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Symptoms of cervical spondylosis are caused by imposition on the spinal cord or the nerves as they exit the spine, or both. Neck and shoulder pain are the most common symptom. Types of neck and shoulder pain include: - stiff neck, most often one of the very first signs. Neck stiffness tends to grow progressively worse over time.
- Radiating pain to the bottom of the skull and/or to the shoulder and down the arm. This radiating pain may seem like a stabbing or a burning, or it might present itself as a dull ache.
Along with pain, cervical spondylosis can be accompanied by parathesias and muscle weakness in the neck, shoulders, arms and hands, and a syndrome called “numb, clumsy hands” . In cases of cervical spondylosis with myelopathy, the legs may be affected, leading to asymmetrical spasticity. and an interruption in stability while walking. Loss of balance might also occur. When myelopathy is present, incontinence may become a problem. Muscle wasting also accompanies cervical spondylosis with myelopathy.
Unfortunately, cervical spondylosis is a condition that gradually gets worse, In very developed cases of this condition, often mobility can only be achieved with a cane or walker. |
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If a person has experienced repeated trauma to the neck, the likelihood of the occurrence of cervical spondylosis is increased. Such trauma might include work and recreational-related stress, for example: - carrying loads on your head (for example, carrying a heavy surfboard down the beach to the waves)
- professional dancing
- professional gymnastics
Certain congential, genetic and acquired risk factors for cervical spondylosis have been identified by researchers: - The condition may run in families.
- A congenitally narrow spinal canal increases the risk of developing cervical spondylosis with myelopathy. With a narrow spinal canal, the spinal cord, a very sensitive structure that relays feelings to the , has less space to fit inside the column of bone it occupies. Spinal canals also narrow as a result of the age-related changes of thickening of spinal ligaments and bone. This type of narrowing has the same effect as congenital narrowing.
- Several varieties of excessive segmental motion such as atlantotaxial instability, often present in persons with Down’s syndrome and Cerebral Palsy, are known risk factors.
- Smoking contributes to degenerative disk disease, and is therefore a risk factor.
- History of trauma (hits and blows) to the forehead predispose one to cervical spondylosis.
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Overview of Cervical Spondylosis and Arthritis of the NeckCervical spondylosis is caused by degenerative changes in the bones and intervertebral disks of the neck. A less technical name for this condition is osteoarthritis of the neck, or degenerative disk disease of the neck. Cervical spondylosis is primarily due to aging. According to the Mayo Clinic, the condition usually first presents after the age of 40 and continues to progress from there. 1 Statistics reveal that men develop cervical spondylosis at an earlier age than women. 1 The condition often leads to myelopathy. Cervical spondylosis is the most common condition of the neck that can affect the spinal cord. What HappensWith age, osteophytes, or bone spurs form on vertebral bodies, as the body’s way of attempting an increase of the surface area and stabilizing the vertebral joint. Generally not successful in this mission, the bone spurs can become painful as they put pressure on spinal nerves, and in some cases the spinal cord.  Cervical Spondylosis - Arthritis of the Neck |
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Back, neck and shoulder pain are common because of spinal anatomy. These areas are vulnerable to injury, such as sprains and strains. Other disorders that may cause back pain include spinal stenosis, herniated disc, degenerative disc disease, pinched nerves, scoliosis and sciatica. Neck pain may result from muscle strain, injury (e.g., whiplash) and conditions. Shoulder pain is commonly caused by dislocation, separation, tendonitis and fractures. Treatment varies according to the type, location, cause and severity of pain. For instance, osteoporosis may be treated with medications (e.g., bisphosphonates) while other forms of chronic back pain may require spine surgery. |
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Pain management is a branch of medicine that applies science to the reduction of pain. It covers a wide spectrum of conditions including neuropathic pain, sciatica, postoperative pain and more. A. Pain management is a rapidly growing medical specialty that takes a multi-disciplinary approach to treating all kinds of pain. Dr. Sameh Yonan, a pain management specialist at the Cleveland Clinic, says "we evaluate, rehabilitate and treat people in pain." Your doctor may refer you to pain management if she or he determines that your pain has become out of control. Pain Management Specialists: What They Do, How to Find OneDoctors who specialize in pain management recognize the complex nature of pain, and a pain doctor "approaches the problem from all directions," Yonan said. Ideally, treatment at a pain clinic is patient-centric, but in reality this may depend on the available resources of the institution. Currently, there are no established standards for the types of disciplines that must be included, and this is another reason why treatment offerings will vary from clinic to clinic. But at the very least, experts say that a facility should offer to patients three types of physicians: a coordinating physician, who provides consultation to specialists on your behalf, a physical rehabilitation specialist, and a psychiatrist, to help you deal with any accompanying depression or anxiety, especially if you have chronic pain. Other medical specialties represented in pain management are anesthesiology, neurosurgery and internal medicine. Your coordinating physician may also refer you for services from occupational medicine specialists, social workers and/or alternative and complementary medicine practitioners. To qualify as a pain management specialist in the eyes of the American Board of Medical Specialties, a health care provider should be an MD with board certification in at least one of the following specialties: - Anesthesiology
- Physical rehabilitation
- Psychiatry and neurology.
