Cervical Spondylosis Explained

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Cervical Spondylosis Explained

 

What exactly is Cervical Spondylosis ?

The term ‘Spondylosis’ refers specifically to any form of bone deneration in the spinal column.  The term ‘Cervical’ refers to the neck area, specifically the 7 spinal vertebrae ( named C1-C7,  from base of skull to top of shoulder area ) in the neck.  So, put together, Cervical Spondylosis (C/S)  just means any degeneration of bone in the spine in that area.  Although  C/S is often used as  a descriptive term for Osteoarthritis in neck area,  it is not, in itself,  a diagnosed disease in the same class as any underlying arthritic disease.  It is a descriptive term for bone degeneration only.

 

How does C/S happen. ?  What are its origins ?

C/S can result from two different sources.  It can happen because of an underlying arthritic condition ( usually Osteoarthritis )  causing a deterioration of bone structure, at any age,  but usually later in life.  It can also happen, more  gradually,  following an injury to the neck,  at any age, but usually occurring in earlier years.   That degeneration, in itself is painless/symptomless,  but if any nerves are threatened or compressed by the degeneration,  a range of symptoms can appear.  It is possible for someone to have extensive C/S ( degeneration),  and have little or no symptoms besides some discomfort.  It is also possible for someone with minor degeneration to suffer the full range of painful symptoms.  It all depends on how a nerve is threatened,  which nerve it is,  and how transient or permanent the compromising is.  The extent of the degeneration doesn’t determine the symptom outcomes....it just creates the options for vulnerability to possible arising issues.

What is ‘Degeneration’ ?

Degeneration of the bone ,  either by injury or underlying arthritic condition,  varies between individuals who have C/S.  Bone structure,  when damaged like that,  tries to repair itself.  In the case of C/S,  that usually means that bone spurs ( osteophytes ) can grow on the bone between the vertebrae,  as a means of stabilising the neck against the vulnerability of any dysfunction resulting from the degenerative changes.  Bone structure all over the body can behave in this manner,  but anywhere on the spine it is called Spondylosis,  and it is generally painless/symptomless.  As a rule,  bone structure attempts to repair itself with adaptive adjustments to guarantee continued functioning.  With the neck area,  and C/S,  because the neck must retain flexibility to continue the functioning of other organs which use the neck ( breathing, swallowing, blood flow,  nerve distribution etc ) ,  the bone repairing  can lead to reactions in the local area or to ‘referred’ areas.  These reactions are listed  below.

Spondylosis,  Stenosis,  Myelopathy and  Radiculopathy ?

We already know that Spondylosis is a description of bone degeneration.  So , what do these other  terms mean.

Stenosis:  When the distance between the vertebrae and the nerve root,  which is located in the central nerve root canal in the spine, is shortened by degenerative changes,  that is called Stenosis.  The vertebrae can actually touch the nerve root itself,  but are unlikely to damage it.  Stenosis is a description of this physical dysfunction.

Myelopathy:  When stenosis occurs,  it can give rise to Myelopathy,  which is the name for a range of nerve symptoms caused by any compression or impingement of the nerve root within the spinal nerve canal.  Myelopathy symptoms are usually restricted to numbness, pins and needles, tingling, burning sensations, general fatigue, loss of power or clumsiness,  in any combination.

Radiculopathy:   Where a nerve is restricted as it exits the spine ( usually by a growth of bone spurs [ called osteophytes]),  it can give rise to a range of referred or radiated symptoms.  These symptoms include all the ‘associated’ issues which are not included in the Myelopathy range of symptoms,  such as...cervicogenic headaches,  stiff neck,  referred or radiated  shoulder/arm/hand/leg/chest pain, muggy head,   any compensatory aches in lower back,  and sometimes anxiety and depression,  in any combination.   Generally speaking,  these symptoms result from physical adjustments required to help protect any threatened nerve in the neck from becoming worse.  Anxiety and depression usually results from the confusion aroused by not being able to predict  ‘tomorrow’s’ symptoms,  and continual worrying about how to ‘fit in’  with work or domestic duties,  all giving rise to a sense of impending  negative functionality.   It is probably worth noting that any threatened nerve will attempt to rectify its vulnerability by instructing muscular reactions, particularly in the neck area, which can result in residual painful reactions elsewhere.  It is probably also worth noting that most of these ‘associated’ issues indicate  ongoing  protective/corrective  measures adopted by the nervous system attempting to contain the problem.   The neck must maintain some flexibility to support the other functions which also use the neck,  and it seems that referring or radiating symptoms to other local areas is the only means of allowing a continuance of flexibility.

