 7 symptoms of appeared, the nerve root symptoms C 6 may appear symptomatic.(3)(4)
Image Diagnosis: On plain cervical X-ray, it is necessary to confirm the overall alignment, narrowing of the intervertebral disc space, and the presence or absence of developmental spinal canal stenosis on a lateral view. If the anterior-posterior diameter of the spinal canal is 12 mm or less or the ratio of the anterior-posterior diameter of the vertebral body to the spinal canal (Torg-Pavlov ratio) is 75% or less at the intermediate level of the C 5 vertebral body, it is considered to be spinal canal stenosis. Instability is evaluated by taking images of the anterior and posterior positions in the lateral view. The oblique view evaluates osteophytes of the Luschka joint and disc stenosis due to the osseous proliferation of the facet joints.
Cervical MRI can evaluate the degree of spinal cord compression due to disc protrusion, bulging ligamentum flavum, and the presence of intramedullary hyperintensity on T 2 -weighted images.
Cerebrospinal Fluid Test: In cerebrospinal fluid, a mild to moderate increase in protein concentration is often seen depending on the degree of circulation disorder due to compression.
Electrophysiological Examination: Electromyography shows neurogenic changes in the muscles of the damaged medullary segment. When a wide range of denervation findings and neurogenic changes are observed, it is necessary to consider the possibility of motor neuron disease. A nerve conduction test of the upper limb is useful for distinguishing it from peripheral neuropathy.
Differential Diagnosis: It is necessary to make a differential diagnosis with all diseases that cause the motor and sensory deficits in the upper limbs. In particular, it is clinically important to distinguish from carpal tunnel syndrome, elbow tunnel syndrome, peripheral nerve disorders such as radial nerve palsy, amyotrophic lateral sclerosis that first appeared in the upper limbs, and cerebrovascular disorder.(5)(6)
- Ahmed SB, Qamar A, Imran M, Usmani A, Mehar Y, ul Haque S. Cervical Spondylosis; An Inevitable But Preventable Catastrophe. 2019.
- Li J, Jiang D-j, Wang X-w, Yuan W, Liang L, Wang Z-c. Mid-term outcomes of anterior cervical fusion for cervical spondylosis with sympathetic symptoms. Clinical spine surgery. 2016;29(6):255-260.
- Baron EM, Young WF. Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery. 2007;60(suppl_1):S1-35-S31-41.
- Wang H, Lyu F, Xiaosheng M, Xia X, Jiang J. Clinical diagnosis and surgical treatment of cervical spondylosis with proximal upper extremity amyotrophy. Chinese Journal of Orthopaedics. 2017;37(4):210-216.
- Haddas R, Lieberman I, Boah A, Arakal R, Belanger T, Ju KL. Functional balance testing in cervical spondylotic myelopathy patients. Spine. 2019;44(2):103-109.
- Kadaňka Z, Jura R, Bednarik J. Cervical vertigo in severe cervical spondylosis: frequent or over-diagnosed? 2019.
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