Cervical Spondylitis

What is Cervical Spondylitis?

Cervical spondylitis is a common degenerative condition of the cervical (neck) spine that most likely is caused by age-related changes (wear and tear) in the intervertebral disc and vertebrae of the neck. Research has shown that CSM (cervical spondylotic myelopathy) is the most common cause of non-traumatic weakness in limbs and a persistent stiffness and nagging pain in the neck.
‘Spondylo’ is a Greek word-meaning vertebra. Spondylitis (or Spondylosis) means changes in the vertebral joint characterized by increasing degeneration of the intervertebral disc with subsequent changes in the bones and soft tissues.
Most often in people above the age of 40, the intervertebral discs get progressively dehydrated and they become more compressible and less elastic. Mineral deposition starts occurring in the intervertebral disc resulting in secondary changes. Although majority of individuals over 40 years of age demonstrate significant radiological evidence of the above changes, only a small percentage develop symptoms of the same. Another noteworthy point is that sometimes the degenerative changes in the cervical spine can be visible on the X-ray as early as in 30’s but it does not call for any treatment if the patient is not symptomatic.
The above changes result in compression of the nerves leading to radiculopathy (pain, numbness, weakness and loss of reflex due to compression and irritation of spinal nerve) or compression of the spinal cord resulting in cervical spondylotic myelopathy (CSM) (commonly caused by spinal stenosis resulting in loss of movements and sensation). Both the neural and spinal cord compression will result in radiculomyelopathy.

Cervical Spondylosis Exercises

Disclaimer: These groups of exercises do not intended to substitute for any that may have been prescribed by your doctor. If you experience any discomfort or pain while performing these activities, stop immediately and seek medical attention. It is advisable to do these exercises and yogasanas under supervision.
Given below are a group of isometric exercises and yogasanas that may be beneficial to relieve and prevent neck pain. These exercise in general helps to build strength, flexibility, and increase range of motion.

Isometric exercise:

They help to strengthen the neck muscles. In isometric exercise, there is very little or no joint movement. In these exercises, the hand provides resistance. It is important to begin these exercises in an erect position. So, sit up straight and slightly tuck your chin before beginning.
Neck extension – Place your palms at the base of the head and apply light forward pressure. Meet the resistance with your head and neck.
Side bending – Sit erect with your head in a neutral position; place your palms above/around the ear. Apply light pressure with the hand and meet the resistance with the head.
Neck flexion – Place the index and middle fingers of both your hands in between your eyes, and apply light backward pressure, meet the resistance with your head and neck.

Flexibility exercise:

These exercises help to relieve spasm and improve neck mobility.
Neck flexion : Sit erect; bend your head forward, try to touch your chin on your chest. Hold for 5 seconds. Repeat 8-10 times.neck.
Neck extension – Take your head back so that your chin is pointing upwards. Repeat 8-10 times.
Neck rotation – Sit erect; then first turn your head slowly to the right. Move it back to the forward position. Relax. Then move it to the left. Repeat 8-10 times.
Neck side bend : Sit erect; tilt your head so that your right ear moves toward your right shoulder. Then tilt your head so your left ear moves toward your left shoulder. Make sure you do not rotate your head while tilting or raise your shoulder toward your head. Repeat this exercise 8-10 times in each direction.

Cervical Spondylitis Causes

Cervical spondylitis results due to abnormal wear of the cartilage and bones of the neck (cervical vertebrae) with degeneration and mineral deposits in the cushions between the vertebrae (cervical disks). This is more common after the age of 40 years.

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  • Repeated occupational trauma e.g., carrying loads on head, professional dancing, gymnastics may contribute.
  • Predisposition to development of cervical spondylitis has been reported in certain families; a genetic cause is possible.
  • Smoking also may be a risk factor.
  • Conditions like congenitally fused spine, cerebral palsy, Down syndrome etc. may be risk factors for spondylotic disease.
  • Doing work that demands minute concentration, people who constantly work by bending their neck
  • Computer professionals, bike users
  • Travelers who travel a long distance and sleep in sitting position
  • Telephone operators or persons who often cradle the phone on the shoulder
  • Habit of holding neck in one position, drivers who keep the neck in the same position for a long time, watching TV in abnormal positions or when lying down
  • Old people

Cervical Spondylitis Symptoms

Clinically, several groups of symptoms, both overlapping and distinct, are seen: neck and shoulder pain, sub-occipital pain and headache, radicular symptoms, and cervical spondylotic myelopathy (CSM).
The most common symptom is intermittent persistent neck and shoulder pain. The pain can be chronic or episodic, associated with long periods of remission.

  • Neck pain is often accompanied by stiffness which progressively worsens. Pain may also radiate to the shoulders or to the occiput. Many patients present with interscapular pain, pain in the arm, forearm, and/or hand pain.
  • Non-specific headaches occurring mostly in the sub-occipital region (lower part at the back of head) and this pain radiates to the base of the neck and to the vertex (top) of the head.
  • Patients without any history of trauma present with pain, loss of sensation, abnormal sensations and weakness, or a combination of these symptoms. These symptoms are often present in the shoulders, arms and rarely in the legs.
  • Occasionally, the pain may be atypical and present as chest pain or breast pain (false angina).
  • Patients with myelopathy can present with symptoms such as difficulty in writing; nonspecific, diffuse weakness; and abnormal sensations.
  • Loss of sphincter control and urinary incontinence occurs in very rare cases, but some patients complain of urgency, frequency, and urinary hesitancy

Cervical Spondylitis Diagnosis

Clinical evaluation is immensely important for the diagnosis of cervical spondylitis. The findings can be confirmed by:

  • X-ray of neck (cervical spine) which may show development of spurs (bony outgrowths) on the vertebrae.
  • MRI (Magnetic resonance imaging) can be done to confirm diagnosis and judge the extent of neural damage, if any.
  • EMG (Electromyelography) can help in diagnosing cervical radiculopathy.
  • Myelography is used to demonstrate nerve root lesion.

Do’s and Don’ts

Do’s

  • Do regular exercise to maintain neck strength, flexibility and range of motion.
  • Use firm mattress, thin pillow.
  • Do turn to one side while getting up from lying down position.
  • Wear a cervical collar during the day.
  • Regularly walk or engage in low-impact aerobic activity.
  • In order to avoid holding the head in the same position for long periods, take break while driving, watching TV or working on a computer.
  • Use a seat belt when in a car and use firm collar while traveling.
  • When in acute pain take rest, immobilize the neck, and take medications as directed.

Don’ts

  • Avoid sitting for prolonged period of time in stressful postures.
  • Avoid running and high-impact aerobics, if you have any neck pain.
  • Do not lift heavy weights on head or back.
  • Avoid bad roads, if traveling by two or four wheelers.
  • Do not drive for long hours; take breaks.
  • Avoid habit of holding the telephone on one shoulder and leaning at it for long time.
  • Do not take many pillows below the neck and shoulder while sleeping.
  • Do not lie flat on your stomach.
  • In order to turn around, do not twist your neck or the body; instead turn around by moving your feet first.
  • Do not undergo spinal manipulations if you are experiencing acute pain.

What are the bad postures that can worsen cervical spondylitis?

1. The head held forward from normal position
2. The shoulders held up and forward
3. The chest bent and rounded
4. The pelvic area tilted backwards
5. The hips, knees and ankles bent

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