Cervical Spondylosis Without Myelopathy, What Are My Options?

Cervical spondylosis without myelopathy is a degenerative condition of the cervical spine that can often be treated without surgery. In some cases, patients who have exhausted conservative management may benefit from surgery.

What is Cervical Spondylosis Without Myelopathy

Cervical spondylosis without myelopathy is a condition where wear and tear accumulate in your neck, without putting pressure on the spinal cord.

The spine is a column of bones called vertebrae, which support your body. In between the vertebrae are spongy tissues called discs. The discs act to cushion your spine. There are also joints in the back of your neck called facet joints. The discs and joints bend and flex to provide motion to your spine.

Nearly all Americans will experience neck pain at some point in their lives.

As we get older, we accumulate wear and tear on our bodies, which leads to degeneration, or breaking down, of those discs. This can eventually cause them to bulge or herniate. It can also lead to bone spurs around the joints of the spine.

The Intervertebral disc is a layer of cartilage that separates the adjacent vertebrae in the spine. There are various medical conditions that can make someone more prone to developing degenerative disc disease. This condition is called cervical spondylosis. This accumulation of wear and tear can cause pain and stiffness in the neck as well as a loss of range of motion. Your lumbar spine, or lower back, can also manifest similar changes leading to pain and dysfunction.

What is Cervical Spondylosis?

Cervical spondylosis can lead to severe neck pain. It can also lead to compression of the spinal cord and nerve roots that run within your spinal canal.

The spinal cord runs down a channel in your neck called the spinal canal. The spinal cord and nerve roots are located behind your discs. When a disc bulges or herniates, it can press backward causing narrowing of the spinal canal. This condition is known as spinal stenosis.

In severe cases, spinal stenosis can lead to spinal cord compression. This can result in radiating arm pain, numbness, and tingling in the arms, as well as clumsiness in the hands and feet. Compression of the spinal cord with these resulting symptoms is called cervical myelopathy. This condition can be serious and lead to progressive neurologic damage and is often treated surgically to remove the pressure on the spinal cord and nerves.

How Do We Treat Cervical Spondylosis Without Myelopathy?

Cases of cervical spondylosis without myelopathy or nerve compression are generally less serious and can often be treated without surgery.

Treatment options that do not involve surgery include anti-inflammatory medications and physical therapy. Alternative medicine options such as chiropractic care, acupuncture, and massage therapy can also be helpful. Some patients also benefit from injections administered by an interventional pain management specialist. A combination of these treatments can often successfully relieve pain and get patients back to their active function.

Do You Need This Condition Further Explained?

In some refractory cases where a patient does not respond to an extensive course of conservative management, surgery can be successful at relieving pain.

In some cases, removing the collapsed and painful disc and replacing it with a cage (spinal fusion) or an implant (disc replacement) can be very effective at relieving pain and restoring function.

Are you suffering from cervical spondylosis without myelopathy? Call for an appointment at, 551-284-3265, with one of our spine specialists today. We are looking forward to hearing your story, and providing you with all of the necessary information for a great patient experience.

Lumbar and Cervical Spondylosis: Symptoms & Treatments

Spondylosis is a nearly universal condition in those who reach advanced age, but it can also affect younger people. While some people experience no symptoms, others may feel stiffness and/or pain in the neck, shoulders or between the shoulder blades.

• What is spondylosis?
• What are the symptoms?




• Are some people more susceptible?
• How is it diagnosed?
• What type of doctor treats it?
• How is it treated?
• What is the surgery for it?

What is spondylosis?

Spondylosis is another word for osteoarthritis of the spine, a condition that usually develops with age, and is the result of normal “wear and tear” on both the soft structures and bones that make up the spine.

Although any part of the spine may be affected, spondylosis is more frequently seen in the spine’s highest and lowest sections – the cervical (neck) and lumbar (low back) areas, respectively. The condition is less commonly found in the thoracic spine (middle portion), possibly because the rib cage serves to stabilize this area and make it less subject to the effects of wear and tear over time.

