Degenerative cervical spine disease

Degenerative cervical spine disease (cervical spondylosis) is osteoarthritis of the spine, which includes the spontaneous degeneration of either disc or facet joints.

Patients typically present with axial neck pain. Most commonly the degeneration is asymptomatic, even though cervical radiographs and magnetic resonance imaging (MRI) may show severe, spontaneous degenerative disease. Neurological complications can occur if the degeneration includes neurological compression.

Neurological complications are common in patients with degenerative cervical spine disease; these include cervical spondylotic radiculopathy, with nerve root compression, and loss of neurological function from pressure on the spinal cord (degenerative cervical myelopathy). Cervical radiculopathy involves typically only a single nerve root territory, whereas cervical myelopathy can cause more diffuse sensory loss, weakness, and reduction or loss of function in the upper (and sometimes lower) extremities.

Treatments differ radically depending on patient presentation, specific symptoms, and whether arthritis-related pain or neurological complications predominate.

Neurological complications may respond to surgical decompression if symptoms do not abate after treatment with conservative measures, depending on their longevity and severity.

Cervical spondylosis is the specific term for osteoarthritis of the cervical spine (the neck), which consists of the seven uppermost vertebrae of the vertebral column (C1 to C7). Cervical spondylosis can present with spontaneous degeneration of either disc or facet joints. Alternative terms include degenerative cervical spondylosis, cervical degenerative disease, cervical spondylosis, cervical osteoarthritis, and neck arthritis.[1]Theodore N. Degenerative cervical spondylosis. N Engl J Med. 2020 Jul 9;383(2):159-68. http://www.ncbi.nlm.nih.gov/pubmed/32640134?tool=bestpractice.com ​

This spontaneous degeneration is commonly asymptomatic and age-related. It can lead to either arthritis-specific symptoms referable to the neck (i.e., loss of joint motion, pain on motion, joint incompetency) or neurological complications secondary to the joint degeneration, including pressure on either the spinal cord (degenerative cervical myelopathy, formerly known as cervical spondylotic myelopathy) and/or cervical nerve roots (cervical spondylotic radiculopathy).[Figure caption and citation for the preceding image starts]: Severe, multi-level degenerative disc disease changes but without significant spinal cord compression (i.e., neither deformation nor intrinsic T2 changes) on cervical MRI (sagittal T2)Dennis A. Turner, MA, MD [Citation ends].[Figure caption and citation for the preceding image starts]: Cervical MRI (sagittal T2) with mild degenerative joint disease and disc bulgingDennis A. Turner, MA, MD [Citation ends].[Figure caption and citation for the preceding image starts]: Cervical MRI (sagittal T2) with moderate degenerative joint disease but no significant spinal cord compressionDennis A. Turner, MA, MD [Citation ends].