Cervical Spondylosis

this presentation is about the spondylosis of the cervical region.
there is information about cervical spondylosis, its etiology, epidemiology, sign symptoms and its treatment options.

1. CERVICAL
SPODYLOSIS
By
Dr. Shazia Abdul Hamid Khalfe, PT
Vice Principal, Assistant Professor & Director PG
IIRS-IUKC

2. •It is a condition involving changes to
the bones, discs, and joints of the
neck. These changes are caused by
the normal wear-and-tear of aging.
With age, the discs of the cervical
spine gradually break down, lose
fluid, and become stiffer. Cervical
spondylosis usually occurs in
middle-aged and elderly people.
3/22/2021 By Dr. Shazia Khalfe 2
Cervical Spondylosis

3. •As a result of the degeneration of
discs and other cartilage, spurs
or abnormal growths called
osteophytes may form on the
bones in the neck. These
abnormal growths can cause
narrowing of the interior of the
spinal column or in the openings
where spinal nerves exit, a
related condition called
cervical spinal stenosis.
3/22/2021 By Dr. Shazia Khalfe 3
Cervical Spondylosis

4. •The condition is present in more
than 90 percent of people aged 60
and older.
•Some people who have it never
experience symptoms. For others, it
can cause chronic, severe
pain and stiffness. However, many
people who have it are able to
conduct normal daily activities.
3/22/2021 By Dr. Shazia Khalfe 4
Cervical Spondylosis

5. •In the cervical spine this chronic
degenerative process affects the
intervertebral discs and facet joints,
and may progress to disk herniation,
osteophyte formation, vertebral body
degeneration, compression of the
spinal cord, or cervical spondylotic
myelopathy
3/22/2021 By Dr. Shazia Khalfe 5
Cervical Spondylosis

6. •Aging is the major factor for
developing cervical osteoarthritis
(cervical spondylosis). In most
people older than age 50, the discs
between the vertebrae become less
spongy and provide less of a
cushion. Bones and ligaments get
thicker, encroaching on the space of
the spinal canal.
3/22/2021 By Dr. Shazia Khalfe 6
Risk Factors for Cervical
Spondylosis

7. •Another factor might be a previous
injury to the neck. People in certain
occupations or who perform specific
activities -- such as gymnasts or
other athletes -- may put more
stress on their necks.
3/22/2021 By Dr. Shazia Khalfe 7
Risk Factors for Cervical
Spondylosis

8. •Poor posture might also play a role
in the development of spinal
changes that result in cervical
spondylosis.
•Work-related Activities That Put
Extra Strain On Your Neck From
Heavy Lifting
3/22/2021 By Dr. Shazia Khalfe 8
Risk Factors for Cervical
Spondylosis

9. •Genetic Factors (Family History Of
Cervical Spondylosis)
•Smoking
•Increased incidence in patients who
carried heavy loads on their heads
or shoulders and in dancers and
gymnasts.
3/22/2021 By Dr. Shazia Khalfe 9
Risk Factors for Cervical
Spondylosis

10. •Evidence of spondylotic change is
frequently found in many
asymptomatic adults, with evidence
of some disc degeneration in:
•25% of adults under the age of 40,
•50% of adults over the age of 40,
and
•85% of adults over the age of 60
3/22/2021 By Dr. Shazia Khalfe 10
Epidemiology

11. •Asymptomatic adults showed
significant degenerative changes at
1 or more levels
•70% of women and 95% of men at
age 65 and 60 were affected
•The most common evidence of
degeneration is found at C5-6
followed by C6-7 and C4-5".
3/22/2021 By Dr. Shazia Khalfe 11
Epidemiology

12. •The primary risk factor and
contributor to the incidence of
cervical spondylosis is age-related
degeneration of the intervertebral
disc and cervical spinal elements.
3/22/2021 By Dr. Shazia Khalfe 12
Etiology

