Section 6. Brain, Spinal Cord, and Nerve Disorders

Chapter 93. Spinal Cord Disorders

Topics: Introduction | Accident-Related Injuries | Spinal Cord Compression | Cervical Spondylosis | Spinal Hematoma | Syrinx | Hereditary Spastic Paraparesis | Acute Transverse Myelitis | Blockage of the Blood Supply | Subacute Combined Degeneration of the Spinal Cord

Cervical Spondylosis

Cervical spondylosis is a disorder in which the disks and vertebrae in the neck degenerate, putting pressure on the spinal cord in the neck.

Cervical spondylosis usually affects middle-aged and older people. With aging, the bone of the spine overgrows and narrows the spinal canal in the neck. As a result, the spinal cord or the spinal nerve roots (the part of spinal nerves located next to the cord (see Section 6, Chapter 76)) are compressed, causing dysfunction.

Symptoms

Symptoms may reflect compression of the spinal cord, the spinal nerve roots, or both. If the spinal cord is compressed, a change in walking is usually the first sign. Leg movements may become jerky (spastic), and walking becomes unsteady. The neck may be painful. If the spinal nerve roots are compressed, weakness in one or both arms may develop, and the muscles may waste away. The neck is likely to be painful. Nerve root compression may be accompanied by or progress to spinal cord compression.

Diagnosis and Treatment

When doctors suspect cervical spondylosis, magnetic resonance imaging (MRI) or myelography with computed tomography (CT) is performed. MRI provides slightly more information, but myelography with CT may be more available. These procedures show where the spinal canal is narrowed, how compressed it is, and which spinal nerve roots may be affected. MRI has generally replaced x-rays of the neck.

Without treatment, spinal cord dysfunction due to cervical spondylosis sometimes lessens or stabilizes, but it may progress. Initially, a soft neck collar, neck traction, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (see Section 6, Chapter 78), and muscle relaxants such as cyclobenzaprine may provide relief. However, when the disorder progresses or when MRI shows severe compression or collapsed or displaced vertebrae, surgery is usually needed. As a rule, surgery does not reverse changes that have already occurred, because the pathways in the spinal cord become permanently damaged unless the disorder is treated very early.