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CERVICAL SPONDYLOSIS

Discussion in 'Lupus & Autoimmune Disease Forum' started by mistymoo, Jul 22, 2012.

  1. mistymoo
    Cheeky

    mistymoo Artist in Residence

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    Cervical spondylosis is a medical term used to refer to the general 'wear and tear' that occurs in the joints and bones in the neck as people get older. The condition is also known as degenerative osteoarthritis. It can lead to episodes of stiffness and neck pain.
    In more serious cases of cervical spondylosis, changes in the structure of bones or joints in the neck can cause nerves to get pinched or compressed. They may also cause them to press against near-by blood vessels, which can temporarily block the flow of blood. This can lead to more serious symptoms such as lack of feeling in your hands and legs, a loss of co-ordination and, less commonly, loss of bladder control.
    Who is at risk from cervical spondylosis?
    As cervical spondylosis is primarily an age-related condition, the older you get the more likely it is that you will develop the condition. It tends to develop earlier in men than women. It is estimated that by the age of 70, nearly 100% of men, and 96% of women, will have some degree of cervical spondylosis.
    Treating cervical spondylosis
    In most cases the symptoms of cervical spondylosis can be controlled using a combination of over-the-counter (OTC) medication, such as ibuprofen or paracetamol, and exercise.
    In more serious cases where there is evidence of damage to the nerves, surgery may be required.
    Symptoms


    Common symptoms of cervical spondylosis
    Around 90% of people with cervical spondylosis will only experience episodes of stiffness and neck pain.
    Other symptoms of cervical spondylosis
    Other symptoms will only usually occur if a:
    • a slipped disc, or changes in bone structure, pinches or irritates a near-by nerve (cervical radiculopathy),
    • if the bones in the neck begin to press against blood vessels, or
    • if the spinal column becomes narrower, compressing the nerves inside (cervical myelopathy).

    Symptoms of cervical radiculopathy
    If a nerve becomes pinched or irritated, the entire length of the nerve can be affected. So, depending on the nerve involved, you may feel a pain radiating from your neck into your arm, shoulder, head or chest.
    You may also experience some numbness in the part of the body that the nerve travels to.
    Symptoms of compressed blood vessels
    If the bones in the neck begin to press against the blood vessels, it can reduce the flow of blood to the brain. The reduction of blood is too small to cause any serious problems, like brain damage, but it can cause episodes of dizziness, especially when you are looking up. You may also experience brief blackouts.
    In some cases, the bones can also press against the oesophagus, which is the tube that carries the food from your mouth to your stomach. This can lead to difficulties in swallowing (dysphagia).
    Symptoms of cervical myelopathy
    Cervical myelopathy can cause more wide-ranging and serious symptoms, as the compression of the nerves inside the spinal column can interfere with the signals that travel between your brain and the rest of your body.
    Symptoms include:
    • a lack of coordination; you may find tasks such as buttoning a shirt increasingly difficult,
    • muscle weakness in your arms or legs,
    • problems walking,
    • loss of bladder control, and
    • loss of bowel control.

    Causes


    The structure of the spine
    To better understand the causes of cervical spondylosis, it is useful to know a little more about the structure of your spine.
    Your spine is made up of vertebrae, discs, and nerves. Vertebrae are the ridge-shaped sections of bone that make up the structure of your spine, and protect the nerves. The vertebrae are supported and cushioned by discs of cartilage. Cartilage is a type of tissue that is tough and flexible.
    As you get older, the cartilage inside the disks becomes harder and more brittle, which means that they provide less support to the vertebrae resting on the disk. This causes your spine to become less stable.
    Your body will try and compensate for this by producing small lumps of extra bone to better support your neck and stiffen the spine. These lumps of extra bone are known as bone spurs or osteophytes.
    Unfortunately, these osteophytes often cause more problems than they solve.
    They can cause the spine to become too rigid leading to the symptoms of stiffness and neck pain.
    Also, the changes in bone structure can then compress nearby nerves and blood vessels, which causing symptoms of more widespread pain, difficulties swallowing, and sudden fainting.
    Herniated disc
    A herniated or 'slipped' disk can also lead to neck pain in cases of cervical spondylosis. As the disc of cartilage becomes harder and more brittle, repeated strain on the neck can cause the disc to split, or rupture. If a rupture occurs, some of the soft core of tissue inside the disc can press against a nerve leading to pain.
    Cervical myelopathy
    In the most serious cases of cervical spondylosis, the changes in bone structure will cause your spinal column to contract (spinal stenosis). This can be a serious problem as your spinal column contains a thick bundle of nerves that run from your brain to the rest of the body.
    If the spinal column contracts too far, these nerves can be damaged, and will lead to a disruption of the signals sent from your brain to the rest of the body. This can lead to symptoms of numbness, loss of coordination, lack of bladder and bowel control and muscle weakness. This is known as cervical myelopathy.
    Left untreated, some cases of cervical myelopathy can lead to permanent nerve damage, resulting in disability. Though with modern medical techniques this is now uncommon.