13. •Degenerative changes in surrounding
structures, including the facet
joints, posterior longitudinal
ligament (PLL), and ligamentum flavum all
combine to cause narrowing of the spinal
canal and intervertebral foramina.
Consequently, the spinal cord, spinal
vasculature, and nerve roots can be
compressed, resulting in the three clinical
syndromes in which cervical spondylosis
presents: axial neck pain,
cervical myelopathy, and
cervical radiculopathy.
3/22/2021 By Dr. Shazia Khalfe 13
Etiology

14. •Factors that can contribute to an
accelerated disease process and
early-onset cervical spondylosis
include exposure to significant spinal
trauma, a congenitally narrow
vertebral canal, dystonic cerebral
palsy affecting cervical musculature,
and specific athletic activities such
as rugby, soccer, and horse riding.
3/22/2021 By Dr. Shazia Khalfe 14
Etiology

15. Cervical spondylosis presents in three
symptomatic forms as:
•Non-specific neck pain - pain
localized to the spinal column.
•Cervical radiculopathy - complaints
in a dermatomal or myotomal
distribution often occurring in the
arms. May be numbness, pain or
loss of function.
3/22/2021 By Dr. Shazia Khalfe 15
Clinical Presentation

16. •Cervical myelopathy - a cluster of
complaints and findings due to
intrinsic damage to the spinal cord
itself. Numbness, coordination and
gait issues, grip weakness and
bowel and bladder complaints with
associated physical findings may be
reported.
3/22/2021 By Dr. Shazia Khalfe 16
Clinical Presentation

17. •Symptoms can depend on the stage
of the pathological process and the
site of neural compression.
Diagnostic imaging may show
spondylosis, but the patient may be
asymptomatic and vice versa. Many
people over 30 show similar
abnormalities on plain radiographs
of the cervical spine, so the
boundary between normal ageing
and disease is difficult to define.
3/22/2021 By Dr. Shazia Khalfe 17
Clinical Presentation

18. •Poorly localized tenderness
•Limited range of motion
•Minor neurological changes (unless
complicated by myelopathy or
radiculopathy)

3/22/2021 By Dr. Shazia Khalfe 18
Signs

19. •Cervical pain aggravated by movement
•Referred pain (occiput, between the
shoulder blades, upper limbs)
•Retro-orbital or temporal pain
•Cervical stiffness
•Vague numbness, tingling or weakness in
upper limbs
•Dizziness or vertigo
•Poor balance
•Rarely, syncope, triggers migraine
3/22/2021 By Dr. Shazia Khalfe 19
Symptoms

20. •On basis of Sign & Symptoms
•History
•Physical examination with a focus
on the neck, back, and shoulders
•Reflexes, ROM, Muscle strength &
power are evaluated
•Sensory and motor evaluation
•X-Ray, MRI etc..

3/22/2021 By Dr. Shazia Khalfe 20
Diagnosis

21. •Neck Disability Index
•The Patient-Specific Functional
Scale (PSFS) for patients with
neck pain
•Performance‐based outcome
measures
3/22/2021 By Dr. Shazia Khalfe 21
Outcome Measures

22. •Contains 10 items (7 related to
ADLs, 2 related to pain, 1 related to
concentration)
•Each item is scored 0 – 5 and the
total score is expressed as a
percentage
•Higher scores correspond to greater
disability
3/22/2021 By Dr. Shazia Khalfe 22
Neck Disability Index

23. •Ask patient to list 3 activities that are
difficult as a result of their
symptoms/injury/disorder
•The patient rates each activity on a scale of
0 – 10; 0 represents inability to perform the
activity and 10 represents the ability to
perform the activity as well as they could
prior to the onset of symptoms
•The 3 activity scores are averaged for a
final score
3/22/2021 By Dr. Shazia Khalfe 23
The Patient-Specific Functional Scale (PSFS) for
patients with neck pain