Treatments:

One of the major problems facing any C/S patient is the number of treatments and medications on offer,  none of which offer any guarantee of success.  Painful issues usually require medication,  whereas general discomforts usually require physiotherapy.  Sometimes the only offered treatment will be surgery,  which comes with the risk of not knowing the long term effects.  Also,  mistakes can happen in surgery,  because of its intricate nature,  and the condition can worsen.  None of the current available treatments, including  physiotherapy, medications and surgery,  are proven to offer much better results than a simple ‘wait and see’ policy for treatment. 

Managing C/S usually comes down to decisions about ‘bearability’ and ‘tolerance’ before making decisions for any medical interventions.   Some C/S patients seem capable of managing without interventions,  whereas others will tend to rely on the interventions.....perhaps all hinged on the toleration levels involved.  Even if a patient submits to all the recommended interventions,  they will still have to self-manage afterwards....so, in theory,  nothing much is likely to change except for some possible temporary relief, gradually reverting back to a similar situation as prior to intervention.   Medications,  whilst possibly offering transient relief,  will have no long term effect,  except maybe creating dependency issues for the patient.  And physiotherapy for C/S is unproven,  and comes with the possibility of aggravating nerve issues.  Probably important ,  with any exercises, is to always be mindful of any possible delayed reactions occurring up to 2 days after the exertions.  Gentle movements are usually ok,  but best to be aware that any stress applied to neck can have repercussions.  Generally speaking,  any resulting increasing of symptoms should dissipate over time,  perhaps 2 or 3 weeks,  if not further aggravated.

 

Overview

C/S is a ‘chronic’ condition,  based on continued degeneration of cervical spine.  Degeneration rates can differ depending on cause of C/S.  If C/S has resulted from a middle-aged onset of osteoarthritis,  for example,  it can degenerate rapidly over a couple of years, giving rise to combination of symptoms which are difficult to rationalise.  That can be a confusing issue to contend with, for any patient or medical adviser.  If C/S has resulted from an earlier injury,  degenerative progress will be much more gradual,  with symptom phases more identifiable,  as with normal ‘wear and tear’ issues.  For all cases,  symptoms can come and go in all combinations depending on how nerves are threatened.  It is possible to have severe degeneration with few symptoms....it really all depends on nerve vulnerabilities,  and that’s something which is almost impossible to predict with any certainty.  Even a current phase with a painful range of symptoms,  can settle down by itself overtime,  allowing better manageability....and that option,  despite the ‘unknowing element’,  should not be overlooked in any consideration of future options.  If any C/S patients are concerned about their medical advisers’ seeming lack of commitment to advising definite treatments,  it is probably due to the uncertainty they already have about predicting progress.  Ultimately,  C/S requires self-management,  despite the interventions,  and it usually comes down to a patient’s own ability to adapt to their condition as best they can,  whilst still considering the treatment options available.  Understanding the symptoms and their causes  is a required first-step in learning how to ease the symptoms,  and adjusting to an accommodating lifestyle can evolve from that understanding,  leading hopefully to better options for self-management.   There are many reasons why any C/S patient might despair of such an overview,  given the difficulties they usually have to face,  but, really,  in terms of future prospects,  it is a positive overview with potential for exploring any new ideas which might help with the general experience of living with C/S.

