CERVICAL SPONDYLOSIS

CERVICAL SPONDYLOSIS

(It's a pain in the neck)

Cervical spondylosis can affect one's quality of life. But the good news is that, with treatment and lifestyle changes, it is possible to lead a near normal life.  Sita, a writer in her fifties, woke up one morning with a stiff neck. Turning her head to any one side was next to impossible. She had been perfectly fine until the previous evening and hadn't done anything strenuous. She put it down to craning her neck in the dentist's chair the previous day. But when the problem persisted, it took a visit to the orthopaedician and an x-ray to confirm what the problem was: Cervical spondylosis.

P.S.Seshadri, 64, didn't have any pain but suffered from severe vertigo. It seemed that an accident 10 years ago - when his two wheeler hit a bump – had come back to haunt him. He has now learnt to live with cervical spondylosis and arrest further deterioration through regular exercise and lifestyle changes.  P.Sridharan, 70, first attributed the radiating pain in his left arm to his heart condition; he had had a bypass years ago. Several investigations later the pain was traced not to his heart but to the cervical spine. The good news is all three responded well to exercise and physiotherapy and are leading near normal lives.

What is cervical spondylosis?

Dr. Sanjay Agarwala, Chief of Surgery and Head of Orthopaedics and Traumatology, Hinduja Hospital, Mumbai, explains: “Cervical Spondylosis is a degenerative condition of the cervical spine where vertebral structures show wear and tear. Arthritic changes happen at various levels causing loss of normal cervical spine structure, osteophyte (bony growth) formation and reduction of the disc space, which may cause pressure on nerve roots. It is often associated with pain in the neck, difficulty in movements and sometimes radiating pain, tingling and numbness in the upper limbs. In advanced stages it may cause weakness.”

The reason for this, points out Dr. Harshvardhan Hegde, Director Orthopaedics, Fortis Group of Hospitals, Delhi, is “due to ageing, excess use or gross under-use, osteoarthritis, Vitamin D3 deficiency and osteoporosis, degenerative changes occur in the joints and discs of the spine. Cervical spondylosis is related to wear out of the joints and lack of exercise in the surrounding muscles.”According to Dr. Sanjay Agarwala, aging is the commonest cause. “Old injuries, old infections, constant and excessive use causing repetitive strain or injury due to sitting before a computer, driving, travelling and improper posture while sitting” are other causes.

Treatment options

Fortunately there are various options for treatment and it is not usually necessary to go under the knife.  Dr Harshvardhan Hegde says, “Most people respond to non-surgical treatment starting with exercise and lifestyle changes. Proper relaxation and exercises to strengthen muscles are recommended because spondylotic changes are now occuring in the young due to excess use; due to long hours before the computer. Incorrect sitting postures (while driving, travelling long distances), watching TV in bed with the neck at an awkward angle tend to aggravate the condition and hasten changes. Stress builds up along the neck and the spine cannot cope. The degenerative changes that have already occurred cannot be reversed but through exercise it can be maintained at the same level. Smoking has a direct impact on the disc (a shock absorber between two vertebrae) and texture. Diabetes, renal function disorders, osteoporosis and Vitamin D 3 deficiency can also accelerate the degenerative changes. Corrective measures include controlling diabetes, giving up smoking, preventing osteoporosis through regular exercise, taking Vitamin D 3 where necessary and correction of abnormal thyroid levels.”

Dr Harshvardhan Hegde stresses the importance of the cervical spine and the need for regular exercise. “The weight of the head goes through the cervical spine, which has seven vertebrae. Muscles that support the cervical spine are called strap muscles. They tend to get wasted if we do not exercise them regularly. Static neck exercises done without moving the head will exercise these muscles. Once they are strengthened, the load will be taken off the spine and be distributed among the muscles.”Dr. Sanjay Agarwala emphasises that the first line of approach is always conservative treatment. “In a majority of cases, this condition can be controlled by conservative treatment: non-steroidal anti-inflammatory drugs, muscle relaxants and physiotherapy like heat therapy, intermittent traction and a planned exercise programme besides lifestyle changes. If patients do not respond to this and develop further symptoms like tingling, numbness and weakness in the upper limbs then further investigations will be necessary. Treatment may involve either suitable steroid blocks or surgical decompression if necessary.”Does alternative medicine offer any cure or palliatives? Dr Sanjay Agarwala feels, “There are various osteopathic manipulative massages, chiropractic, acupuncture and trigger point therapies but they are not medically proven.”

What you can do

Exercise neck muscles regularly *Take periodic breaks between long stretches of work at the computer *Use a chair that supports the neck and head so that you can rest the head every hour *Use a firm mattress and a bolster type pillow that supports the neck *Keep diabetes under control *Quit smoking *Prevent osteoporosis through regular exercise *Take Vitamin D 3 if advised by your doctor

                                                                  Prof. John Kurakar