The inflammation of the cervical joints and the pain are the consequence of the anatomical alterations of the vertebral column . 
Neck arthrosis is a relatively common disease characterized by wear of the cervical joints over time.

It usually occurs in the elderly (over 60 years of age) and can cause various symptoms such as neck pain and stiffness .

The spine is composed of many bones, called vertebrae; each of the vertebrae has a large hole in the center. The vertebrae are located one above the other, so that the holes are aligned and form the vertebral canal. 
This channel provides protection and space for the spinal cord and for nerves that go from the brain to the rest of the body. Each vertebra connects with the upper and lower vertebrae through two types of joints:

  • The facet joints on both sides of the spine,
  • The central disk.

There are also small holes on each side of the spine, known as the intervertebral foramen. 
They are located between two adjacent vertebrae and allow the nerves to exit the vertebral canal. 
Over time, wear of the discs, joints and bones can cause degenerative changes in the spine. 
These degenerative changes may include disc height reduction, loss of joint cartilage, formation of bone spurs (osteophytes), and bone thickening.

This set of changes is known as cervical arthrosis. With the progression of arthrosis, the vertebral canal and the intervertebral foramen may diminish. The consequence is that bones can exert pressure on the spinal cord and nerves, which causes many symptoms.

 

What are the causes of cervical arthrosis?

Aging is the most important factor for the development of cervical spondylosis. In most people over 50, the discs between the vertebrae become less spongy and have difficulty supporting the weight and movements of the head. 
The bones and ligaments are thicker and invade the space of the spinal canal.

Another factor could be an anterior neck injury. People who exercise certain professions or sports, such as gymnasts or other athletes, may be more prone to stress in the neck.

poor posture can play an important role in the development of changes in the spine that lead to cervical spondylosis.

 

What are the symptoms of cervical arthrosis?

Cervical spine arthrosis may be asymptomatic for years, but a violent movement, trauma, or holding a wrong position may cause inflammation of the spinal joints. 
These symptoms can range from mild to severe.

The symptoms of cervical arthrosis can be: 
1. Neck pain : 
The discomfort can spread to the shoulders and the base of the skull. The movements of the neck can aggravate the pain. 
The pain may radiate along the arm to the hand and fingers . This phenomenon is caused by irritation of a nerve that goes from the spinal cord from the neck to the arm. 
The pain tends to come and go almost suddenly.

Severe pain may occur after an unusual movement of the neck, with a tear of a neck muscle or ligament. 
However, sudden pain can develop for no apparent reason. Some people have chronic (persistent) pain.

Humidity and change of atmospheric pressure (two days before rain or snow) increase the intensity of pain and stiffness.

2. Neck stiffness with severe limitation of all movements, especially in the morning for about half an hour.

3. Visual disturbances or tinnitus .

4. Cracks during movements.

5. Cervical arthrosis can cause headache . The headache often starts at the nape just above the neck and extends up to the top of the forehead.

6. There may be a pinched and pinched sensation in an arm or hand, in addition to tingling and weakness . These symptoms are caused by the compression of a spinal nerve between one vertebra and another. 
The symptoms of the nerves of the neck are typical of a discopathy that causes a strong pressure on a nerve. This disease is called cervical radiculopathy or cervicobrachial neuralgia  because it affects the brachial plexus (nerves of the neck).

7. More rarely, lack of touch, asthenia (weakness) of the legs or incontinenceoccur when a vertebra or disc presses the spinal cord. This problem is called ‘cervical myelopathy’. It is important to report these symptoms to a physician

Vertigo of cervical origin

The dizziness that originates in the neck represents a difficult diagnosis because there is no diagnostic test to confirm that the cervical arthrosis is the cause of dizziness. 
If the patient has neck pain and all illnesses that cause dizziness have been excluded, the doctor prescribes a treatment for the cervical spine.

This type of dizziness  worsens during the movements of the head or after maintaining a certain position for a long time. 
Vertigo usually begins after neck pain and may be accompanied by headaches. 
Often dizziness decreases when cervical pain is reduced. The symptoms usually last from a few minutes to a few hours and are not disabling.

The doctor should rule out labyrinthitis, which is another cause of dizziness, but is much more serious; in fact, the patient for a few days gets so bad that he can not get out of bed. 
Another possible cause is atherosclerosis , so it is necessary to perform color Doppler ultrasonography of the carotid arteries to exclude a circulatory origin. 
The treatment of this type of vertigo consists of the therapy for the cervical arthrosis, in particular the mckenzie exercises , the therapeutic massage and the correction of the posture.