Illustration of cross-section of spine, dorsal (back to front) and lateral (side) views, showing its vertebral sections.

What are the symptoms of spondylosis?

People with spondylosis experience may or may not experience pain or, indeed, any symptoms at all. Those who have no symptoms may become aware of the condition only when they are being assessed for another medical issue that calls for imaging of the spine with an X-ray, MRI, or CT scan. When symptoms are present, they vary depending on the area where the condition develops and the structures that are affected, but they can include pain or limited range of motion.

Individuals with spondylosis who are otherwise without pain may experience crepitus, a feeling or sound of crunching in the spine, along with a limited range of motion. This usually is not concerning for nerve or spinal cord damage.

What are the symptoms of cervical spondylosis?

Neck pain and/or stiffness are common symptoms. In cases where spondylotic changes to the spine put pressure on adjacent nerves, patients may experience pain, numbness or tingling that extends down the arm, with or without symptoms in the neck itself. This type of nerve pain, which results from compression or inflammation of the nerve the cervical spine is known as cervical radiculopathy. Severe cases may also cause compression the spinal cord which may manifest as weakness or impaired motor function in the arms or hands, or other symptoms in a condition called cervical myelopathy.

What are the symptoms of lumbar spondylosis?

Low back pain, leg pain and/or other signs of nerve compression are the most common symptoms. Pain or tingling symptoms that extend outward to the hip or down the leg can result from compression or inflammation of nerves, a condition referred to as lumbar radiculopathy. For example, a person may have pain in their knee and think it is injured, but later learn that this pain is caused by spondylosis that is compressing a nerve which extends down to the knee. Irritation of the sciatic nerve in particular, is quite common, and is commonly known as sciatica.

Is spondylosis serious?

Because spondylosis can affect people in many different ways, there is no single answer to this question. Many cases of spondylosis are effectively treated with physical therapy and pain relief measures. However, orthopedists advise seeking more immediate care if the following symptoms, which are associated with pressure on the nerves, are present:

• weakness, including foot drop (difficulty lifting the toes and forefoot off the floor)
• bladder or bowel dysfunction, especially incontinence
• changes in balance that cannot be attributed to other factors
• numbness either in a stripe-like pattern or involving the fingers
• severe pain, especially electrical or shock like pain
• pain in the arms and/or legs that has not responded after attempting other nonsurgical measures like physical therapy, oral pain medications and/or injections

Are some people more likely to develop spondylosis than others?

Spondylosis is likely to affect most people to some degree as they age, as it is the natural result of years of the spine being subject to the forces of gravity. There may be a genetic component (an inherited tendency) to develop the condition, but research has not clearly established this link.

An association between traumatic injury to the spine and the development of spondylosis later in life has been established.

How is spondylosis different from spondylolisthesis?

Although the names sound similar, spondylolisthesis is a condition in which one of the vertebrae (the bones that make up the spine) has moved out of place – usually in a forward direction. While this is a distinct diagnosis, spondylolisthesis may occur as a result of spondylosis, which can cause other structures of the spine move out of their normal position.

Other conditions that may result from spondylosis include:

• spinal stenosis – a narrowing of the spinal canal
• degenerative scoliosis – a sideways curvature of the spine due to osteoarthritis
• degenerative disc disease – wear and tear of the disc space

How is spondylosis diagnosed?

A diagnosis of spondylosis is based primarily on information seen on images of the spine: Changes to the bones are most clearly seen on X-ray, while changes to the soft structures – including the disks that act as cushions between the vertebrae – are more clearly seen on MRI or CT scans.

Abnormalities that may be detected include bone spurs, which are small growths of extra bone, or bulging or herniated discs. Both of these findings can cause narrowing in the spinal canal and put pressure on adjacent nerves. It’s important to note that wear and tear on the spine may show up on imaging tests, without the individual experiencing any pain or discomfort.