    Diagnosis


    Cervical spondylosis can usually be recognised by the symptoms. However, to rule out other possibilities and confirm the diagnosis, various tests can be carried out. These are outlined below.
    Physical examination
    Cervical spondylosis can limit the range of motion in your neck. To check if this is the case, your GP may ask you to try and rotate your head from side to side and then tilt your head towards your shoulders.
    Your GP may also test your reflexes in your hands and feet and check you have full sensation in all your limbs. Problems with your reflexes or a lack of sensation could indicate the presence of nerve damage.
    Your GP may also study how you walk, as cervical myelopathy can often affect a person's gait and balance.
    X-Ray
    An X-ray may be able to identify whether there is any damage to the structure of your spine and to detect the presence of osteophytes.
    Computer topography (CT) and MRI Scans
    A computer topography (CT) and MRI scans are usually only used if it is felt that there is the possibility of nerve damage. CT scans produce a 3-dimensional image that is much more detailed than an X-ray; the bones involved can be seen more clearly.
    While a MRI scan, unlike an X-ray can also detect any damage or problems with the nerves.
    Myeologram
    A coloured dye may be injected inside your spine in order to make the spinal column more visible during an X-ray or CT scan. This procedure is known as a myelogram.

    Treatment


    The goals in treating cervical spondylosis are to relieve pain and prevent any permanent damage to your nerves. The various treatment options are outlined below.
    Pain relief
    Over-the-counter painkillers
    Over-the-counter painkillers are effective in relieving symptoms of pain. The type of painkiller known as nonsteroidal anti-inflammatory drugs (NSAID) is thought to work best. The NSAID ibuprofen is normally recommended instead of aspirin, as there is less chance of adverse side effects. (Aspirin should never be taken by anyone under the age of 16.)
    NSAIDs may not be suitable if you have asthma, high blood pressure, liver disease, heart disease or a history of stomach and digestive disorders. In these circumstances, paracetamol would probably be more suitable. Your pharmacist or GP will be able to advise you.
    Codeine
    If you pain is more severe, your GP may prescribe the mild opiate painkiller codeine which you can taken in combination with NSAIDs.
    Amitriptyline
    If pain persists for more than a month, and has not responded to other painkillers, your GP may prescribe a medicine called amitriptyline.
    Amitriptyline is a medicine that was originally designed to treat depression, but doctors have found that it is also useful in treating pain.
    You may experience some side effects when taking amitriptyline. They include:
    • drowsiness,
    • dry mouth,
    • blurred vision,
    • constipation, and
    • difficulty urinating.

    Do not drive if you find that amitriptyline is making you drowsy.
    Amitriptyline should not be taken by people with a history of heart disease.
    Gabapentin
    If your pain does not respond to amitriptyline or you cannot take it because you have a history of heart disease, an alternative medicine called gabapentin can be used.
    Gabapentin is a medicine that was originally designed to prevent seizures in people with epilepsy but, like amitriptyline, it has also been found to be useful for treating nerve pain.
    Possible side-effects of gabapentin include:
    • drowsiness,
    • dizziness,
    • tiredness, and
    • loss of coordination.

