Cervical osteoarthritis (or cervical spondylosis) is the chronic degeneration of the joints and intervertebral discs located between the cervical vertebrae.
Inflammation of the cervical joints and pain are consequences of anatomical changes in the spine.
Arthrosis of the neck is a relatively common disease characterized by cervical joint wear over time.
This is usually seen in the elderly (over 60 years of age) and it can cause various symptoms such as pain and neck stiffening.
The spine is composed of many bones, so-called vertebrae, each of which has a large opening in the center. The vertebrae are arranged one above the other, so that the openings lie on top of each other and form the spinal canal.
This channel gives protection and space to the spinal cord and nerves that run from the brain to the body. Each vertebra connects to the vertebra above and below it through two types of joints:
- the facet joints on both sides of the spine,
- the central discus.
There are also small openings on both sides of the spine, known as foramina intervertebralia (intervertebral holes). They are formed by two adjacent vertebrae and allow the nerves to exit the spinal canal.
Over time, wear and tear on the intervertebral discs, joints and bones can cause degenerative changes to the spine.
These degenerative changes can include a reduction in the height of the intervertebral discs, a loss of articular cartilage, the formation of bone ridges (osteophytes) and a compaction of the bones.
This series of changes is known as cervical osteoarthritis. As osteoarthritis progresses, the spinal canal and intervertebral holes may narrow. The result is that pressure is exerted on the spinal cord and nerves, which leads to many symptoms.
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What are the causes of cervical arthrosis?
Aging is the main factor in the development of cervical spondylosis. In most people over the age of 50, the intervertebral discs between the vertebrae become less spongy and have difficulty supporting the weight and movements of the head.
Bones and ligaments become thicker and thicker, narrowing the space of the spinal canal.
Another factor could be a previous injury to the neck. In people with certain activities or sports, such as gymnastics or other athletics, the neck may be exposed to particular stress.
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 spondylosis?
Osteoarthritis of the cervical spine can be asymptomatic for years, but vigorous movement, trauma or an inconvenient position can lead to inflammation of the vertebral joints.
When symptoms occur, they can range from mild to severe.
Possible symptoms of cervical osteoarthritis:
- Neck. The discomfort can spread to the shoulders and the base of the skull. Neck movements can increase the pain.
The pain can radiate along the arm to the hand and fingers. This phenomenon is caused by the irritation of a nerve that runs from the cervical marrow to the arm.
The pain tends to go and come suddenly.
After an unusual neck movement, you may feel severe pain, with strain of the neck muscles or a ligament.
Also, a sudden flaming pain may occur for no reason. Some people have chronic (persistent) pain.
With humidity and atmospheric pressure fluctuations (e.g. two days before rain or snow), the intensity of pain and stiffening increases. - Neck stiffening with severe restriction of all movements, especially in the morning for about half an hour.
- Visual disturbances and tinnitus.
- Crunching and crepitation during movements.
- Cervical osteoarthritis can cause headaches. Headaches often start in the neck and just above the neck and spread to the upper forehead.
- There may be a feeling of pinpricks in one arm or hand, as well as tingling and weakness. These symptoms are caused by pressure on a spinal nerve between two vertebrae.
The symptoms of the cervical nerves are typical of discopathy, which exerts strong pressure on a nerve. These complaints are called cervical radiculopathy or cervicobrachialgia because they affect the brachial nerve plexus (nerves of the neck). - Less common are lack of tactile sensation, asthenia (weakness) of the legs or incontinence, which occurs when a vertebra or disc presses on the spinal cord. These complaints are called “cervical myelopathy”. It is important to report these symptoms to a doctor immediately.
Dizziness of cervical origin
If dizziness has its origin in the neck, it results in a difficult diagnosis, because there are no diagnostic tests that confirm that cervical arthrosis is the cause of dizziness. If the patient has neck pain and all diseases that can provoke dizziness are excluded, the doctor prescribes therapy for the spine.
This type of dizziness gets worse with head movements and after prolonged adherence to a certain position.
Usually, dizziness begins after neck pain and may be accompanied by headaches.
Often the dizziness decreases when the neck pain subsides. The symptom usually lasts from a few minutes to a few hours and is not disabling.
The doctor must rule out labyrinthitis, which is another cause of dizziness, but it is much more serious, because usually the patient feels so bad for a few days that he can not get out of bed.