To better understand the impact spondylosis may be having on a patient, the orthopedist may order X-rays to look at the skeleton in motion, for example when the spine and neck bend backward or forward.

What type of doctor treats spondylosis?

People should first consult their primary care physician for back and neck pain. For persistent pain or symptoms associated with pressure on the nerves, such as weakness, are best assessed by a physician who specializes in musculoskeletal medicine, such as a physiatrist (a doctor who practices physical and rehabilitative medicine), a pain management doctor or a spine surgeon.

Once a diagnosis has been made, the type of physician who may best treat a patient’s symptoms depends on individual case. For many people, a physiatrist and physical therapist can treat people nonsurgically. In cases where spondylosis-related anatomic changes require removal or release of tissue, a spine surgeon will become involved. In some cases, a physiatrist or spine surgeon may also refer the patient to see a neurologist for additional care. (Find a doctor at HSS who treats spondylosis.)

How is spondylosis treated?

Treatment for spondylosis depends on the specific set of symptoms and findings that a patient is found to have and the area of the spine that is affected. Initial measures almost always include physical therapy to strengthen the muscles that support the spine and, in some cases, epidural injections to reduce inflammation and pain. Short courses of oral pain medication, like anti-inflammatories, may also be prescribed.

Although non-operative treatment won’t change the structural effects of spondylosis – the wear and tear on tissues and the pressure on the nerves – it can provide relief while the nerve adapts to these changes in the spine anatomy. In many cases, this allows the symptoms to decrease without surgery.

What is the surgery for spondylosis?

If a person continues to have pain and debility from spondylosis after conservative measures are tried, surgical treatment may be recommended. The specific procedure needed depends on the abnormalities present in the spine, but it will generally involve addressing the area of the spine that is pressing on a nerve.

Some examples of minimally invasive surgical treatment for spondylosis include:

• removal of a bone spur in cervical spondylosis
• placement of spacers to recreate space lost by disc wear, allowing nerves to be free of compression
• removal of soft tissues that can become thickened in spondylosis that press on nerves

In some cases, a patient with spondylosis will require more extensive surgery to remove more a portion of the spine that is causing pain, and a fusion of the vertebrae, a surgery that stabilizes the bone.  Anterior cervical discectomy with fusion (ACDF surgery) is one such procedure in the neck. For low back pain or other problems associated with lumbar spondylosis, a lumbar laminectomy, with or without fusion, or various other types of lumbar fusion surgery may be appropriate.

What is the recovery time for spondylosis surgery?

Recovery time varies depending on the nature of the surgery, with minimally invasive procedures permitting a more rapid return to daily activities. Many patients will complete a course of physical therapy beginning at six weeks after their operation. Keeping the supporting muscles flexible and strong and maintaining a healthy weight are the best way to prevent further problems in the spine.

Patients are also advised to assess and adjust ergonomic conditions that may have exacerbated their pain, for example raising a computer monitor to eye level to eliminate the tendency to hunch forward while doing office work.

Are there any dietary supplements that can help treat or prevent spondylosis?

There is no evidence at this time that any particular diet or supplement will help with spondylosis. It’s always a good idea to follow a healthy diet and to use supplements with caution, as these products are not regulated by the US Food and Drug Administration (FDA).

Updated: 4/17/2023

Authors

Sariah Khormaee, MD, PhD

Assistant Attending Orthopedic Surgeon, Hospital for Special Surgery
Assistant Professor of Orthopedic Surgery, Weill Cornell Medical College

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Treatment of spondylosis of the cervical spine in Moscow at the Dikul clinic: prices, appointments

Cervical spondylosis is a common degenerative disease of the cervical spine. It is believed that the development of spondylosis is associated with age-related changes in the intervertebral discs. Several syndromes are observed clinically. These include: neck and shoulder pain, suboccipital and headache pain, radicular symptoms, and cervical spondylogenic myelopathy. As the disc degenerates, mechanical stresses increase and osteophytes form along the ventral part of the spinal canal.