 

Complications of cervical arthrosis

Radiography shows a loss of lordose cervical

Cervical Radiculopathy

Cervical radiculopathy means that the root of a nerve is compressed or damaged in the area where it leaves the spinal cord in the region of the neck (cervical).

Although there are other causes of radiculopathy, cervical arthrosis is a common cause. 
Degenerative changes of the joints between the vertebrae and the formation of osteophytes cause areas of shrinkage that may compress the nerve. 
Another cause is a prolapse of the disc (out of place). 
This damage is also called ‘ herniated disc ‘, although in reality the disc does not slip. What happens is that a part of the inner softest area of ​​the disc comes out (hernia) through a lesion on the outermost part of the disc. The disc presses the nerve that passes between two vertebrae.

In addition to neck pain, the symptoms of a radiculopathy include:

  • Loss of sensation (numbness),
  • Tingling ,
  • Pain,
  • Weakness in arm and hand innervated by nerve.

These symptoms may be worse than neck pain. 
Usually the symptoms are worse in one arm, but they can affect both arms. The pain may be severe enough to interfere with sleep. 
The lower cervical vertebrae (C4-C5-C6-C7) are those that can cause pain in the arm and hand. 
On the other hand, cervical arthrosis in the upper part of the neck (C1-C2-C3) can cause symptoms in the neck and head to the forehead.

The doctor may suspect the presence of a brachialgia based on the symptoms. Physical examination may detect a loss of sensation (paresthesia), force, and tendon reflexes in the arm area innervated by the affected nerve. 
The most indicated examination is the MRI that shows if the nerve roots are compressed.

The disc herniation (exit of the inner disc material) and arthrosis hardly occur together because at 55/60 the disc is dehydrated and therefore the substance of the central nucleus can not come out.

 

Mielopatia cervical

Osteophytes are bony beaks that form with arthrosis and can press the nerve causing severe pain. 
disc protrusion can push an osteophyte into the nerve causing the reduction of available space. 
It turns out that a surgery to remove the osteophytes does not solve the problem definitely given that it can return after a while; therefore, the surgeon should do a more extensive operation to release the nerve.

Myelopathy occurs when something presses on or damages the spinal cord. 
Cervical arthrosis is a possible cause of this disorder because degenerative changes in the joints may narrow the channel through which the spinal cord passes. The protrusion of a cervical disc can cause myelopathy if it occurs in the central hole of the vertebra.

Since the spinal cord consists of groups of nerve fibers that connect the brain to the rest of the body, the pressure on these nerves in the neck region can produce symptoms in almost the entire body.

Symptoms of cervical myelopathy may include:

  • Difficulties to stand. For example, the legs can be rigid and poorly coordinated.
  • Changes in hand sensitivity. For example, it becomes difficult to recognize the objects in the usual way and objects can fall out of the hands.
  • Bladder disorders. For example, a person may have trouble emptying his bladder or may have incontinence .

The doctor should monitor changes in tendon reflexes, strength and tenderness of the legs and arms. Useful instrumental exams are magnetic resonance imaging and electromyography (nerve conduction examination done by inserting needles into the skin). 
This shows if the spinal cord is being pinched and whether a surgical treatment to relieve the pressure may be helpful.

 

How is the diagnosis of cervical arthrosis diagnosed?

The doctor asks the patient’s symptoms and collects his / her medical history. You should then have a physical examination of the neck, spine, and shoulders. It is necessary to test the reflexes and the strength of the hands and arms. 
If pain is limited to the neck, the only recommended instrument examination is radiography(RX). 
The plates show the degenerative changes of the bones and any reduction of the space between the vertebrae. 
Only in case of symptoms that extend to the arms or hands, it is necessary to perform an MRI to see if there is nerve compression.

 

How to treat cervical artrose?

