Cervical spondylosis

Cervical spondylosis is caused by wear and tear of the bones, discs and joints in the neck (the cervical spine). It is mostly a part of ageing and is often seen in people over 40. Many people with it have no symptoms at all.

Over time the discs can wear and bony spurs can form. These changes can sometimes press on the nerves leaving the spine (cervical radiculopathy) or on the spinal cord itself (cervical myelopathy).

When there are symptoms, they usually come on gradually and can come and go:

• Neck and shoulder pain or stiffness
• Pain that spreads from the neck around the shoulder blade or into the arm
• Headaches that start at the back of the neck or head
• Pain that is worse after sitting or standing for long, at night, or when coughing, sneezing or moving the neck
• Tingling or numbness in the shoulders or arms

Less often there is weakness, loss of balance, leg pain or numbness, or trouble controlling the bladder or bowels. These need prompt medical attention.

Ask for an urgent appointment for severe neck pain that starts suddenly or quickly worsens, heaviness or weakness in the arms or legs, pins and needles in an arm with neck or arm pain, or pain between the shoulder blades. See a doctor if neck pain or stiffness lasts more than a few weeks.

Ageing and long-term wear on the neck are the main cause. The discs and joints wear down, and bony spurs may form. A previous neck injury or a family history of the condition can make it more likely at any age.

• Age, especially over 40
• A previous neck or spine injury or operation
• A family history of the condition
• Physically demanding work
• Being overweight
• A ruptured disc, severe arthritis, or a spinal canal that is narrow from birth

Most people have some long-term symptoms, which usually improve without surgery. Less often, pressure on a nerve or the spinal cord can lead to:

• Weakness or numbness in the arms or legs
• Poor balance and difficulty walking
• Loss of bladder or bowel control
• Occasionally, permanent disability

Age-related wear cannot be fully prevented, but these steps may lower the risk or ease symptoms:

• Keep a healthy weight
• Protect the neck from injury
• Do gentle neck exercises and stay active
• Use good posture

A doctor examines the neck and shoulders, checks neck movement, reflexes, strength and feeling, and watches you walk. Tests depend on the symptoms:

• X-rays, to look for arthritis of the neck
• MRI or CT scans, for severe or lasting pain, or weakness or numbness
• Nerve tests (EMG and nerve conduction studies), to see how well the nerves are working

Most treatment does not involve surgery. Doctors advise gentle neck exercises, better posture and keeping up usual activities, with pain relief such as paracetamol as advised. Heat or cold packs may help. A muscle relaxant or other medicine may be prescribed for pain that lasts a long time, and physiotherapy is recommended if symptoms do not improve within a few weeks.

Surgery is considered only if a nerve is pinched or the spinal cord is affected, or if pain continues or movement or feeling is lost. It is not always a cure, but it may stop symptoms from getting worse. Treatment usually takes a few weeks to work, and pain and stiffness can return.