24. •Movement or activity limitations
associated with the patient’s neck
pain and be used to assess the
changes in the patient’s level of
function over the episode of care.
These activities should be
measurable and reproducible.
3/22/2021 By Dr. Shazia Khalfe 24
Performance‐based outcome
measures

25. •When evaluating a patient with neck
pain over an episode of care,
assessment of impairment of body
function should include measures that
can rule in or rule out:
•neck pain with mobility deficits,
including cervical active range of
motion, the flexion rotation test, cervical
and thoracic segmental mobility tests,
and
•neck pain with radiating pain/cervical
radiculopathy, including the upper limb
tension test, Spurling's test, distraction
test, and the Valsalva test.
3/22/2021 By Dr. Shazia Khalfe 25

26. •Posture
•Functional movement
•ROM
•Muscle strength
•Neurologic Assessment
•Reflexes
•MMT
•Special tests
3/22/2021 By Dr. Shazia Khalfe 26
Observation

27. •The patient is positioned in supine. During
the ULTT that places a bias towards
testing the patient’s response to tension
placed on the median nerve, the examiner
sequentially introduces the following
movements to the symptomatic upper
extremity. Scapular depression
•Shoulder abduction to approximately 90
degrees with the elbow flexed
•Forearm supination, wrist and finger
extension
•Shoulder lateral rotation
•Elbow extension
•Contralateral then ipsilateral cervical side-
bending
3/22/2021 By Dr. Shazia Khalfe 27
Neck Flexor Muscle Endurance
Test

28. •A positive test is indicated by the
presence of any of the following
findings: Reproduction of all or part
of the patient’s symptoms
•Side-to-side differences of greater
than 10 degrees of elbow or wrist
extension
•On the symptomatic side,
contralateral cervical side-bending
increases the patient’s symptoms, or
ipsilateral side-bending decreases
the patient’s symptoms
3/22/2021 By Dr. Shazia Khalfe 28

29. 1.Shoulder girdle depression
2.Shoulder abduction
3.Shoulder external rotation
4.Forearm Supination
5.Wrist and Finger extension
6.Elbow extension
7.Cervical side flexion
3/22/2021 By Dr. Shazia Khalfe 29
Upper Limb Tension Test 1
(ULTT1, Median nerve bias)

30. 1.Shoulder girdle depression
2.Elbow extension
3.Lateral rotation of the whole arm
4.Wrist, finger and thumb extension
3/22/2021 By Dr. Shazia Khalfe 30
Upper Limb Tension Test 2A
(ULTT2A, Median nerve bias)

31. •Shoulder girdle depression
•Elbow extension
•Medial rotation of the whole arm
•Wrist, finger and thumb flexion
3/22/2021 By Dr. Shazia Khalfe 31
Upper Limb Tension Test 2B
(ULTT2B, Radial nerve bias)

32. •The patient is seated and asked to side
bend and slightly rotate head to the
painful side.
•The clinician places a compressive
force of approximately 7 kg through the
top of the head in an effort to further
narrow the intervertebral foramen.
•The test is considered positive when it
reproduces the patient’s symptoms.
The test is not indicated if the patient
does not have upper extremity or
scapular region symptoms.
3/22/2021 By Dr. Shazia Khalfe 32
Spurling’s Test

33. •The patient is positioned in supine.
•The examiner grasps under the chin
and occiput, flexes the patient’s
neck to a position of comfort, and
gradually applies a distraction force
of up to approximately 14 kg.
•A positive test occurs with the
reduction or elimination of the
patient’s upper extremity or scapular
symptoms. The test is not indicated
if the patient has no upper extremity
or scapular region symptoms.
3/22/2021 By Dr. Shazia Khalfe 33
Distraction Test