Treatments for cervical arthrosis are usually non-surgical. The most suitable medical specialist to treat this disorder is the orthopedic surgeon, but if the symptoms affect the hands or feet the most suitable is the neurosurgeon. 
The doctor usually prescribes one or a combination of the following treatments:

 

Natural remedies for cervical arthrosis

  • Rest, when the pain is strong,
  • Heat or ice. Ice is contraindicated in the neck; the cold can only slow the circulation and stiffen the muscles. 
    It is not true that ice is an excellent anti-inflammatory; in reality, it is just a vasoconstrictor (tightens the arteries) and is useful immediately after a trauma to cause less swelling. 
    After 24/48 hours of pain onset it is useless or even counterproductive because it slows down the healing process.
  • A warm compress is a therapy that helps relieve localized pain. 
    One of her grandmother’s remedies is silk scarf, which can also be used in summer to keep the neck warm. 
    There are necks that warm the neck because it is possible to introduce hot water into them.
  • Avoid air conditioning and wind currents because they can cause muscle contractures and stiffness.
  • Among natural remedies, arnica and devil’s claw are little effective natural anti-inflammatories because they do not penetrate deep enough.

 

Medicines

Non -steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (eg, Alivium), naproxen (Flanax), or selective COX-2 inhibitors (such as Celebra®) are helpful in relieving pain from inflammation that usually accompanies arthrosis . 
Topical anti-inflammatory creams, such as Voltaren, are less effective because they have a very shallow action and do not reach the joints.

The cortisone injections are made in order to reduce the inflammation that causes the pain. 
The doctor injects the steroids directly into the affected area. 
Muscle relaxants like Muscoril help decrease the painful muscle contractures in the neck and muscles around it, but many patients can not take them because they can cause bowel disorders.

 

Exercises for cervical arthrosis

The following exercises are prescribed for patients suffering from this neck disorder. 
The patient should talk to the physiotherapist to find out which of these exercises are appropriate for his or her case. 
Generally, they should be performed 3 times a day, but only if they do not cause an increase in symptoms.

 

Rotations of the neck
Beginning: sitting with the spine and neck straight, the shoulders should be slightly back. Rotate your head looking back past the shoulders, until you feel a slight or moderate elongation. Exercise only if you do not feel pain. 
Keep your neck straight. 
Repeat 10 times on both sides.

Retraction of chin
Start: sitting or standing with spine and neck straight, shoulders should be slightly back. Pull your chin back trying to create a “double chin” in front of the neck. 
Stop when you feel a slight or moderate stretch. 
Keep your eyes and nose facing forward. Hold for 2 seconds and repeat 10 times.

 

Lateral inclination of the neck

Start: sitting with spine and neck straight. Tilt your head toward your shoulder until you feel a slight stretch. You should not feel pain when performing this exercise. 
Repeat at least 10 times on both sides.

 

Physiotherapy and rehabilitation for cervical arthrosis

  • Vertebral tracts help control chronic symptoms or provide relief in the more severe episodes of arthrosis pain.
  • Physical therapy and neck strengthening exercises help maintain range of motion and prevent stiff neck .
  • Physical therapy is used to reduce inflammation and therefore pain. The most appropriate therapies are ECR and ultrasound because they penetrate deeply and manage to act in the joint. I personally believe that TECR  is the best therapy because it is most effective in absorbing the inflammatory fluid and further warming the neck. 
    Doctors still recommend Tens (Transcutaneous Electrical Nerve Stimulation), but this is a therapy that has only a temporary effect that goes away in 2 hours.
  • Osteopathy can give a great benefit to patients with cervical arthrosis because it serves to balance the entire body. It is a discipline that corrects the posture , unlocks and realigns the joints, relaxes the contracted muscles and also acts on the muscles of the internal organs.
  • Changes of activities performed, reduction of activities and positions that cause discomfort may be useful, for example by changing the posture in the bed, or the use of pillows or pillows.
  • Avoid using a rigid neck that does not solve the problem, but increases the stiffness of the joints.
  • Thermal treatments are a good natural remedy for arthritis. Many patients report feeling much better when they take mud baths.

 

Sport for cervical arthrosis

Freestyle swimming is certainly not one of the most suitable activities for cervical arthrosis because it requires performing full rotations that can cause pain. 
Backstroke is a more useful swimming style, but not everyone is able to do it because it is more difficult.

In addition, many seniors do not know how to swim or do not feel comfortable in the pool.

Body building is a very difficult sport and can cause tension in the neck, so it is best to avoid it.

Postural gymnastics in gym is a great way to reduce stiffness and pain caused by inflammation of the cervical joints.

 

When to operate?

Surgery is only necessary in rare cases, especially when there are symptoms of cervical stenosis (loss of strength and tenderness in the limbs). The purpose of surgery is to remove the source of pressure on the spinal cord and nerves. The surgery gives a stabilization of the cervical spine with implants or by the fusion of the vertebrae.

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