Transcript CERVICAL SPONDYLOSIS

= Arthritis of the neck
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Degenerative condition
Affects the vertebral bodies, the
intervertebral discs ,the facet joints and
eventually the contents of the spinal canal
Involves the degeneration of cartilage and the
formation of osteophytes (spurs)
Results in pain and stiffness
Worsens with age
Denegation that occurs
naturally with age
Occurs in the facet joints
and the intervertebral
discs
Discs lose water and
weaken
Movement
segment
Increase in mechanical stress at cartilage end
plates with an increase in pressure at the
facet joints
Cartilage therefore gets worn away and results
in bone on bone contact
Body response is the formation of
osteophytes=spurs
Supports the decaying vertebrae
Creates a narrow space for nerves to pass
Disc:
 Decreased elasticity of annulus fibrosis
 Loss of fluid in nucleus pulposes
Therefore unable to withstand compression
forces and bulges
decrease in disc
height
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Formation of osteophytes:
◦ Forms where tension is the greatest
◦ Forms at the edges of the vertebrae
Facet joints
 In closer contact due to decreased height of
the disc
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Stretching of the capsule due to inferior facet
moving down on the superior facet
Facet joints move into a position of extension
and therefore experience an increase of stress
during normal daily activities
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Vertebral body:
 Development of sclerosis= hardening of
tissue/structures
Intervertebral foramen:
 Decreased due to the formation of
osteophytes and loss of disc height
Spinous processes:
 Formation of a false joint due to the spinous
processes coming into contact with one
another
Normal versus abnormal cervical segments
Collapse of intervertebral disc and
joint space
Three stages occur during degeneration
1. Dysfunction
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Dysfunction of the trunk fascia, muscles ,
ligaments, capsule, neural structures and zjoints.
Results from mechanical stress , injuries and
overuse injuries
2. Instability
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Disc mal-alignment and degeneration due to a
loss of protection from these structures
Results in segmental stability
Stabilisation period
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This is the body's effort towards healing
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Age –especially above 60 years
Family history of neck pain
Overweight
Sports
Occupations involving excessive
neck motion/overhead working
Previous neck injury/trauma
Ruptured/slipped disk
Pathology of the cervical spine
Spur formation with narrowing of the
disc space
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Can develop
◦ Slowly
◦ Sudden onset
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Headaches
Neck stiffness
Weakness
◦ Difficulty with lifting arm
or squeezing hand
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Abnormal sensations
or numbness
◦ Shoulder/arms/legs
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Pain
◦ Mild
◦ Severe
Location: behind neck , m.trapezius, upper
arm, forearm and fingers
Aggravated by:
◦ Sudden movements
◦ Stretching at end range
Worse in the morning
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Loss of balance
Muscle spasms of neck
and shoulders
Grinding/popping
noise with movement
Reduced reflexes
Difficulty rotating head
in all directions
Conservative:
 Physiotherapy
◦ Strengthening of neck muscles
◦ Stretching
◦ Neck traction
◦ Posture therapy
◦ Ice/hot packs
◦ Care of the neck and
advice
◦ Passive mobilisations
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Medication
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NSAIDS (aspirin,ibuprofen)
Muscle relaxants
Steroid injections
Anti convulsants/antidepressants
Narcotics/opiods (not on a daily basis)
Soft collars NB ! Short term only!
◦ Limits neck motion
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Surgery (foraminotomy ,laminectomy , spinal
fusion)
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Uncommon
If conservative management fails
Only for severe pain
Neurological symptoms
Long lasting Cervical Radicular Pain Managed
With Surgery , Physiotherapy , or a Cervical
Collar: A Prospective ,Randomized Study .
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Compared the effect of surgery,
physiotherapy and a cervical collar on cervical
radicular pain as a result of cervical
spondylosis
Included 81 patients who have experienced
cervicobrachial pain for at least 3 months
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The pain must be a direct result from a root
compression with or without a bulging disc
Patients were randomly allocated to each
treatment method
It was concluded at the end of a 12 month
evaluation that either method was a
successful as the next
This implied that the condition is dominant in
its degeneration
Persson,L.C.,Carlsson,C.,Carlsson,J.1997.LongLasting Cervical Radicular Pain Managed With
Surgery ,Physiotherapy , or a Cervical Collar :
A Prospective ,Randomized Study . Sweden :
Lippincott , Williams & Wilkins.
Fox.M.L.2009.American Academy of
Orthopaedic Surgeons.
http://orthoinfo.acios.org/topic.cfm
Retrieved on 12 May 2012.
Vorvick,L.J .,Benjamin,C and
Zieve,D.2011.National Center for
Biotechnology Information:US National Library
of Medicine.
www.ncbi.nlm.nih.gov/pubmedhealth/PMH001
4721
Retrieved on 12 May 2012.
Barnes,R.2011.NEUROMUSCULAR-SKELETAL
REHABILITATION DICTATE.(Unpublished
dictate.) University of the Free State , Free
State.