All C/S patients seek improvements in their quality of life.  How they go about that probably depends on how re-assuring they perceive the available treatments to be.  If their experiences confirm an unreliability in those treatments,  then the option for improving self-management techniques  might become the only option with potential for general improvement.  It’s a challenging choice which most C/S patients will probably have to face at some point,  at least until the treatments offered are proven to be fit for purpose.

In general,  C/S patients will inevitably encounter a confusion of advice from various medical providers.  The treatment options have not yet been standardised ,  so options and opinions and choices will vary across the board.  Such confusion can easily lead to anxiety about prospects,  which in turn can feed into a ‘catastrophising’ overview being difficult to avoid.  Only the C/S  patients, themselves,  can contain that prospect from becoming their default negative overview of their own condition.   Frustration from failing treatments can also feed into a patient’s overview in a similar manner.   Really,  the only means, despite the difficulties,  of avoiding these possible negative influences,  is to develop a robust self-management (self-efficacy) regime which allows the patient to learn to cope as best as possible....and doesn’t allow the failing treatments or the confused advice to dominate  the mood.    The medications and treatments have to be perceived for what they are before a patient can begin to think of other possible means of managing the condition.  The medications, treatments and surgery will still be available if all other methods fail,  but probably wise to try to manage without first.  A search on Google for self management advice for C/S would be a good place to start.  There are some useful sites which offer advice,  and a process of trial and error might offer up some results.  Just be wary of anything which suggests a further stressing of the neck,  or anything which suggests dietary changes,  or anything which requires a fee.

 

Thank you for reading. 

3 likes, 13 replies

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13 Replies

  • Posted

    Thank you for this easy to follow information, it can be very baffling at

    Times trying t o find out the meaning of medical terminology. You have managed to put it all together and give myself plenty of food for thought.

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  • Posted

    most times you have no idea what they are saying but this was very easy to read and understand . I have it in the lumber and hips as well as c/s would be very interested in finding out more about that as well as c/s
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  • Posted

    This is an excellent and clear summation.  Thanks so for your vivid insight.  
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  • Posted

    Thank you for this Gerry. I've followed your discussions and you have obviously been suffering for some time. You do know your stuff! What helps you to get through each day? I'm having a parcticularly bad day today so any suggestions would be gratefully received!

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  • Posted

    Thanks for the summary Gerry it is better than anything I've seen on the web. I have a OH call at work tomorrow and usually despair thrying to explain to the nurse what my condition is but this time I'm going to use this!
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  • Posted

    Thanks,  one and all.  It was good for me just putting it together,  and I hope it reflects how C/S patients perceive their condition.  So often, on C/S forums,  the discussion seems to keep plummeting towards increasing the meds, or wishing for surgery,  and I have to admit I can find that a bit annoying.  So I put my annoyance to good purpose and came up with the Overview.....just as a means of restoring some balance to the issues we face.  Of course,  I know that it's different for everyone,  but at the same time thought it might be good to have a common understanding that we can all relate to.  Hope it works !

    Brevis....sorry about the rough day....it happens.  My best method for ensuring tomorrow's symptom aren't too bad is to alter my sleeping habits.....sleep on sofa for a few nights,  change pillows etc.....seems to work for me.  It's all about the angle of the neck when sleeping,  and finding the 'cosy zone' where the neck is least strained before going to sleep.  Also,  sleeping, or napping, semi-upright on sofa helps ease or shift any cyclical symptoms from setting in.  Might be worth trying,  but it can take a couple of nights for adjustments to settle.  It only takes a minor improvement for the whole C/S thing to become more manageable.  No appointments, no fees,  and all done in the comfort of your own home.  

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  • Posted

    Cervical Spondylosis Symptoms Explained

    A personal overview of C/S symptoms and their relevance.

     

    C/S symptoms should really be broken down into 2 classes......indirect ‘associated’ symptoms, and direct ‘neurological’ symptoms.

