Cervical spondylosis and spondylotic cervical myelopathy
Last reviewed: 23.04.2024
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Cervical spondylosis is an osteoarthritis of the cervical vertebrae causing stenosis of the spinal canal and sometimes cervical myelopathy due to the impact of bone osteoarthritic sprouting (osteophytes) on the lower cervical segments of the spinal cord, sometimes involving neighboring cervical roots (radiculomyelopathy).
Cervical spondylosis caused by osteoarthritis occurs quite often. Less often, in particular with a congenital narrowness of the spinal canal (less than 10 mm), it can lead to stenosis and the effects of bone sprouting on the spinal cord, causing myelopathy. Osteophytes in the region of intervertebral foramen, most often between C5 and C6 or C6 and C7 vertebrae, can cause radiculopathy. The clinical manifestation is caused by the involved neural structures.
Compression of the spinal cord usually causes gradually growing spastic paresis, paresthesia both in the hands and in the legs, reflexes can be increased. The neurological deficit may be asymmetric, nonsegmental, and strengthen with a cough or Valsalva trial. Ultimately, muscle atrophy and flaccid paresis of the upper limbs can develop according to the level of damage, with a spastic paresis below the level of defeat.
Compression of the roots often causes radicular pain in the early stages, with the later joining weakness, decreased reflexes and muscle atrophy.
Cervical spondylosis can be suspected in the presence of a characteristic neurological deficit in elderly patients suffering from osteoarthritis or having radicular pain at the level of C5 or Sb.To clarify the diagnosis, MRI or CT is mandatory.If there are signs of involvement of the spinal cord, cervical laminectomy is usually necessary. To reduce the degree of compression, but at the same time, the front osteophytes remain, and vertebral instability and kyphosis may develop, so that front access with vertebrae stapling uetsya more often. If you only need to hold radiculopathy conservative treatment with NSAIDs (such as diclofenac. Lornoxicam) and alyuvantov (tizanidine), a soft cervical collar. With the ineffectiveness of this treatment may be considered for surgical decompression.
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