34. •Other non-specific neck pain lesions -
acute neck strain, postural neck ache
or Whiplash
•Fibromyalgia and psychogenic neck pain
•Mechanical lesions - disc prolapse or
diffuse idiopathic skeletal hyperostosis
•Inflammatory disease - Rheumatoid
arthritis, Ankylosing
spondylitis or Polymyalgia rheumatica
•Metabolic diseases - Paget's
disease, osteoporosis, gout or pseudo-
gout, Infections -
osteomyelitis or tuberculosis
•Malignancy - primary tumours, secondary
deposits or myeloma
3/22/2021 By Dr. Shazia Khalfe 34
Differential Diagnosis

35. •Medical management
i.Non surgical
ii.Surgical
•Physical therapy management

3/22/2021 By Dr. Shazia Khalfe 35
Treatment

36. •There is little evidence for using
exercise alone or mobilisation and/or
manipulations alone.
•Mobilisation and/or manipulations in
combination with exercises are
effective for pain reduction and
improvement in daily functioning in sub-
acute or chronic mechanical neck pain
with or without headache.
•There is moderate evidence that
various exercise regimens, like
proprioceptive, strengthening,
endurance, or coordination exercises
are more effective than usual
pharmaceutical care
3/22/2021 By Dr. Shazia Khalfe 36
Physical Therapy Management

37. •Treatment should individualised, but
generally includes rehabilitation
exercises, proprioceptive re-
education, manual therapy and
postural education
•Manual therapy
•Postural education
•Electrotherapeutic modalities
•Patient education
•Home exercises
3/22/2021 By Dr. Shazia Khalfe 37
Physical Therapy Management

38. •A Costello M et al 2018 study
comparing isometric exercises to
dynamic exercises, both with
traditional physiotherapeutic
methods concluded that short-term
physiotherapy plays a significant
role in the treatment of cervical
spondylosis. Comparison between
the two treatment techniques gives
priority to dynamic exercises,
contrary to isometric exercises
3/22/2021 By Dr. Shazia Khalfe 38
Physical Therapy Management

39. •Physical modalities such as cervical
traction, heat, cold, therapeutic
ultrasound, massage, and
transcutaneous electrical nerve
stimulator (TENS) lacked sufficient
evidence regarding their efficacy in
the treatment of acute or chronic
neck pain.
•In patients experiencing radicular
pain, cervical traction may be
incorporated to alleviate the nerve
root compression that occurs with
foraminal stenosis
3/22/2021 By Dr. Shazia Khalfe 39
Philadelphia Panel finding

40. •Trigger point injections can be
employed to treat myofascial trigger
points, which can clinically manifest
as neck, shoulder, and upper arm
pain.
3/22/2021 By Dr. Shazia Khalfe 40

41. 3/22/2021 By Dr. Shazia Khalfe 41

42. • Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks
C, Robertson EK, Altman RD, Beattie P, Boeglin E. Neck Pain: Revision 2017:
Clinical Practice Guidelines Linked to the International Classification of
Functioning, Disability and Health From the Orthopaedic Section of the American
Physical Therapy Association. Journal of Orthopaedic & Sports Physical
Therapy. 2017 Jul;47(7):A1-83.
•Flynn TW, Cleland JA, Whitman JM. User’s Guide to the Musculoskeletal
Examination: Fundamentals for the Evidence Based Clinician. Evidence in
Motion. 2008.
•Osman A et al. The Pain Catastophizing Scale:Further Psychometric Evaluation
with Adult Samples. Journal of Behavioral Medicine. 2000; Vol.23(4): 351-365.
• Rivest K et al. Relationships between pain thresholds, catastrophizing and
gender in acute whiplash injury. Journal of Manual Therapy. 2010; Vol 15:154-
159.
•Childs JD et al. Neck Pain: Clinical Practice Guidelines Linked to the
International Classification of Functioning, Disability, and Health From the
Orthopaedic Section of the American Physical Therapy Association. The Journal
of Orthopaedic Sports Physical Therapy. 2008;38(9):A1-A34.
•O’Sullivan SB, Schmitz TJ. Physical Rehabilitation: Fifth Edition. Philadelphia:
F.A. Davis Company; 2007.
• Murphy DR, Hurwitz EL. A theoretical model for the development of a diagnosis-
based clinical decision rule for the management of patients with spinal pain.
BMC Musculoskelet Disord. 2007, Aug 3;8:75.
3/22/2021 By Dr. Shazia Khalfe 42
References

