Cervical Spondylosis And Myelopathy

Cervical spondylosis, often referred to as arthritis of the neck, is a common, age-related condition that affects the joints and discs in the cervical spine, which is located in the neck. It is marked by the wear and tear of cartilage and bones in the neck.

Myelopathy, in the context of cervical spondylosis, refers to the compression of the spinal cord in the cervical region. This compression can lead to a range of neurological symptoms. Myelopathy is a more severe condition and is considered a major complication of cervical spondylosis.

The development of cervical spondylosis and myelopathy is typically linked to age-related changes in the spine. However, several factors can contribute to or accelerate these changes:

• Ageing
  The discs in the spine naturally degenerate and lose their cushioning ability with age. The vertebrae and the joints between them also start to wear down, contributing significantly to cervical spondylosis.
• Osteoarthritis
  This common joint disorder causes the deterioration of cartilage, which aids in smooth joint movement. In the cervical spine, this can lead to the formation of bone spurs (osteophytes) that may compress spinal nerves or the spinal cord.
• Previous Neck Injuries
  Trauma to the neck, such as from a car accident or a fall, can lead to an earlier onset of cervical spondylosis or worsen existing conditions.
• Occupational and Lifestyle Factors
  Jobs or activities involving repetitive neck motions, awkward positioning, or heavy lifting can place extra stress on the cervical spine, hastening the wear-and-tear process.
• Smoking
  Smoking has been linked to increased neck pain and cervical spine degeneration, possibly due to decreased blood supply to the discs and other neck structures.
• Genetic Factors
  Some individuals may have a genetic predisposition to develop cervical spondylosis.

Non-surgical treatments aim to relieve pain, improve function, and delay or avoid the need for surgery. Common non-surgical treatments include:

Physical Therapy: Physical therapy can be crucial in managing cervical spondylosis. Exercises to strengthen neck muscles, improve flexibility, and maintain the range of motion can help alleviate symptoms and prevent further degeneration.

Medications: Various medications can be used to manage pain and inflammation. These include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen for pain relief and reducing inflammation.
• Muscle relaxants to relieve muscle spasms.
• In some cases, oral corticosteroids or steroid injections may be recommended to reduce severe inflammation.

Lifestyle Modifications: Making changes to daily activities can help manage symptoms. This includes using ergonomic furniture, avoiding activities that strain the neck, and practising good posture.

Heat and Cold Therapy: Applying heat or cold to the neck can provide temporary pain relief. Heat therapy can relax tense muscles, while cold therapy can reduce inflammation and numb pain.

Soft Neck Collar: For temporary relief, especially in acute flare-ups, a soft neck collar can be used to provide support and limit neck motion, allowing muscles to rest.

Surgery for cervical spondylosis and myelopathy is generally considered when non-surgical treatments have failed to relieve symptoms, or when there is significant spinal cord or nerve root compression. Common surgical options include:

• Anterior Cervical Discectomy and Fusion (ACDF)
  This procedure involves removing a damaged disc to relieve spinal cord or nerve pressure. The vertebrae above and below the removed disc are then fused using a graft.
• Cervical Laminectomy
  In this procedure, part of the vertebra (the lamina) is removed to create more space for the spinal cord and relieve compression.
• Cervical Laminoplasty
  This surgery involves reshaping or repositioning the bones of the spinal canal to relieve pressure on the spinal cord without removing the bones entirely.
• Posterior Cervical Decompression
  This procedure may be recommended if multiple levels of the cervical spine are affected. It involves removing bone spurs and portions of the lamina to relieve pressure on the spinal cord and nerve roots.
• Artificial Disc Replacement
  In some cases, rather than fusion, an artificial disc may be inserted after removing a damaged disc. This can help maintain more natural neck motion post-surgery.

While cervical spondylosis is often related to ageing and may not be entirely preventable, some strategies can help reduce the risk of developing it or slow its progression. These include:

• Maintaining Good Posture: Proper posture reduces stress on the cervical spine. When sitting, especially for long periods, ensure the back is straight, shoulders are back, and the computer screen is at eye level.
• Regular Exercise: Engaging in regular physical activity helps maintain neck strength and flexibility. This can include exercises specifically targeted at neck muscles, as well as general aerobic activities.
• Ergonomic Workspaces: Setting up an ergonomic workstation can help minimise strain on the neck. This includes using chairs with proper support, positioning keyboards and monitors at comfortable levels, and taking frequent breaks to change position.
• Weight Management: Maintaining a healthy weight reduces the overall strain on the spine and joints, including those in the cervical region.
• Avoiding Smoking: Smoking is associated with increased spinal degeneration. Quitting smoking can help slow down this process and improve overall health.
• Managing Stress: Chronic stress can lead to muscle tension and tightness in the neck. Techniques such as yoga, meditation, and deep breathing can help manage stress and reduce its impact on the body.