What is Cervical Spondyloarthritis & How is it Treated?
The spinal canal is a bony tube made up of vertebrae, through which the spinal cord and the nerves pass. The neck region of the spine is called cervical spine which is made of seven vertebrae. There is a space between each vertebra called as intervertebral disc. It is a gel-like region, which acts as a cushion in between two vertebrae. The function of the disc is to prevent friction between the vertebrae and to allow movement of the spine. The nerve root branches from each vertebral level and forms the nerves of the arms. The cervical spine is also prone to degenerative disease. One such condition is cervical spondyloarthritis. Let us see the details of the condition in terms of symptoms, causes, diagnosis and treatment.
What is Cervical Spondyloarthritis?
Spondylosis is a form of arthritis of the spine. When it occurs in the neck region it is called as cervical spondyloarthritis or cervical spondylosis. It is also called as cervical osteoarthritis or neck arthritis.
Cervical spondyloarthritis is a type of degenerative disease that affects the joints and vertebrae of the neck. It is an age related condition where the vertebrae develop the small rough areas on the bone and the intervertebral discs become thin. It is equivalent to the "wrinkles" on the spine. Cervical spondyloarthritis results due to the wear and tear of the cartilage and bones in the neck region. In many people it does not cause any symptoms while in other cases it causes neck pain. Spondylosis might also lead to the compression of a nearby nerve root, which causes chronic and severe pain in the upper back and extremities.
It must be noted that both spondylosis and spondylitis mean arthritis of the spine, however there is a difference between both. Spondylosis means degeneration of the vertebrae and joints, while spondylitis means inflammation of the joints and vertebrae.
Symptoms of Cervical Spondyloarthritis
The initial development of cervical spondyloarthritis is not evident. When the degenerative process has already advanced, the pain, the limited mobility of the spine and morning sickness is slowly observed. The symptoms of cervical spondyloarthritis include:
- Pain in the neck that may travel to the arms or shoulders can be a symptom of cervical spondyloarthritis
- Stiffness in the neck which causes limited flexibility
- A grinding feeling during neck movement can also be a symptom of cervical spondyloarthritis
- Weakness, tingling, and numbness in extremities
- Difficulty walking
- Pain and numbness due to nerve pressure in arms
- Weakness in the arms and legs
- Trouble keeping proper balance.
In later stages, when degeneration has reached the maximum level, it causes trouble controlling the bladder or bowels and is called as cervical myelopathy. It must be noted that all the symptoms do not develop at once but occur gradually.
Prevalence Rate of Cervical Spondyloarthritis
Cervical spondyloarthritis is a normal part of the ageing process. The condition is prevalent in 85% of the individuals above 60 years. Although due to the modern lifestyle, cervical spondyloarthritis is becoming common in an early age of 40 years or even before.
Prognosis of Cervical Spondyloarthritis
Most patients with cervical spondyloarthritis, when treated surgically or non-surgically, get relief from the discomfort. The effectiveness of treatment method depends on the severity of the condition. Patients with severely damaged nerves and degenerative diseases continue to experience the numbness and pain, even after surgery.
Causes and Risk Factors of Cervical Spondyloarthritis
The following are the causes of cervical spondyloarthritis:
- Increased age
- Neck injuries
- Occupational or work related activities, puts extra strain on the cervical spine region
- Lack of physical activity
- Genetic factor such as a family history
- Being overweight.
Pathophysiology of Cervical Spondyloarthritis
Arthritis is a term used to describe pathological changes of the joints and their associated structures such as bones, cartilage and ligaments. When arthritis is caused without involvement of immune system, it is called as non-inflammatory arthritis. Spine arthritis is a degenerative process mainly associated with aging. The neck (cervical) and lower back (lumbar) region are affected in most of the cases sue to osteoarthritis.
Till the old age, there are lots of wear and tear of the spine and dehydration; as a result the intervertebral discs lose its elasticity. The vertebrae develop rough areas and the discs become thin. Due to which the spine in the neck region loses its stability and shows first symptoms of pain and later reduction in flexibility of movement of neck. If this condition is not treated then it progresses to cervical stenosis and later into cervical myelopathy.