43. •Kuo DT, Tadi P. Cervical Spondylosis. InStatPearls [Internet] 2019 Nov 26. StatPearls
Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551557/ (last
accessed 31.1.2020)
•Xiong W, Li F, Guan H. Tetraplegia after thyroidectomy in a patient with cervical
spondylosis: a case report and literature review. Medicine (Baltimore) 2015;94(6):e524.
Available from:https://www.ncbi.nlm.nih.gov/pubmed/25674751 (last accessed 1.2.2020)
•Ferrara LA. The biomechanics of cervical spondylosis. Advances in orthopedics. 2012
Feb 1;2012. Available from: https://www.hindawi.com/journals/aorth/2012/493605/ (last
accessed 1.2.2020)
•Singh S, Kumar D, Kumar S. Risk factors in cervical spondylosis. Journal of clinical
orthopaedics and trauma. 2014 Dec 31;5(4):221-6.
•D.H. Irvine, J.B. Foster, Prevalence of cervical spondylosis in a general practice, The
Lancet, May 22 1965
•Sandeep S Rana, MD, Diagnosis and Management of Cervical Spondylosis. Medscape,
2015
•Kelly JC, Groarke PJ, Butler JS, Poynton AR, O'Byrne JM. The natural history and clinical
syndromes of degenerative cervical spondylosis. Advances in orthopedics. 2011 Nov
28;2012.
•Moon MS, Yoon MG, Park BK, Park MS. Age-Related Incidence of Cervical Spondylosis
in Residents of Jeju Island. Asian spine journal. 2016 Oct 1;10(5):857-68.
•McCormack BM, Weinstein PR. Cervical spondylosis. An update. West J Med. Jul-Aug
1996;165(1-2):43-51.
•Takagi I, Cervical Spondylosis: An Update on Pathophysiology, Clinical Manifestation, and
Management Strategies. DM, October 2011
•Binder AI. Cervical spondylosis and neck pain. BMJ: British Medical Journal. 2007 Mar
10;334(7592):527.
3/22/2021 By Dr. Shazia Khalfe 43
References

44. •Ellenberg MR, Honet JC, Treanor WJ. Cervical radiculopathy. Arch Phys Med Rehabil.
Mar 1994;75(3):342-52
•Heller JG. The syndromes of degenerative cervical disease. Orthop Clin North Am. Jul
1992;23(3):381-94. (Level: A1)
• Kaye JJ, Dunn AW. Cervical spondylotic dysphagia. South Med J. May 1977;70(5):613-
4. (Level: A1)
•Kanbay M, Selcuk H, Yilmaz U. Dysphagia caused by cervical osteophytes: a rare case.
J Am Geriatr Soc. Jul 2006;54(7):1147-8. (Level: C)
•Binder AI. Cervical spondylosis and neck pain: clinical review. BMJ 2007:334:527-31
• Zhijun Hu et al., A 12-Words-for-Life-Nurturing Exercise Program as an Alternative
Therapy for Cervical Spondylosis: A Randomized Controlled Trial, 20 March 2014
•J. Lafuente, A.T.H. Casey, A. Petzold, S. Brew, The Bryan cervical disc prosthesis as
an alternative to arthrodesis in the treatment of cervical spondylosis, The Bone and
Joint Journal, 2005.
•M. Pumberger, D. Froemel, Clinical predictors of surgical outcome in cervical
spondylotic myelopathy, The Bone and Joint Journal, 2013
• Fukui M, Chiba K, Kawakami M, Kikuchi SI, Konno SI, Miyamoto M, Seichi A,
Shimamura T, Shirado O, Taguchi T, Takahashi K. Japanese orthopaedic association
cervical myelopathy evaluation questionnaire (JOACMEQ): Part 2. Endorsement of the
alternative item. Journal of Orthopaedic Science. 2007 May 1;12(3):241.
• Revanappa KK, Rajshekhar V. Comparison of Nurick grading system and modified
Japanese Orthopaedic Association scoring system in evaluation of patients with cervical
spondylotic myelopathy. European Spine Journal. 2011 Sep 1;20(9):1545-51.
• D.R. Lebl, A. Hughes, P.F. O’Leary, Cervical Spondylotic Myelopathy: Pathophysiology,
Clinical Presentation, and Treatment, the Musculoskeletal Journal of Hospital for
Special Surgery, Jul 2011.
• Hyun-Jin Jo et al., Unrecognized Shoulder Disorders in Treatment of Cervical
Spondylosis Presenting Neck and Shoulder Pain, The Korean Spinal Neurosurgery
Society, 9(3):223-226, 2012

