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Cervical spondylosis is the term given to wear and tear which can affect the tissues and bones in the neck as you get older.
The most common symptoms are neck pain, headaches and a stiff neck. The headaches associated with cervical spondylosis usually begin just over the spine at the base of the head before travelling towards the forehead. The neck pain and stiff neck will usually flare up and go away, leaving suffers pain free for a while.
Occasionally, cervical spondylosis can lead to trapped nerves, causing symptoms in the hands, arms and legs. These include pins and needles, loss of feeling, radiating pain and even co-ordination problems and difficulty walking. There are many sufferers of cervical spondylosis, however, who experience no symptoms at all.
It may be surprising to learn that around 90 per cent of all people will be suffering from some form of cervical spondylosis by the age of six, although many will not even be aware that they have the condition. It is common as the effects of aging cause bone and tissues to wear down. Spinal disks, for example, can shrink and dry out and ligaments can stiffen.
More serious symptoms are usually caused by a bone or a slipped disk irritating or pinching a nerve, a condition called cervical radiculopathy, or if a person is suffering from cervical myelopathy, where the spinal canal formed by protective bones gets narrower and the spinal cord is squashed inside.
Cervical radiculopathy can cause a sharp pain to move down one arm. This is called brachialgia. Turning your head and stretching your neck can increase the pain and you may also suffer from pins and needles or numbness in your arm.
Cervical myelopathy causes some of the most severe symptoms as it can interfere with signals from your brain. This means that you may suffer from co-ordination difficulties, a weakness or heavy feeling in your legs or arms, walking difficulties and sometimes incontinence. This condition should be treated as soon as possible as it can lead to the permanent damaging of the spinal cord and disability.
If you are suffering from neck pain and your GP suspects it might be cervical spondylosis, then they will first conduct a physical exam. The stiff neck can prevent it moving to its full extent. The GP will check if you can move the head to each side and lower it in the direction of your shoulders. During the test they will also check your hand and feet reflexes and ensure there is no reduction in the sensations you feel in your limbs. This is because, along with neck pain, these could be signs of nerve damage due to the spinal cord narrowing: referred to as cervical myelopathy.
If your GP is still unsure of the diagnosis, they might decide to refer you for an X-ray. This can be used to highlight other symptoms, including osteophytes. These are sections of additional bone that are a feature of cervical spondylosis and can be a cause of the neck pain.
As well as a physical exam, there are other tests that can be used to confirm the diagnosis. These are often conducted if the medical team suspects the presence of cervical myelopathy or if you have more severe neck pain and other symptoms that are not responding to standard treatments.
An MRI scan can show up any underlying damage that has been caused to the nerves. These scans use radio waves and powerful magnetic fields to gain a more detailed view of what is inside your body.
An alternative to an MRI scan is a CT scan. During this scan, a number of x-rays are taken and these are then put together digitally to create a complex view. This offers a more detailed analysis of the bones than a traditional X-ray. In the majority of cases an MRI scan will be preferred but if a patient can’t have one for a medical reason, such as having a pacemaker installed, a CT scan will be used instead.
There are many conditions which can be characterised by neck pain. If you are suffering from a stiff neck or other symptoms of cervical spondylosis, you should speak to your GP. They will be able to carry out the initial tests and then refer you for more specialist checks or treatment if required.
There are a number of medications that can help relieve neck pain or a stiff neck in cervical spondylosis. These include analgesics, muscle relaxants, amitriptyline and gabapentin all of which have different actions.
Probably the painkillers of choice for cervical spondylosis symptoms are non-steroidal anti-inflammatory drugs (NSAIDs). These include ibuprofen, diclofenac and naproxen. If the first NSAID you try is not effective it is worth trying another. NSAIDs do not suit everyone, and if you have certain conditions such as high blood pressure, asthma, heart disease, liver disease or stomach ulcers paracetamol would probably be a better alternative.
If you have severe neck pain a mild opiate analgesic such as codeine may be prescribed. This can be taken at the same time as paracetamol or NSAIDs. Codeine is unsuitable for people who have head injuries or asthma. It is not generally recommended to be taken over a long period of time, but your GP will advise you about this.
Diazepam, a muscle relaxant, may be prescribed to relieve spasms in your neck muscles. Because it is also a sedative, it can make you feel sleepy and exacerbate the effects of alcohol. Muscle relaxants should only be used for short periods.
This medication can be effective in the treatment of nerve pain, and may be prescribed if you have persistent pain that fails to respond to the other medications.
This is used to help radiating arm pain and pins and needles. It has to be taken for at least a fortnight before you will notice any improvement, but it can help with symptoms caused by nerve root irritation.
If you have severe nerve root pain, a nerve root injection into the neck may reduce inflammation and relieve neck pain. This would normally be performed at a pain clinic.
All the above medications have different side effects, and should be discussed with your doctor before you decide whether they would be suitable for you.
There are certain measures you can take to help yourself relieve the symptoms of cervical spondylosis. Swimming, walking or other low impact exercises may help to reduce neck pain.
Sleeping with a single firm pillow can help to reduce strain and ensuring that your posture is correct when you are sitting or standing can also be helpful. A cervical collar can help to keep your neck more comfortable, although it should not be worn for over a week unless recommended by your GP.
Surgery is the last option and is generally only carried out when there is definite evidence that your spinal cord is being compressed or a nerve is being pinched. Surgery may also be the answer to prevent worsening of any underlying damage to the nervous system or if the pain has failed to respond to any other treatment.
A stiff neck or neck pain caused by cervical spondylosis can be treated by a variety of medications, and symptoms can also be relieved by certain self-help measures. Surgery is not usually necessary, but your GP will discuss treatment options with you.