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Cervical spondylosis
Last reviewed: 04.07.2025
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Cervical spondylosis - osteoarthritis of the cervical spine - leads to stenosis of the canal, and with the proliferation of bone tissue (osteophytes) at the lower level of the cervical spine - to cervical myelopathy, sometimes with involvement of the lower cervical nerve roots (radiculomyelopathy).
Causes cervical spondylosis
Cervical spondylosis due to osteoarthrosis is common. Sometimes, especially against the background of a congenitally narrow (< 10 mm) spinal canal, it leads to compression of the spinal cord with the development of myelopathy. Osteophytes of the intervertebral foramen, most often at the level of C5-6 and C7-8, can lead to the development of radiculopathy. Manifestations are determined by which structures are involved. A congenitally narrow canal increases the risk of cervical spondylosis.
Symptoms cervical spondylosis
Spinal cord compression usually results in gradually increasing spastic paresis and/or paresthesia in the hands and feet, reflexes may be increased. Asymmetric non-segmental neurological deficit, aggravated by coughing or Valsalva maneuver, and centromedullary syndrome are possible. Over time, muscle atrophy and flaccid paresis of the upper limbs appear at the level of the lesion, combined with spasticity below this level.
Compression of the nerve roots leads to the early onset of radicular pain, which may then lead to weakness, decreased reflexes, and muscle atrophy.
Cervical spondylosis should be considered when an elderly patient with osteoarthritis or radicular pain at the C5 or C7 level exhibits characteristic neurologic deficits.
Diagnostics cervical spondylosis
In case of symptoms of cervical root or spinal cord damage, MRI and electrodiagnostic studies (EMG, somatosensory and motor evoked potentials) are indicated. X-ray of the spine with visualization of intervertebral openings in oblique projections reveals osteophytes and decreased height of intervertebral discs, but the sensitivity and specificity of these changes are low. If the sagittal diameter of the spinal canal in the cervical region is less than 10 mm, the risk of spinal cord compression is high.
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Treatment cervical spondylosis
Sometimes the symptoms of cervical spondylosis spontaneously regress or stabilize. Conservative treatment includes wearing a soft orthopedic collar and taking NSAIDs or other mild analgesics. Cervical spondylosis is operated using decompressive laminectomy, which is indicated for compressive myelopathy, and for radiculopathy - if conservative treatment is ineffective and / or electrodiagnostic confirmation of neurological dysfunction.
When the spinal cord is involved, a laminectomy is necessary, the posterior approach reduces compression, but it leaves the anterior osteophytes, and spinal instability and kyphosis may eventually develop, so the anterior approach is now increasingly used. In isolated radiculopathy, non-surgical treatment with NSAIDs and wearing a soft cervical orthopedic collar is indicated. If ineffective, surgical decompression may be required.