CERVICAL

SPONDYLOSIS

Dr. ALKA
BNYS, MD (Nutrition and dietetics) Jr.2
CONTENT
Case Study
Anatomy of Spine
Introduction
Epidemiology
Etiology
Pathophysiology
Clinical Features
Diagnosis
• Differential Diagnosis
• Management
 CASE STUDY

Name- Anjali
Age- 21yrs.
Gender- Female
Occupation- MBBS 3rd Year Student
Presenting complaints: Neck pain from past 2 months.
Neck stiffness from past 2 months.
History of presenting complaints: Patient was apparently well until 2 months back, she was reportedly
suffering from cervical pain at C5 to C7, the pain is onset after waking up in the morning, she is unable to move
or bend the neck to the right side due to stiffness of neck muscles, the pain is aggravated after a long sitting and
it is relieved by after walking and doing some neck exercises.
Past history: N/C/O DM, TB, HTN, COPD
Medical history: Taking allopathic treatment.
Surgical history: none
Gynaecological History: LMP- 28 November; Cycle of 30 days ; Blood flow- Normal
Family history: not relevant
Personal history:-
 Diet- vegetarian
 Appetite- good
 Thirst- adequate
 Habit: none
 Sleep: sound
 Bowel: Irregular
 Micturition: Regular
 Exercise: Regular
General Appearance:-
 Built: well built
 Nutrition: Average
 Gait: Normal
 Icterus: absent
 Pallor: absent
 Cyanosis: absent
 Clubbing: absent
 Tongue: not coated
 Ear: no discharge
 Nose: no DNS
• Vitals:-
 Pulse: 92 bpm
 BP: 130/80 mmHg
 RR: 17 cycles/min
 Temperature: Afebrile
 Weight: 53 kg
 Height: 5.5 inch
 BMI : 20.2 kg/m2

• Physical examination:
 No restriction in ROM except on the right side due to pain.
 On palpation there is tenderness (+)
 Spurling's test (+)
 Lhermitte's Sign(-)
• Investigations -
• Differential diagnosis :- Neck sprain or strain

• Final Diagnosis: Cervical spondylosis (C4-C5)