Another possible cause is atherosclerosis (or atherosclerosis), in which Doppler sonography of the carotid arteries is performed to rule out a circulatory cause.
The treatment of this type of dizziness consists in the therapy of cervical arthrosis, in particular in exercises according to McKenzie, massage therapy and correction of posture.
Complications
Cervical radiculopathy
Cervical radiculopathy means that the root of a nerve is compressed or damaged in the area where it exits from the spinal cord of the neck (cervical).
Although there are other causes of radiculopathy, cervical arthrosis is one of the most common.
Degenerative changes in the intervertebral joints and osteophyte formation cause constrictions that can constrict the nerve.
Another cause is disc prolapse (herniated disc).
This damage is also called a “disc hernia”, even though the discus does not actually shift. What happens is that part of the softer inner area of the intervertebral disc exits through a tear in the outer part of the disc (hernia). The discus presses on the nerve that runs between the two vertebrae.
In addition to neck pain, symptoms of radiculopathy include:
- loss of sensitivity (numbness),
- Tingle
- Ache
- Weakness in the arm and hand, which are innervated by the nerve.
These complaints can be more annoying than the neck pain.
Usually, the pain in one arm is stronger, but it can affect both arms. The pain can be so severe that it interferes with sleep.
The lower cervical vertebrae (C4, C5, C6, C7) are the ones that can cause pain in the ham and hand.
Cervical osteoarthritis in the upper neck areas (C1, C2, C3), on the other hand, can cause symptoms in the neck and head up to the forehead.
Based on the symptoms, the doctor may suspect brachialgia. Physical examination may indicate a loss of sensitivity (paresthesia), strength, and tendon reflex behavior in the arm area supplied by the affected nerve.
The most appropriate examination is magnetic resonance imaging, which shows when nerve roots are compressed.
Disc hernia (exit of the internal disc material) and osteoarthritis very rarely show up together, because in 55-60 years the intervertebral disc is dehydrated and therefore the substance of the central nucleus can not escape.
Osteophytes are bone prongs that form with osteoarthritis, can press on the nerve and cause pain in the process.
Disc protrusion can press an osteophyte against the nerve, causing a narrowing of the available space.
The difficulty is that surgical intervention to remove the osteophytes does not definitively solve the problem, as they form again in a short time. So the surgeon needs to perform a more comprehensive operation to free the nerve.
Cervical myelopathy
Myelopathy exists when something presses on the spinal cord or damages it.
Cervical osteoarthritis is a possible cause of this condition because degenerative changes in the joints can narrow the canal through which the spinal cord passes. The protrusion of a cervical disc can cause myelopathy if it occurs in the central opening of the vertebra.
The spinal cord is made up of groups of nerve fibers that connect the brain to the rest of the body. The pressure on these nerves in the cervical region can cause symptoms virtually throughout the body.
Symptoms of cervical myelopathy include:
- Difficulties to stand. For example, the legs may be stiff and uncoordinated.
- Changes in the sensitivity of the hands. For example, it can be difficult to recognize objects in the usual way and things can fall out of hand.
- Bladder disorders. For example, you may have difficulty emptying your bladder or incontinence.
The doctor must control changes in tendon reflexes, strength and sensitivity of legs and arms. More helpful technical examinations are magnetic resonance imaging and electromyography (examination of nerve conduction velocity measured by needles in the skin).
This shows whether the spinal cord is “pinched” and whether surgical treatment can be useful for relieving pressure.
How is cervical arthrosis diagnosed?
The doctor asks the patient about the symptoms and records the medical history. This is followed by physical examinations, during which the neck, back and shoulders are examined. The examination of the reflex behavior and strength in the hands and arms is carried out.
If the pain is limited to the neck, the only advisable technical examination procedure is the X-ray.
The X-rays show degenerative changes in the bone and possible height reductions between the vertebrae.
Only if the pain spreads to the arms or hands, you need a magnetic resonance imaging to see if there is compression of the nerves.
How to treat cervical osteoarthritis?
Treatments for cervical osteoarthritis are usually non-surgical in nature. The doctor who treats this condition is the orthopedist, but if the symptoms reach into the hands or feet, the neurosurgeon is the appropriate specialist.
The doctor usually prescribes one or a combination of the following therapies:
Natural remedies
- In case of severe pain, rest.
- heat or ice; Ice is contraindicated in the neck. Cold can only slow down circulation and stiffen the muscles.