Often associated with spondylosis are degenerative changes in the facet joints, hypertrophy of the ligamentum flavum and ossification of the posterior longitudinal ligament. All this can contribute to damage to pain-sensitive structures (eg, nerves, spinal cord), which creates various clinical syndromes. Spondylotic changes are often observed in people of the older age group. However, only a small percentage of patients with radiographic evidence of cervical spondylosis are symptomatic.

Treatment of cervical spondylosis is usually conservative; the most commonly used treatments are non-steroidal anti-inflammatory drugs (NSAIDs), physical modalities, and lifestyle modifications. Sometimes surgical treatment is performed.

Surgery is recommended for cervical radiculopathy with persistent symptoms and failure of conservative treatment.

The indications for surgical treatment of cervical spondylogenic myelopathy are somewhat controversial, but most clinicians recommend surgery for moderate to severe myelopathy.

Epidemiology

Cervical spondylogenic myelopathy is the most common cause of non-traumatic spastic paraparesis and quadriparesis. Almost 23.6% of patients with non-traumatic myelopathic symptoms had cervical spondylogenic myelopathy.

Cervical spondylosis is more common in men.

The results of studies using radiographic data showed that spondylosis changes are most common in people over 40 years of age. After all, more than 70% of men and women have spondylosis in adulthood, but radiographic changes are more pronounced in men than in women.

Causes of cervical spondylosis

The bones and cartilage in the neck are prone to wear and tear, which can lead to the development of cervical spondylosis. The most likely causes of the development of the condition:

• Bone spikes (osteophytes)

These bone growths are the result of the body trying to increase the amount of bone tissue in response to increased stress in order to strengthen the spine. However, additional bone formations can put pressure on the nerve structures with the formation of pain manifestations.

• Disc degeneration

Between the spinal bones are discs, which are thick pads that absorb force vectors from lifting, twisting, and other activities. The material inside these discs can dry out over time. This leads to the fact that the bony surfaces of the vertebrae begin to touch when moving, which can become a source of pain. According to the Mayo Clinic, the process of degeneration typically begins around the age of 40.

• Herniated disc

Intervertebral discs may develop cracks, allowing the shock-absorbing material of the disc to leak out. Bulging discs can have a compressive effect on the roots or spinal cord with the development of certain neurological symptoms (pain, sensory disturbances, muscle weakness).

• Trauma

If the patient had a neck injury, such as a whiplash injury during an accident, this accelerates the degenerative processes.

• Bundle seal

The tight ligaments that connect the spinal bones to each other can become even more rigid over time, which affects the mobility of the movement segments of the neck.

• Overload

Some occupations or hobbies involve repetitive movements or heavy lifting.

Risk factors

The greatest risk factor for developing cervical spondylosis is aging. Cervical spondylosis is usually associated with involutional changes in the joints of the neck. Disc herniation, degeneration and bone growths (osteophytes) – all this is associated with involutional changes in the body.

Other risk factors:

• neck injuries
• heavy lifting work that puts extra strain on the neck
• holding the neck in an uncomfortable position for a long time or repeating the same neck movements throughout the day
• genetic determinism
• smoking
• overweight and inactivity

Cervical spondylosis symptoms

Most people with cervical spondylosis may not have significant symptoms. If symptoms do occur, they can be variable (mild or severe), acute or chronic.

A common symptom is pain around the shoulder blade. Some complain of pain in the course of the hand and fingers. Pain may increase:

• when standing
• seated
• when sneezing
• when coughing
• neck extension

Another common symptom is muscle weakness. Muscle weakness makes it difficult to raise arms or grasp objects.

Other common symptoms include:

• stiffness that gradually increases
• headaches most often occurring in the back of the head
• sensory disturbances in the upper or lower limbs

Symptoms, which are less common, often include incoordination and loss of bladder or bowel control. These symptoms require emergency medical attention.

When should I see a doctor?

If a person suddenly develops numbness or tingling in the shoulder, arms or legs, or if the patient has lost bowel or bladder control, seek medical attention as soon as possible!

