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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.
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.
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.
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