3/22/2021 By Dr. Shazia Khalfe 44
References

45. • Todd AG. Cervical spine: degenerative conditions. Current reviews in musculoskeletal
medicine. 2011 Dec 1;4(4):168.
•Melvin D. Law, Jr., M.D.a, Mark Bemhardt, M.D.b, and Augustus A. White, III, M.D., Cervical
Spondylotic Myelopathy: A Review of Surgical Indications and Decision Making, Yale journal
of biology and medicine,1993
•Kyoung-Tae Kim and Young-Baeg Kim, Cervical Radiculopathy due to Cervical
Degenerative Diseases : Anatomy, Diagnosis and Treatment, The Korean Neurosurgical
Society, 2010 (Level: 2a)
• Rahim KA, Stambough JL. Radiographic evaluation of the degenerative cervical spine.
Orthop Clin North Am. Jul 1992;23(3):395-403. (Level: 3a)
•Heller JG. The syndromes of degenerative cervical disease. Orthop Clin North Am. Jul
1992;23(3):381-94. (Level: 4)
•Binder AI. Cervical spondylosis and neck pain: clinical review. BMJ 2007:334:527-31 (Level:
5)
•Kieran Michael Hirpara, Joseph S. Butler, Roisin T. Dolan, John M. O'Byrne, and Ashley R.
Poynton , Nonoperative Modalities to Treat Symptomatic Cervical Spondylosis, Advances in
Orthopedics, 2011 (Level: 1b)
•Ian A. Young, Lori A. Michener, Joshua A. Cleland, Arnold J. Aguilera, Alison R. Snyde,
Manual Therapy, Exercise, andTraction for Patients With Cervical Radiculopathy: A
Randomized Clinical Trial, 2009 (Level: 1b)
•Azemi, Arjeta & Ibrahimaj Gashi, Arbnore & Zivkovic, Vujica & Gontarev, Seryozha. (2018).
THE EFFECT OF DYNAMIC EXERCISES IN THE TREATMENT OF CERVICAL
SPONDYLOSIS. 7. 19-24.
•ichale Costello, Treatment of a Patient with Cervical Radiculopathy Using Thoracic Spine
Thrust Manipulation, Soft Tissue Mobilization, and Exercise, the Journal of Manual and
manipulative therapy (Level: 3b)
• Ibrahim M. Moustafa and Aliaa A. Diab, Multimodal Treatment Program Comparing 2
Different Traction Approaches for Patients With Discogenic Cervical Radiculopathy: A
Randomized Controlled Trial, Journal of Chiropractic Medicine (2014) 13, 157–167 (Level:
1b)
3/22/2021 By Dr. Shazia Khalfe 45
References

46. 3/22/2021 By Dr. Shazia Khalfe 46