If discomfort and pain begin to interfere with daily activities, then a consultation with a neurologist is necessary. Despite the fact that spondylosis is part of the involutional changes, nevertheless, there are various methods of treatment that can improve well-being and reduce symptoms.

Diagnosis

The diagnosis of cervical spondylosis requires differential diagnosis from other conditions with similar symptoms. Diagnosis of the disease is based on physical examination data, imaging findings and neurophysiological studies.

Physical examination

First, the doctor finds out the presence of symptoms, their intensity, location, history of the disease. A neurological examination is then performed, which includes examining reflexes, testing muscle strength, determining sensory deficits and determining range of motion in the neck. Your doctor may do a walking test to determine how much damage your spinal cord has.

If the doctor suspects cervical spondylosis, he will order imaging tests and neurophysiological studies to verify the diagnosis.

Imaging

• Radiography can be used to visualize bone spurs and other abnormalities.
• CT can provide more detailed images of the neck.
• An MRI scan that creates images using radio waves and a magnetic field helps the doctor detect compression of nerve structures.
• Myelogram – this procedure uses the injection of contrast in certain areas of the spine. A CT scan or X-ray is then used to obtain more detailed images of these areas.
• EMG (ENMG) is used to check the functionality of nerve fibers, the method checks the electrical activity of the nerves and the conduction of impulses to the muscles.
• ENMG determines the speed and strength of the signals that the nerve sends. This allows you to determine the presence and level of damage to nerve fibers.

Treatment of Cervical Spondylosis

Treatment of cervical spondylosis aims to reduce pain, reduce the risk of permanent damage and restore the patient’s normal lifestyle. Non-surgical methods are usually very effective and avoid surgery.

Treatments for cervical spondylosis include neck immobilization, pharmacological treatment, lifestyle modifications, and physical modalities (eg, traction, manipulation, exercise).

• neck immobilization (using a soft collar or rigid brace) is often used as a non-surgical treatment for neck pain and/or suboccipital pain syndromes caused by spondylosis and cervical radiculopathy.

As symptoms improve, the collar should only be worn during strenuous work. In the end, you can stop wearing the collar.

Stiffer orthoses and devices may better restrict movement of the cervical spine, but they may decrease muscle tone and cause neck stiffness. The use of a daily neck exercise program can limit the loss of muscle tone.

Pharmacological treatment includes several options.

• NSAIDs are the mainstay of pharmacological treatment. They are effective in reducing the biological effects of inflammation and pain. Their use should be monitored for adverse effects such as gastropathy, renal toxicity, hypertension, liver damage and bleeding. Selective cyclooxygenase-2 (COX-2) inhibitors such as celecoxib may reduce the risk of gastrointestinal toxicity, but they increase the risk of cardiovascular events.
• Antidepressants. These drugs are indicated in the presence of chronic pain syndromes
• Muscle relaxants such as carisoprodol and cyclobenzaprine may also be effective in patients with neck spasm.
• Opioids – These drugs may be given to patients with severe pain. In addition, for elderly patients with contraindications to the use of NSAIDs, opioids may be a reasonable alternative, but given the development of dependence, they must be used with caution.
• Steroids. The use of steroids is controversial. In some patients with severe radiculopathy, oral steroids can rapidly relieve pain and symptoms. Steroids may also be beneficial in patients with progressive cervical spondylogenic myelopathy. Epidural steroid injections may help patients with radicular symptoms.
• Preparations for the treatment of neuropathic pain. Drugs such as gabapentin can be quite effective for chronic pain associated with cervical spondylosis.

• Lifestyle modifications (eg, body mechanics training, relaxation techniques, posture awareness, ergonomics, and/or workplace changes) may relieve symptoms.

Physical therapy is one of the oldest methods of treatment for diseases of the spine.

• Traction therapy. M Mechanical stretching of the neck with the help of specialized equipment allows you to increase the distance between the vertebrae, reduce root compression and improve circulation in the epidural space.