Complications of Cervical Spondyloarthritis
Rarely, untreated cases of severe cervical spondylosis may progress and cause the permanent damage in the form of cervical myelopathy which involves:
- Balancing problems
Diagnosis of Cervical Spondyloarthritis
The doctor records the complete history and performs physical examination. It is followed with questions regarding the symptoms and how it affects the daily life. There is a physical examination of the back, neck, movements, skin sensation, and muscle strength.
To detect exact cause of pain, the doctor recommends a number of tests which includes:
- Imaging Tests to Diagnose Cervical Spondyloarthritis: The first step is the X-Ray of the neck region to know the reason of neck pain. The use of advanced imaging tests such as MRI and CT scan gives a three dimensional image which provides better structural information. These scans allow checking of the soft tissues such as nerves, disc and muscles around the neck and spinal cord.
- Myelography for Diagnosing Cervical Spondyloarthritis: During this test, the doctor injects a dye into the fluid around the spinal cord and performs CT scan to check for the bone spurs and discs interacting with individual nerves.
- Nerve Conduction Tests to Diagnose Cervical Spondyloarthritis: These include electromyography test and somatosensory evoked potential (SSEP) tests which shows how well the nerves are passing along signals from spinal cord to the muscles.
How is Cervical Spondyloarthritis Treated?
The non-surgical treatment for cervical spondyloarthritis is given when the symptoms are mild and surgical treatment is given when the symptoms are severe.
- Non-Surgical Treatment for Cervical Spondyloarthritis: It is also called as the conservative management for cervical spondyloarthritis patients with no neurologic symptoms and is given to provide relief from pain.
- Patient is educated about the history of cervical spondyloarthritis and self-care options and coping techniques are taught.
- Pain relievers such as ibuprofen or aspirin and muscle relaxants are advised.
- Exercises such as stretching and strengthening may ease the symptoms of cervical spondyloarthritis.
- Wearing of soft collar around neck helps in relieving of the pain and other symptoms associated with cervical spondyloarthritis.
- Cold and heat pack may provide relief.
- The pain relievers can be injected into the neck or the space in the spinal canal.
- Surgical Treatment for Cervical Spondyloarthritis: Surgery is indicated for patients with progressive nerve symptoms and compression of the spinal cord or else it is not recommended. The surgeon may perform surgery such as Laminectomy (to remove the bone to relieve pressure) or perform fusion of two or more bones in the spine.
Exercises for Cervical Spondyloarthritis
The doctor recommends that one should maintain the daily activity instead of inactiveness or rest. Hence, neck exercise, stretching, and muscle strengthening are advised.
- Physical therapy including mechanical traction and manipulation is advised for cervical spondyloarthritis.
- A good posture may be very helpful while working. Sitting upright, Yoga, Pilates and Alexander technique improve neck posture.
- A firm supporting pillow may help during sleeping.
Prevention of Cervical Spondyloarthritis
One cannot prevent cervical spondyloarthritis; however, the following steps may be helpful in preventing progression of the condition:
- Being physically active
- Using good posture
- Prevent excessive neck stretching while exercising or playing sports.
- Avoiding trauma to the neck.
Lifestyle and Coping with Cervical Spondyloarthritis
Patients with mild symptoms follow non-surgical treatment for three to six months. Some have to wear the collar brace for three months. After surgery, the patient has to stay in the hospital for few days and follow exercises as advised by the physical therapist, which do not put extra strain on the neck.
Cervical spondyloarthritis is a progressive disease and most of its symptoms are seen in the old age. It is mainly caused due to the wear and tear of the spinal canal in the neck region. If not treated, it may turn dangerous and result into myelopathy. Surgical treatments are considered to be effective in severe cases of cervical spondyloarthritis. When patient starts feeling better, they can perform their previous activities. However, they need to modify their activities to avoid problems in future.