     ‘Associated’ symptoms are reactive symptoms caused by any threatened nerve instructing muscular reactions as a means of protecting an endangered nerve from becoming more compromised.  The first duty of any nerve is to protect its own functionality,  thus ensuring continued protection for the body area it serves.  A threatened,  but not actually yet compressed, nerve tends to adopt behaviour which produces symptoms (referred and radiated) that, in themselves,  are not further threatening to the source problem ( threatened nerve in neck ).  Some continued functionality of nerve sensations along the nerve extension is all that matters....so,  for instance,  in the case of a ‘numb hand’,  the accompanying ‘pins and needles’ or ‘tingling’ usually indicates a continued functionality of the nerve in that area,  although reduced.  Although ‘Associated’ symptoms won’t produce a numb hand,  they will attempt to help stop that result from happening.

    ‘Neurological’ symptoms are a direct result of some actual compression of any nerve in the cervical spine.  The compression can be transient or more permanent depending on degeneration levels.  The symptoms are more nerve sensation based....numbness, tingling, burning,  loss of power etc.,  and tend to be more lasting than ‘associated’ symptoms.  These are the symptoms that Neurologists are concerned with when assessing options for surgery.  Most ‘neurological’ symptoms are an indication of continued functionality of ‘reduced’ protection along the full extension of the nerve.  Again,  that protective duty is all that matters.  There is no need for the nerve to manifest its endangered status at the source of the problem (trapped nerve in neck).

     

    A threatened or trapped nerve will always try to continue its duties.  It will also try to adjust its positioning within the spine to a lesser compromised position.  In order to achieve that result,  it can instruct various muscular reactions to either restrict certain movements, or to help with re-positioning.  Most C/S symptoms,  except for ‘neurological’ symptoms from actual trapped nerve,   result from these efforts to ‘self-correct’.

     

    Breakdown of Symptoms:

     

    Associated symptoms:  

    Cervicogenic headaches...caused by muscular reactions at base of skull.

    Pain in Shoulder / Chest / Arm...caused by muscular reactions at base of neck.

    Stiff Neck...caused by muscular reactions in neck area, to reduce movement.

    Frozen Shoulder...caused by cyclical muscular reaction between neck/shoulder.

    Muggy Sore Head....caused by muscular reactions at base of skull.

    Stuck Neck...caused by muscular reactions to reduce movement neck area.

    General Fatigue.....caused by exhaustion due to continued reactions.

    Anxiety/Depression....caused by uncertainty about symptom progression.

     

    Neurological symptoms:

    ( All caused by actual compression of nerve,  and it should be noted that local area functionality, in all instances,  is reduced rather than stopped )

    Numb Hand....  Indicates compression in neck, and reduced nerve functionality.  Is really only semi-numb/clumsy.

    Pins n Needles/Tingling.... Indicates continued sensitivity in local area.

    Burning along nerve....Indicates sensitivity along nerve extension.

    Loss of Power....indicates reduced nerve functionality.  Really only semi-loss of power .

    Bowel/Bladder Dysfunction...Indicates reduced nerve control.  Again semi-reduced.

    Leg Dysfunctions....Indicate reduced nerve control.

    All these ‘reduced’ symptoms indicate that the nerves will continue their duties in a limited capacity,  even at the expense of creating  ‘lesser threatening’ symptoms.  The only other option available to the nervous system to protect and heal the source problem would be to completely shut-down the flexibility of the neck until healing occurred naturally,  but doing so would compromise so many other vital neck functions that it’s really not an acceptable option.  The ‘stuck neck’ symptom usually only occurs at the beginning of the C/S,  last a few weeks,  and then moves on to  more referred and radiated response methods as a lesser threatening option.