It is not true that ice is a good remedy for inflammation. In fact, it only serves vasoconstriction (narrowing of the arteries) and helps reduce swelling immediately after trauma.
24-48 hours after the onset of pain, it is ineffective or even contraindicated, because it slows down the healing process. - A heat pack is a therapy that helps reduce local pain.
Among the old home remedies, it is the silk scarf, which can be used even in summer to keep the neck warm.
There are collars that warm the neck because you can pour warm water inside, for example products from Nexcare. - Air conditioners and drafts should be avoided because they can lead to muscle contractures and stiffening.
- Among the natural remedies, arnica and devil’s claw are not very effective as natural anti-inflammatories, because they do not go into enough depth.
Drug
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (for example, dolormine), naproxen (proxene), alrheumism or selective COX-2 inhibitors (for example, celecoxib) are effective in reducing the pain associated with inflammation that usually accompanies osteoarthritis.
Local anti-inflammatory ointments such as Voltaren are less effective because they act very superficially and do not reach the joints.
Cortisone injections are given to reduce the inflammation that causes the pain. Corticosteroids are injected directly into the affected area.
Muscle relaxants such as Ortoton reduce painful muscle contractures in the neck and surrounding muscles, but many patients do not tolerate them because they can cause intestinal discomfort.
Exercises for cervical arthrosis
The following exercises are suitable for patients suffering from these neck complaints.
You should talk to the physiotherapist to find out the appropriate exercises for your situation.
As a rule, you have to do them 3 times a day, but only if they do not cause an exacerbation of symptoms.
Head turning
Start: Sit with your back and neck straight, shoulders slightly backwards. Turn your head, look back over your shoulder until a slight pull is felt. Perform the exercise only if no pain is felt.
Keep your neck straight.
Repeat 10 times on both sides.
Retracting the chin
Beginning: Sit or stand with your back and neck straight, your shoulders should point slightly backwards. Retract chin and try to form a “double chin” at the front of the neck.
As soon as you feel a light or moderate pulling, it must be adhered to.
Keep your eyes and nose facing forward. Hold the position for 2 seconds and repeat everything 10 times.
Lateral inclination of the neck Beginning: Sit with your back and neck
straight. Bend your head to the shoulder until a slight pull is felt. There should be no feeling of pain during the exercise.
Repeat at least 10 times on both sides.
Physiotherapy and rehabilitation
- Vertebral tractions help control chronic symptoms or provide relief for more severe osteoarthritis pain.
- Kinesitherapy and exercises to strengthen the neck help to maintain the spectrum of movements and prevent neck stiffness.
- Physiotherapy serves to reduce inflammation and thus also pain. The most suitable therapies are Tecartherapy and ultrasound treatments, because they go deep and can act on the joints. Personally, I believe that Tecartherapy is the best because it most effectively absorbs inflammatory exudates and warms the neck more.
- Doctors also recommend TENS, but this is a therapy that has only a temporary effect that passes after 2 days.
- Osteopathy can bring great relief to patients with cervical osteoarthritis, because it helps the whole body to rebalance. It is a discipline that corrects posture, releases and realigns blocked joints, loosens muscle tension and also acts on the muscles of the internal organs.
- change in activities performed: reduce activities and attitudes that cause discomfort; for example, change the sleeping position or use pillows or pillows.
- Avoid rigid neck supports, which do not solve the problem, but only increase the stiffening of the joints.
- Thermal cures are a good remedy for osteoarthritis. Many patients report feeling better after mud packs.
Sport
Freestyle swimming is certainly not the appropriate activity for cervical osteoarthritis, because it forces full head rotation, which can cause pain.
Backstroke swimming makes much more sense, but not everyone can do it because it’s more difficult.
In addition, many elderly people cannot swim or do not find it pleasant to stay in a swimming pool.
Bodybuilding is a very hard exercise and can lead to tension in the neck, so it is better to refrain from.
Performing postural gymnastics in a fitness center is a good way to reduce stiffness and pain caused by the inflammation of the cervical joints.
When to operate?
Surgical intervention is required only in rare cases, especially when symptoms of cervical stenosis (loss of strength and sensitivity in the extremities) appear. The goal of surgery is to remove the cause of the pressure on the spinal cord and on the nerves. Surgically, the cervical spine is stabilized with implants or by fusion of the vertebrae.