    Do not drive if you find that gabapentin is making you drowsy.
    You should not suddenly stop taking gabapentin as you will experience withdrawal symptoms. These could include
    • anxiety,
    • insomnia,
    • nausea,
    • pain, and
    • sweating.

    If you wish to stop taking gabapentin, or you no longer need to take it, your GP will advise that the dose should be reduced gradually over the course of a week. This should prevent any withdrawal symptoms.
    Muscle relaxants
    If you are experiencing an episode of acute severe pain your GP may prescribe a short course of diazepam. Diazepam is largely used as a sedative or tranquilliser, but it can also be used to relax muscles.
    Diazepam can make you feel very sleepy, so if you have been prescribed this medication you should not drive at all. After your course of medication has ended, you should wait at least 24 hours before driving.
    Diazepam will also make the effects of alcohol worse, so you should avoid excessive drinking while you are taking the medication.
    Diazepam has the potential to be habit-forming, so your GP will not usually prescribe more than a seven day course of the medication.
    Exercise and lifestyle changes
    Your GP may refer you to a physiotherapist who will be able to teach you some exercise techniques that will strengthen your neck muscles and reduce strain on your spine.
    You may also benefit from taking part in low-impact aerobic exercises such as swimming or walking.
    You should also use one firm pillow at night, rather than two soft pillows, as this will reduce the strain on your neck.
    The long-term use of a neck brace or collar is not recommended as it can make your symptoms worse. So you should not wear a brace for more than a week, unless specifically instructed to by your GP.
    Surgery
    Surgery is usually only recommended in the treatment of cervical spondylosis if:
    • there is evidence of progressive nerve damage that cannot be treated any other way, or
    • your symptoms continue to get worse despite treatment.

    The type of surgery used will depend on the underlying causes of pain and/or nerve damage, such as a herniated disc or a narrowing of your spinal column. Some of the surgical techniques are explained below.
    Laminectomy
    A laminectomy is a surgical technique used to treat cases of cervical myelopathy. The surgeon will make an incision in the back of your neck and then remove a small piece of bone from the vertebrae, which will reduce the compression on the nerves inside the spinal column.
    Fusion surgery
    Fusion surgery is used to treat vertebrae that have slipped out of position. The surgeon uses metal rods to fuse the vertebrae back into place.
    Anterior Cervical Discectomy
    Anterior cervical disectomy is a technique used when a herniated disk, or a osteophyte (bone spur) is pressing on a nerve. The surgeon will make an incision in the front of your neck, and then remove the disk or piece of bone that is responsible
    Prosthetic intervertebral disc replacement
    Prosthetic intervertebral disc replacement is a new surgical technique that can be used in the treatment of cervical spondylosis. It involves removing any damaged discs and replacing them with artificial discs.
    The results of this technique have been promising, though as it is a very new technique, there is no evidence about how well it works in the long-term or whether there will be any complications.
    Prosthetic intervertebral disc replacement is only available at specialist spinal surgery centres.

    Prevention


    As cervical spondylosis is part of the ageing process, there is not much that can be done to prevent it. However, taking regular exercise and limiting activities that place pressure on the head, neck, and shoulders can help to prevent some of the symptoms. The best exercises for the health of the cervical spine are low-impact activities, such as swimming, walking, or yoga.
    Lowering the risk of neck injury by using the correct equipment and techniques when playing sports, may reduce the risk of developing cervical spondylosis.
    Good posture whilst standing, sitting, working at the computer, driving and sleeping will also help to prevent damage to the spine.
    • Winner Winner x 1
  2. Terry
    Blah

    Terry Well-Known Member

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    Hello Misty,
    I was born with cervical spondylosis and they found it in my early 20's through having 20 miniture MRI x-rays done, my backs disfigured and i have two vertebrae supporting my neck and it's now spread into my ribs but if they'd have found it when i was a child my back would have been plated to try and help straighten it but apparently my age was to old to do so.

    Very informative information on the Autoimmune Disease [​IMG]

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