     

    Generally speaking,  in terms of overviewing the progressive tendencies,  the ‘associated’ symptoms come first,  can last many years before a nerve is eventually compromised,  and the symptoms will change to ‘neurological’ symptoms.  But all symptoms can come in all combinations depending on transient vulnerabilities created by particular neck movements.  Strangely,  an onset of neurological symptoms can help relieve previous ‘associated’ symptoms, seemingly because the previous threat of compromise has become a reality of compromise,  and there is no longer a need for the protective ‘associated’ symptoms.  In my opinion,  the ‘associated’ symptoms are usually the more painful,  are not easily recognisable by the medical advisers,  and their lack of definition can cause many side issues for coping and management.  The neurological symptoms,  being more identifiable, and having direct correlation to particular nerve entrapments,  are given more attention by the medical advisers....and there is generally better support available.

    Personally,  I consider the headaches and muggy sore head the worst symptoms because of how they can interact with the other symptoms,  making the other symptoms seem worse than they are.  I think it is really important to learn how to deal with the headaches before attempting any other treatments.  Will post the next instalment on headache treatments shortly.

     

    Hope this helps clarify the complexities we all experience.

    This is a personal overview of C/S symptoms.

     

    Gerry Daly

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  • Posted

    Cervicogenic Headaches Explained

    A personal overview of Cervical Spondylosis Symptoms

     

    Cervical Spondylosis comes with a range of varied symptoms.  Perhaps the most distressing of those symptoms are cervicogenic headaches,  usually accompanied by muggy sore head sensations,  because of the manner in which the headaches interfere with our perceptions of other simultaneously manifested symptoms, such as stiff neck, arm pain etc.   Cervicogenic headaches tend to appear on waking in the morning,  they can intensify or ease down depending on causal circumstances,  and because of the way they de-focus and blur thinking clarity,  they can be frustrating and have a negative ‘umbrella’ effect over any resolve to manage all symptoms.

                Usually, a C/S patient will wake up with a ‘cotton wool’ sore  head sensation which gradually evolves into a clarified headache within a half-hour or so.  The first hour or two are critical for determining whether the headache is likely to intensify and last all day,  or whether it might ease down to something more manageable.  Sometimes painkillers are required at outset ( always with a small snack to dissipate possible stomach issues ),  because  the earlier the pain is subdued,  the better for general management options for all issues.  Sometimes,  with less intense pain,  it’s probably wise to see how it evolves over a couple of hours before considering the painkiller options,  because if it is showing a tendency to ease,  it is sometimes best to go with that and see where it leads.  The only painkiller that has worked consistently for me, for headaches, is ibuprofen....but might be different for everyone.

    Any management techniques are best served without painkillers masking the effects.  Also,  it is probably best to allow any taken painkillers to do their thing whilst awake,  because a return to sleeping or napping seems to neutralise their lasting effect.   Generally speaking,  the muggy sore head sensation should ease similarly, either naturally or with painkillers,  but the resulting effect usually doesn’t leave much mental energy for functioning normally.  Headaches and muggy sore head must eventually be rested off for any restoration of physical or mental energy to occur,  but perhaps best to leave that resting until the painkillers have run their course for a few hours.  If resting is done too early,  there’s a possibility of waking again with the same problems,  and the process must be repeated again....not a pleasant outcome.  It does seem that if the resting is delayed,  there are usually better outcomes for the remainder of the day,  with possible less need to boost painkiller intake.

     

    That’s an overview of tackling the symptoms as they happen,  rather than tackling the cause before anything happens.  Cervicogenic headaches are caused by muscular stresses at base of skull.  Those stresses, themselves, are caused by instructed muscular reactions to a threatened nerve in cervical spine.  So,  the headaches are really a ‘secondary’ symptom,  despite their distressing nature....they don’t result directly from the nerve issue,  they result from the reactions to the nerve issue.  That might seem like a mute point to be making, to anyone experiencing a C/S headache,  but it’s actually important for assessing how to avoid the headaches before they are likely to occur.