• Manual therapy. Manipulations used by chiropractors and osteopaths have been described 4000 years ago. This method remains a popular treatment for back pain.

Techniques vary and include low-speed, high-amplitude manipulations; high-speed, low-amplitude manipulations (eg, jolts or impulse manipulations) and maneuvers.

Contraindications for manual therapy are: vertebral fractures, dislocations, infections, malignant tumors, spondylolisthesis, myelopathy, various rheumatological and connective tissue disorders and the presence of objective signs of nerve root compression.

• Exercise therapy. Exercises that are used to treat neck pain include isometric exercises to strengthen the neck, stretching and flexibility of the neck and shoulders, physical activity to strengthen the back, and aerobic exercises.

Other commonly used treatments include heat, cold, acupuncture, massage, trigger point injections, transcutaneous electrical nerve stimulation, and low-intensity cold laser. Most of the passive modalities used to treat osteochondrosis of the cervical spine are performed by physiotherapists and exercise therapy doctors and are most effective in combination with other treatment methods.

surgical>

If there are severe symptoms that are resistant to current conservative treatments, surgery may be required. Surgical procedures include the removal of bone spikes (osteophytes), parts of the bones of the vertebrae, or a herniated disc in order to eliminate the mechanical effect of these formations on the nerve structures.

Surgery for cervical spondylosis is rarely required. However, a doctor may recommend surgery if there is severe pain and movement problems.

Cervical spondylosis – symptoms, causes, treatment

This disease is treated by a neurologist.

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Spondylosis deformans of the cervical spine is most often associated with the natural aging process. Signs of degenerative changes in this area are more often found in women and men over 60 years of age. The symptoms are variable. Treatment is predominantly conservative, progressive neurological deficit involves surgery. Neurologists and vertebrologists also call the described pathology “osteoarthritis”; spondylitis of the cervical spine is another disease of an inflammatory, but not destructive, dystrophic nature.

CMRT specialist tells

Kuchenkov A.V.

Orthopedist • Traumatologist • Surgeon • Phlebologist • Sports doctor • 24 years of experience

Publication date: May 17, 2021

Verification date: January 10, 2023

All facts have been verified by a doctor.

Contents of the article

Causes of cervical spondylosis

Symptoms of cervical spondylosis

Clinical manifestations may be absent for a long time.

Neck pain may indicate direct nerve compression, degeneration of the vertebral disc, joint, ligaments, segmental instability of the spinal motion segment. Discomfort sensations are local in nature and radiate to the back of the head, shoulder, shoulder blade, upper limb. Pain may increase with certain positions, interfere with sleep.

Spondylosis of the cervical vertebrae less often leads to loss of sensation in the hands like gloves. If osteophytic spurs are large, the patient complains of dysphagia – a violation of the act of swallowing. Some people suffer from manifestations of vertebrobasilar insufficiency – dizziness, headaches, unstable blood pressure. Cervical radiculopathy, manifested by backache, hyperesthesia, weakness of adjacent muscles, is a suspicion of an acute herniated disc.

Stages of development of the disease

Metabolic processes are disturbed against the background of natural aging of the body. Due to the loss of moisture, the intervertebral discs and ligamentous apparatus, which act as shock absorbers, lose their elasticity. Such changes initiate the biomechanical incompetence of the joint, which leads to further destruction of the disc and protrusion of the annulus fibrosus outward.

Growth of bone elements (osteophytes), first on the anterior longitudinal ligament, and then on the lateral surfaces of the vertebrae, reduce the diameter of the spinal canal, sometimes with compression of the spinal cord and roots. In the advanced stage, degeneration of the articular surfaces and ligaments reduces joint mobility and acts as a limiting mechanism against further destruction. Thickening and ossification of the posterior longitudinal ligament also reduces the diameter of the bony canal and contributes to myelopathy.

How to diagnose

Physical examination and special tests are performed by a neurologist to determine a preliminary diagnosis.