Cervical Spondylosis And Myelopathy

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Dr Kau Chung Yuan (许医生)


MRCS (Ireland)

MMed (Ortho)

FRCSEd (Ortho)


What are 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.


Common symptoms of cervical spondylosis and myelopathy include:

  • Neck Pain and Stiffness
    This is often the most noticeable symptom of cervical spondylosis. The pain might worsen with movement and can radiate to the arms or shoulders.
  • Numbness and Tingling
    Compression of nerves in the cervical spine can cause sensations of numbness, tingling, or “pins and needles” in the arms, hands, or fingers.
  • Weakness
    Muscle weakness, especially in the arms or hands, can occur if nerve compression affects muscular control.
  • Loss of Coordination
    Myelopathy can lead to difficulties in coordination, such as unsteady walking or problems with fine motor skills in the hands.
  • Reduced Range of Motion
    The stiffness and pain of cervical spondylosis can limit the range of motion in the neck.
  • Headaches
    Headaches, particularly occipital ones originating in the back of the head, can be a symptom of cervical spondylosis.


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Diagnosing cervical spondylosis and myelopathy involves a comprehensive approach that includes clinical evaluation, patient history, and diagnostic imaging. The process typically includes:

Medical History and Physical Examination

The orthopaedic surgeon will inquire about symptoms, their onset, and any activities or factors that worsen them. A physical examination can assess neck movement, muscle weakness, reflexes, and sensory deficits.

Imaging Tests

Imaging tests play a crucial role in diagnosing cervical spondylosis and myelopathy. Common imaging modalities include:

  • X-rays: These can reveal bone spurs, loss of disc height, and other changes associated with cervical spondylosis.
  • Magnetic Resonance Imaging (MRI): An MRI is more detailed and can show soft tissues including discs, nerves, and the spinal cord. It is particularly useful in detecting spinal cord compression in cases of myelopathy.
  • Computed Tomography (CT) Scan: Sometimes used in conjunction with an MRI, a CT scan provides a detailed view of the bones in the cervical spine and can reveal more intricate abnormalities.
Nerve Function Tests

In some cases, tests to assess nerve function may be conducted. These include electromyography (EMG) and nerve conduction studies, which evaluate the electrical activity of muscles and the speed of nerve signals.

Blood Tests

While not used to diagnose cervical spondylosis directly, blood tests can help rule out other conditions that may mimic its symptoms, such as rheumatoid arthritis or infections.

Non-Surgical Treatment Options

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.

Surgical Treatment Options

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.

Dr. Kau Chung Yuan

MBBS (S’pore)

MRCS (Ireland)

MMed (Ortho)

FRCSEd (Ortho)

Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.

He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.

  • Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
  • Master of Medicine (Orthopaedics), Singapore (MMed) 2013
  • Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
  • Bachelor of Medicine and Surgery (MBBS, Singapore) 2004

Prevention Strategies

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.

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    Frequently Asked Questions (FAQs)

    Can Cervical Spondylosis Be Cured?

    Cervical spondylosis is a chronic condition, primarily due to ageing, and cannot be completely cured. However, the symptoms can often be effectively managed with appropriate treatment. The focus is usually on relieving pain, improving function, and maintaining quality of life.

    How Common Is Cervical Spondylosis and Who Is Most at Risk?

    Cervical spondylosis is very common, particularly in older adults. The risk of developing it increases with age. However, it can also affect younger individuals, especially those with a history of neck injury or those in occupations involving repetitive neck movements.

    Can Exercise Worsen Cervical Spondylosis?

    Exercise is generally beneficial for cervical spondylosis as it helps in maintaining neck strength and flexibility. However, exercises that strain the neck excessively should be avoided. Consulting an orthopaedic surgeon for appropriate exercise recommendations is advisable.

    Is Surgery Always Required for Cervical Myelopathy?

    Surgery is not always necessary for cervical myelopathy. The need for surgery depends on various factors, including the severity of symptoms, the degree of spinal cord compression, and the patient’s overall health. Non-surgical treatments are often considered before resorting to surgery.