                It seems that most ‘associated’ protective C/S symptoms are instigated during  the sleep process,  that’s why they are usually most prominent on waking.  What seems to happen is,  whilst we sleep and all is relaxed,  the nervous system instructs muscular reactions to help protect the threatened nerve status for the next day or two....all depending on whatever aggravations occurred the previous day or two.  Finding the best neck posture for sleeping/napping  (whether that be changing pillow, changing mattress, sleep on sofa etc ) can accommodate that process to complete its adjustments quickly, and with least resistence.....all leading to a lesser requirement for protective muscular reactions,  and thus less resulting ‘secondary’ symptoms like headaches.  My own favourite is a semi-propped up posture on sofa for sleeping / napping....it works absolute wonders mostly.  But,  because of variance across the C/S population,  it’s probably more a matter of trial and error for anyone to find what suits their own particular degenerative status.

     

    What this approach is really about is getting one step ahead of possible nerve responses....basically outwitting the nervous system with pre-emptive actions.  Changing sleeping/napping regimes can appear daunting to anyone who just wants to rest off the aches and pains in their favourite ‘cosy’ zone,  but the rewards from making alterations can make all that worthwhile when the effects are experienced.  Sleeping horizontally in the same bed,  over a period of time,  possibly in the same draught,  and possibly never allowing the neck to find its own least stressed posture,   I suspect  can add to the cyclical nature of many C/S  ‘associated’ symptoms,  particularly if that bed is not accommodating the ongoing processes.  These sleeping alterations will do nothing for ‘neurological’ symptoms,  but by reducing or changing ‘associated’ symptoms,  the alterations can render the whole C/S thing more manageable.

                Perhaps  one thing that should be borne in mind is that,  with any assisted adjustments or manipulations applied to the neck  (just as in physiotherapy),  there is usually a delayed response...so any attempts should only be assessed after 2 or 3 days.  It is also likely that the first night or two of any attempted adjustments could be troublesome until the adjustment results kick in...there again, the ideal posture could be discovered straight away,  and locked in memory for future use when needed.  Once any beneficial changes are noted,  it’s usually ok to return to bed sleeping again.  The variance of sleeping regimes impacts on ‘associated’ symptoms,  and can be used in conjunction with medications if needed, but probably best without in terms of assessing results.  

     

    For anyone who might consider this method of sleep adjustments too risky or difficult to contemplate,  I would suggest the use of a Cervicogenic Ortho Soft Pillow  ( ridged around outside rim, hollowish inside rim, and raised bit at centre ),  used at different angles to assess results, if they wish to continue in their usual bed.  They can sometimes work for easing headaches,  but again it all depends on finding the least stressed posture for the neck before falling asleep.  Another relevant point to make would be this.....the shorter the time spent asleep,  the more likelyhood of less symptoms appearing on waking. 

    Beat the headaches,  and the rest gets easier.  The key to affecting ‘associated’  nerve responses seems to lie in the sleeping processes.

     

    This is a personal overview of how to tackle C/S headaches/muggy sore head.

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    • Posted

      Hello Gerry,  I just turned 40 and I am working in Thailand right now.  10 days ago I woke up with a nerve pain in my shoulder.  The pain moved to the arm and hand.  I went to see a doctor, I saw an orthopedic who asked me for an xray and told my I have spondylosis, gave me some medicine and told me to go to therapy for a week.  That's what I'm doing right now.  The pain persist though.  And as I am researching in the internet I'm freaking out by reading about CS.  Is it really un cureable?  Would I be able to go to the gym again and live my normal life? 

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  • Posted

    Brilliantly detailed, clear to understand, so thankyou for this.

    I am in pain and discomfort all the time, despite strong pain relief, exercises, physio, nothing has worked or eased the symptoms.

    I do however, thanks to you, have a greater knowledge of the condition and realise that all I have left is, a more positive attitude towards this bitch of a condition. 😒

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    • Posted

      You got it in 1 Emmie you do learn to live with the pain, I have had cervical and lumber spondalosis for 50 years or so now,along with osteoporosis in the same areas but you do get used to the pain and remember pain is there to remind you you have a problem, if there was no pain we would all be doing more than we should and causing even more problems , take care and thanks once again to Gerry for his take. on spondalosis very informative
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  • Posted

    What is calcification mines with other spine problem
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