Dr. James Dillard, an assistant professor of medicine at Columbia University College of Physicians and Surgeons, says that the pain management physician should also have her or his practice limited to that specialty in which they hold the certification. You can check to see if the doctors at the pain management clinic you are considering are board certified by going to the American Board of Medical Specialties web site. Goals of Pain ManagementWhile some types of pain come from primary sources such as headaches, and others from secondary sources such as from surgery, the field of pain management treats all of it as a disease. This allows for the application of science, and the latest advances in medicine to relieve your pain. And while many patients, especially those in chronic pain, see a psychiatrist or therapist as part of the experience, learning to cope with pain is less and less the focus of treatment. "We now have many modalities, including medication, interventional pain management techniques (nerve blocks, spinal cord stimulators and similar treatments), along with physical therapy and alternative medicine to help reduce the pain," says Yonan. The goal of pain management is to minimize pain, rather than eliminate it. This is because quite often it is not possible to completely do away with it. Two other goals are to improve function and increase quality of life. These three goals go hand-in-hand. As a first-time patient in a pain management clinic, you might experience the following: - Evaluation.
- Diagnostic tests, if necessary, as determined in the evaluation.
- Referral to surgeon, if indicated by the tests and evaluation.
- Interventional treatment, such as injections or spinal cord stimulation.
- Physical therapy to increase range-of-motion and strength, and to prepare you to go back to work.
- Psychiatry to deal with depression, anxiety and/or other issues that may accompany your chronic pain.
- Alternative medicine to provide a complement to your other treatments.
Back and neck pain sufferers who do best with a pain management program, says Yonan, are those who have had multiple back surgeries, including failed surgeries, and are still in pain, those with neuropathy, and those for whom it has been determined that surgery would not benefit their condition. "People who have become addicted to pain medication actually need more sophisticated help than what a pain management program can offer them. A chronic pain rehab program is a better choice for these people," he says. According to Pain Physician, results from research studies on pain management are not always applicable to the problems patients come in with to the clinics on a day-to-day basis. Unfortunately, this has a negative effect on insurance reimbursement and other payment arrangements, as well as standardization of this medical specialty. "Better understanding of pain syndromes by communities and insurance companies and more studies on pain will help increase insurance coverage for pain management treatments. In the future, the use of technology will help improve the outcomes of interventional pain management techniques," Yonan says. Sources:
Manchikanti, L. MD, Mark V. Boswell, M. MD, PhD., James Giordano, J. PhD Pain Physician 2007; 10:329-356
Personal Interview. Dr. Sameh Yonan, MD, Pain Management Specialist at Hillcrest, Willoughby and South Pointe Pain Centers at Cleveland Clinic Health System
James N. Dillard, MD., DC. CAc. The Chronic Pain Solution: Your Personal Path to Pain Relief Bantam Dell a division of Random House New York 2003 |
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