What Is Cervical Spondylosis?
Cervical spondylosis is a natural wear process that includes the discs in the neck vertebrae thinning with age, bony spurs (osteophytes) forming at the edges of the vertebrae, and arthrosis developing in the joints. Like lumbar wear, seeing wear on an image does not always mean there will be pain or another symptom. What matters is whether the wear is compressing the structures in the neck — the nerve roots or the spinal cord. For this reason the treatment decision rests not on the image but on the patient's symptoms and examination findings.
Symptoms: From Neck Pain to Arm Radiation
The most common symptom is neck pain and stiffness; this is usually benign and passes without surgery. When the wear compresses a nerve root (cervical radiculopathy), pain, numbness or weakness can radiate to the arm and fingers — relief on placing the arm in a certain position is typical. In some patients tension-type headache and dizziness may accompany it. Most of these symptoms regress over time and with non-surgical treatment; the real thing to watch for is a more serious picture in which the spinal cord is under pressure.
Myelopathy: The Picture That Must Be Taken Seriously
The most important complication of cervical spondylosis is the wear narrowing the spinal canal and pressing on the spinal cord (cervical myelopathy). Its warning signs differ from ordinary neck pain: loss of hand dexterity (difficulty buttoning, holding a pen, picking up coins), widespread weakness in the arms or legs, unsteadiness and stiffness when walking, urinary urgency. If these symptoms are present, the picture cannot be regarded as 'ordinary age-related wear'; spinal-cord compression should be assessed with MRI and the surgical option discussed. In myelopathy, early evaluation is important to prevent progressive damage.
Treatment: According to Symptom and Compression
In cervical spondylosis that runs asymptomatic or with mild neck pain, treatment is non-surgical: physiotherapy that strengthens the neck and upper-back muscles, posture adjustment, pain-relieving medication and ergonomic measures. In arm-radiating pain due to nerve-root compression (radiculopathy), interventional procedures may be considered in addition to these; most radiculopathy regresses without surgery. Surgery comes up in resistant nerve compression that does not respond to non-surgical treatment and, especially, in signs of spinal-cord compression (myelopathy); in this case decompression is performed via an anterior or posterior approach, with stabilisation when needed. The method is chosen according to the site of compression and the patient's anatomy.
Realistic Expectations and Prevention
The honest picture in neck wear is this: the wear is irreversible, but the great majority find relief with non-surgical methods and continue an active life. The group needing surgery is a minority, generally those with signs of nerve or spinal-cord compression. The most effective prevention is keeping the neck and shoulder muscles strong, avoiding prolonged forward-bent screen use (phone/computer ergonomics) and a correct pillow and sleeping position. Knowing the warning signs of myelopathy (loss of hand dexterity, unsteady walking) and getting an evaluation without delay if they appear is the most important point.