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CERVICAL SPONDYLOSIS ON A
NECK X-RAY AND NECK PAIN
Nearly everyone develops cervical spondylosis as they get older but few have persistent neck pain.
Cervical spondylosis may not be the explanation
Cervical Spondylosis refers to age-related changes in the neck.
This page is not designed to be a comprehensive resource about all the things that can go wrong in the neck - there are other sources of information about this on this web.
But....in our experience in neurology, cervical spondylosis causes a lot of confusion for doctors and patients and we thought we should outline some important facts:
Here are FOUR THINGS to know about Cervical Spondylosis.
1. Everyone gets it eventually - by the age of 70 everyone has some degree of cervical spondylosis. In that sense its like getting grey hair.
2. It usually doesn't cause symptoms. If it always did, most of the population would have a sore neck all the time
3. It can be associated with more severe and sometimes dangerous problems. Sometimes these normal age related changes CAN cause medical problems. Nerve roots can become trapped in the neck (cervical radiculopathy) and rarely the spinal cord can become trapped as it passes down throught the neck (cervical myelopathy).
4. But..even if you have neck pain and an x-ray shows cervical spondylosis that doesn't necessarily mean that is the cause of your symptoms. Neck pain is often caused by muscle spasm or ligament strain rather than problems with the bones in the neck.
Lets look at these four things more carefully
1. Everyone gets it eventually
2. It usually doesn't cause symptoms.
Studies of people with no neck symptoms have shown that cervical spondylosis is a normal part of ageing. For example, a study by Matsumoto and colleagues looked at 497 people with no neck symptoms in Japan. Changes of spondylosis (disc degeneration) were found in
around 15% of people in their twenties and around 85% of all patients over the age of 60.
80% of these people, with no symptoms in their neck remember, had a disc bulge and 20% had a disc prolapse.
Below is a picture of a really pristine neck MRI scan and next to it is an abnormal scan of a 45 year old man WITH NO SYMPTOMS. You don't need to be a doctor to see that the scan on the right doesn't look normal. Look at the bulging discs shown by the arrows.
3. It can be associated with more severe and dangerous problems. Cervical spondylosis CAN cause serious problems with trapped nerves or a trapped spinal cord but this is unusual and surgery is only very rarely needed. The symptoms of these problems might be weakness of the legs or sevee pain going in to the arm.
4. But even if you have neck pain and have cervical spondylosis that doesn't necessarily mean that this is the cause of your symptoms. For example if someone has a whiplash injury and has a stiff neck afterwards someone might do an x-ray. That x-ray might show some cervical spondylosis. But there is good chance that those changes would have been there BEFORE the neck pain started. So what do those changes mean? Well they may not be helping but the cervical spondylosis may have little to do with the pain.
Chronic neck pain, like chronic back pain, often has a lot more to do with pain coming from muscles and ligaments and the brain than it does to do with bones or discs.
This is important because people with neck pain are encouraged to exercise their neck and may be understandably reluctant to do so if they think they have 'arthritis' of the spine or 'wear and tear'.
Patients who just have neck pain without pain going to their arms or leg symptoms do not usually need to see a neurologist. Treatment varies but may include pain management and exercise
Young Patient with no symptoms
Normal MRI of neck
Young Patient with no symptoms.
MRI of neck shows disc bulging as seen in cervical spondylosis