Cervical spondylosis.pptx

CS

1. CERVICAL SPONDYLOSIS By Kirti singla

2. INTRODUCTION CERVICAL – C1 [ cervical vertebra] C2 C3 C4 C5 C6 C7 SPONDYLOSIS – Spondy [ spine] Losis [ degeneration]

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4. . Cervical spondylosis also called as cervical osteoarthritis is a term that encompasses a wide range of progressive degenerative changes that affect all the components of the cervical spine It is a natural process of aging and presents in the majority of people Neck pain is a widespread condition, and the second most common complaint after low back pain. This condition is associated with a significant burden of disease with substantial disability and economic cost , Although ageing is the primary cause, the location and rate of degeneration as well as degree of symptoms and functional disturbance varies.

5. EPIDEMIOLOGY 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 Asymptomatic adults showed significant degenerative changes at 1 or more levels The most common evidence of degeneration is found at C5-6 followed by C6-7 and C4-5".

6. RISK FACTORS 1. Ageing is the major factor for developing cervical O.A. [cervical spondylosis ] as the disc between the vertebra become less spongy and provide less of a cushion 2. Sedentary lifestyle 3. Occupational factors with repetitive movement of hands and fingers include prolong computer keyboarding and cell phone texting has played a large role in increased prevelence of neck pain in past 20 years 4. Previous injury to neck 5. Pressure on neck such as gymnast 6. Poor posture might also play role in development of spinal changes that result in cervical spondylosis

7. ETIOLOGY Dehydrated Disc- It act like cushions between the vertebra of spine . By the age of 40 , most people spinal disc begin to dry and shrink which allows more bone to bone contact between the vertebra Herniated disc- Bulging or herniated disc which sometimes can press the spinal cord and nerve root Bone spurs- Disc degeneration often result in the spine producing extra amount of bone sometime called bone spur, pinch the spinal cord and nerve roots Stiff ligaments – ligaments are tissue that connects bone to bone . Increasing age can make spinal ligament stiffen and calcify making neck less flexible

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9. SYMPTOM Neck stiffness and pain Headache that may originate in the neck Pain in the shoulder or arms Tingling , numbness and weakness in arms , hands, legs, or feet Lack of coordination and difficulty walking Abnormal reflexes Muscle spasm Pain shooting down into one or both arms

10. COMPONENT COMPONENT THAT AFFECTED BY CERVICAL SPONDYLOSIS ARE- 1. MUSCLE 2. DISC 3. SPINAL CORD 4. BONE

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12. CLINICAL PRESENTATION Three clinical syndromes in which cervical spondylosis presents: 1. Axial neck pain, [ Muscle] 2. Cervical  Myelopathy , [spinal cord] 3. Cervical  Radiculopathy [disc]

13. CLINICAL PRESENTATION Axial neck pain Commonly complain of stiffness and pain in the cervical spine that is most severe in the upright position and relieved with bed rest when removing the load from the neck Neck motion, especially in hyperextension and side-bending, typically increases the pain In upper and lower cervical spine disease, patients may report radiating pain into the back of the ear or occiput versus radiating pain into the superior trapezius or periscapular musculature, respectively

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15. CERVICAL RADICULOPATHY  - This occurs when the root of a nerve is pressed on or damaged as it comes out from the spinal cord in the neck (cervical) region Radicular symptoms usually follow a myotomal distribution depending on the nerve root(s) involved and can present as unilateral or bilateral neck pain, arm pain, scapular pain, paraesthesia , and arm or hand weakness Degenerative changes to the joints around the vertebrae and osteophyte formation produce areas of narrowing which may impinge the nerve. Prolapse disc can or cannot affect the nerve and cause radiculopathy

16. . , Symptoms of radiculopathy include loss of feeling (numbness), pins and needles, pain and weakness in parts of an arm or hand supplied by the nerve. These other symptoms may actually be the main symptoms rather than neck pain. There may be shooting pains down into the arm. The symptoms are usually worse in one arm, but may affect both. The pain may be severe enough to interfere with sleep. The lower cervical vertebrae are the usual ones affected, causing these symptoms in the arms. However, if the upper vertebrae are involved, the pain and numbness occur at the back and the side of the head A doctor's examination may show changes to the sensation, power and tendon reflexes to areas of the arm supplied by the affected nerve.

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18. 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. Can initially present with hand weakness and clumsiness, resulting in the inability to complete tasks requiring fine motor coordination (e.g., buttoning a shirt, tying shoelaces, picking up small objects) Frequent reports of gait instability and unexplained falls Urinary symptoms (i.e., incontinence) are rare and typically appear late in disease progression

19. CERVICAL MYELOPATHY This occurs when there is pressure on or damage to the spinal cord itself. Again, cervical spondylosis is a common cause of this condition as the degenerative changes to the vertebra can narrow the canal through which the spinal cord passes. A prolapse of a cervical disc can also cause myelopathy if the prolapse is into the central canal of the vertebra. a tumour or infection can also affects this part of the spinal cord

20. . The symptoms of a cervical myelopathy may include: 1. Difficulties with walking. For example, the legs may feel stiff and clumsy. Can initially present with hand weakness and clumsiness, resulting in the inability to complete tasks requiring fine motor coordination (e.g., buttoning a shirt, tying shoelaces, picking up small objects 2. Changes to the sensation of the hands. For example, it may be difficult to feel and recognise objects in the usual way and you may have a tendency to drop things. 3. Problems with your bladder. For example, you may experience problems with emptying your bladder, or incontinence. A doctor's examination may show changes to the sensation, power and tendon reflexes to the legs and arms

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22. EXAMINATION. As osteoarthritis is primarily a clinical diagnosis, patient history and the physical examination is usually sufficient to make a confident diagnosis. Joint pain and limited range of motion are usual symptoms in patients with cervical osteoarthritis. The pain tends to worsen with activity, especially following a period of rest . Physical examination follows a normal cervical examination and includes: - 1. Inspection: posture, oedema , erythema , evidence of trauma, muscle atrophy, skin abnormalities and joint deformity.

23. . 2. Palpation of facet joints, examining of anatomic abnormality, temperature . 3. Range of motion of the cervical region and shoulder region. 5. Neurological evaluation: motor and sensory evaluation of sensation, reflexes and muscle strength. 6. Muscle testing: searching for myofascial trigger points in the sternocleidomastoid , cervical paraspinal muscles, levator scapulae, the upper trapezius and suboccipital musculature. 

24. INVESTIGATION An x-ray can reveal any physical damage to the spine, and whether there are any bone spurs. If the patient has severe, radiating arm pain that does not improve, an MRI test may be useful for looking at the nerve roots, as there could be a  herniated disc . An MRI scan can also help pinpoint exactly where the problem is, and whether surgery is necessary. A myelogram  is another diagnostic test. A health professional will inject a colored dye into the spine. This dye shows in imaging scans, such as x-rays. A CT scan can help to assess the bony structure of the cervical spine. Electromyography (EMG) and nerve conduction studies (NCS) can help to assess specific muscles and ne

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