 ANATOMY OF SPINE
• The entire spinal column consists of 24 individual bones called vertebrae (singular vertebra), plus 2 sections of
naturally fused vertebrae the sacrum and the coccyx located at the very bottom of the spine. When most people
talk about the spinal column, they’re actually referring to the vertebral column: the 24 circular vertebrae that
march down the middle of the back.
The vertebral column can be divided into 5 regions:
• Cervical spine: 7 vertebrae of the neck (C1-C7)
• Thoracic spine: 12 vertebrae of the mid-back (T1-T12)
• Lumbar spine: 5 vertebrae of the lower back (L1-L5)
• Sacrum
• Coccyx
• A normal vertebral column creates a graceful, double-S curve when viewed from the side of the body. The cervical
vertebrae gently curve inward, while the thoracic spine curves gently outward, followed by the lumbar spine,
which curves inward again. This structure gives the spinal column great strength and shock-absorbing qualities.
Sacrum and Coccyx :
• The sacrum (or sacral spine) is a triangular-
shaped bone located below the last lumbar
spinal vertebrae. The sacrum sits between the
hip bones (called iliac bones) and forms the
back of the pelvis. The sacrum connects to the
pelvis at the left and right sides by the sacroiliac
joints (SI joints).
• The coccyx, just below the sacrum are 3 to 5
small bones that naturally fuse together at
adulthood forming the coccyx or tailbone.
Sometimes the coccyx is termed the coccygeal
vertebrae. Although the tailbone is very small
and may seem insignificant, it plays an
important role in supporting your weight when
you sit.
Spine Movement Enablers and Stabilizers:
 Discs, Facet Joints, Ligaments, Muscles
• The spinal column doesn’t consist only of bones. To maintain its double-S shape, provide skeletal
support and route the nerves where they need to go, the spine also relies on a number of supporting
structures.
• First among these structures are the spinal discs, called intervertebral discs. Each disc is similar to a
fibrous pad of tissue (called fibrocartilage) and anchored in place by vertebral endplates
(called cartilaginous endplates) starting at C3 through L5 sacrum. These discs act as interbody spacers
and shock absorbers. Notably, there is no spinal disc between C1 and C2, nor is there a disc between
the sacrum and the coccyx.
Facet joints
• These are paired (left, right sides) at the back of each
vertebral body (C3-L5). These joints help stabilize the
spine while allowing flexion (bending forward),
extension (bending backward) and twisting movement
(called articulation). Similar to other joints in the
body, each facet joint is encased in a capsule of
connective tissue that produces a nourishing fluid that
lubricates the joint. Cartilage coats the joint surfaces
ensuring smooth movement.
Ligaments
• The ligaments are strong fibrous bands that hold
the vertebrae together, stabilize the spine, and
protect the discs. The three major ligaments of the
spine are the ligamentum flavum, anterior
longitudinal ligament (ALL), and posterior
longitudinal ligament (PLL). The ALL and PLL
are continuous bands that run from the top to the
bottom of the spinal column along the vertebral
bodies. They prevent excessive movement of the
vertebral bones. The ligamentum flavum attaches
between the lamina of each vertebra.
Spinal cord
• The spinal cord is about 18 inches long and is the
thickness of your thumb.
• The spinal cord is a long, fragile tubelike structure
that begins at the end of the brain stem and continues
down almost to the bottom of the spine.
• The spinal cord consists of bundles of nerve axons
forming pathways that carry incoming and outgoing
messages between the brain and the rest of the body.
• The spinal cord contains nerve cell circuits that
control coordinated movements such as walking,
swimming, and urinating. It is also the center for
reflexes.
 INTRODUCTION
• Cervical spondylosis is a generalized disease process affecting all cervical spine levels.
• It encompasses a sequence of degenerative changes in the intervertebral discs, osteophytosis of the
vertebral bodies, hypertrophy of the facets and laminal arches, and ligamentous and segmental
instability.
• The natural history of cervical spondylosis is associated with the aging process.
• Studies involving the radiological investigation of asymptomatic individuals show that spondylotic
changes increase with each decade of life: –
• 5-10% by the age of 20-30 years
• >50% by age 45 years, and
• >90% by 60 years of age.

Reference: Lestini WF, Wiesel SW. The pathogenesis of cervical spondylosis. Clinical orthopaedics and related research. 1989 Feb
1(239):69-93.
 EPIDEMIOLOGY-

• Evidence of spondylotic change is frequently found in many asymptomatic adults, with 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
showing some evidence of disc degeneration.
• The most frequently affected levels are C6-C7, followed by C5-C6. Symptomatic cervical
spondylosis most commonly presents as neck pain.
• Another study of asymptomatic adults showed significant degenerative changes at 1 or more levels
in 70% of women and 95% of men at age 65 and 60.
• Cervical spondylosis is a common condition that is estimated to account for 2% of all hospital
admissions. It is the most frequent cause of spinal cord dysfunction in patients older than 55 years.

Kelly JC, Groarke PJ, Butler JS, Poynton AR, O'Byrne JM. The natural history and clinical syndromes of degenerative cervical
spondylosis. Adv Orthop. 2012;2012:393642. [PMC free article] [PubMed]
 A study carried out in 2014 at a rheumatology clinic at Ogun state found 36 symptomatic CS pts with
male to female ratio of 1.8:1 and C4-C7 was the most affected cervical spine levels.
SEX:
• Both sexes are affected equally. Cervical spondylosis usually starts earlier in men than in women.
AGE:
• Symptoms of cervical spondylosis may appear in persons as young as 30 years but are found most
commonly in individuals aged 40-60 years.

Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. 2010 Dec;24(6):783-92. [PubMed]
 ETIOLOGY

• The primary risk factor and contributor to the incidence of cervical spondylosis is age-related
degeneration of the intervertebral disc and cervical spinal elements.
• Degenerative changes in surrounding structures, including the uncovertebral joints, facets joints,
posterior longitudinal ligament (PLL), and ligamentum flavum all combine to cause narrowing of
the spinal canal and intervertebral foramina.
• Consequently, the spinal cord, spinal vasculature, and nerve roots can be compressed, resulting in
the three clinical syndromes in which cervical spondylosis presents: axial neck pain, cervical
myelopathy, and cervical radiculopathy.
 PATHOPHYSIOLOGY

Lisa A. Ferrara, "The Biomechanics of Cervical Spondylosis", Advances in Orthopedics, vol. 2012, Article ID 493605, 5 pages, 2012
[Link]
 OTHER CLINICAL FEATURES:
• Neck pain and stiffness is one of the earliest presentations of cervical spondylitis. Some of the characteristic
features of this condition are:-
• Chronic or episodic pain and stiffness in the neck and shoulder region.
• The pain tends to get worse over a period of time.
• There may be periods initially when the pain disappears completely; later as the disease advances the pain
may remain persistent.
• Pain may radiate (travel) from neck to shoulders, arms, forearms, hands, lower part of the head, upper back.
• Coughing, sneezing, other movements of the neck may worsen symptoms.
• Along with pain, there may be abnormal sensations (tingling numbness), loss of sensation, weakness in any
of the above regions.
• There may be non-specific headaches in the lower part of the back of the head.
• Sensation of loss of balance.
• Loss of control over the bladder or bowels. (if the spinal cord is compressed)
• Occasionally there may be a typical pain presenting as chest pain or breast pain.
 PHYSICAL EXAMINATION:

• Spurling sign –
Radicular pain is exacerbated by extension and lateral bending of the neck toward the side of the lesion,
causing additional foraminal compromise.
• Lhermitte sign –
This generalized electrical shock sensation is associated with neck extension.
SPURLING TEST LHERMITTE`S SIGN
 DI AG NO S I S

X-ray :
These pictures are traditionally ordered as a first step in imaging the spine. X-rays will show aging changes, like
loss of disk height or osteophyte formation.

Magnetic resonance imaging (MRI) :

This study can create better images of soft tissues, such as muscles, disks, nerves, and the spinal cord.

Computed tomography (CT) scans:

This specialized x-ray study allows careful evaluation of the bone and spinal canal.
X-RAY
CT-SCAN
MRI
Myelogram
This test involves generating images using X-rays or CT scans after dye is injected into the spinal canal. The dye
makes areas of the spine more visible.
Nerve function tests- In some cases, it may be helpful to determine if nerve signals are traveling properly to the
muscles. Nerve function tests include:-
• Electromyogram (EMG):
This test measures the electrical activity in the nerves as they transmit messages to the muscles when the muscles
are contracting and when there at rest. The purpose of an EMG is to assess the health of muscles and the nerves that
control them.
• Nerve conduction study:
For this test, electrodes are attached to the skin above the nerve to be studied. A small shock is passed through the
nerve to measure the strength and speed of nerve signals.
 DIFFERENTIAL DIAGNOSIS

• To arrive at an accurate diagnosis, it is critical for the physician to consider other disorders that have similar symptoms
as cervical spondylotic myelopathy (a "differential diagnosis"). Other conditions associated with neck pain and arm pain.
• Neck sprain and strain.
• Rheumatoid arthritis.
• Ankylosing spondylosis.
 NATUROPATHIC
MANAGEMENT

AIMS of the treatment:

• To Relieve the Pain & Symptoms
• To improve the strength of weak neck muscles
• To improve ROM
• To Optimize Function
• To Improves quality of life
 Diet Therapy
Title Journal Conclusion
Role of vitamin A Bangladesh Medical Vitamin E administration at a dose of 100 mg daily for three weeks
and E in Research Council resulted in a significant increase in serum vitamin E level
spondylosis Bulletin,1992 accompanied by complete relief of pain.
Mahmud Z, The results strongly indicate that vitamin E is effective in curing
Ali SM spondylosis and most probably due to its antioxidant activity.
Title Journal Conclusion
Influence of International Journal of The present investigation demonstrated that six weeks of 3 g
Ginger and Preventive dietary ginger and cinnamon, on consecutive days, reduced the
Cinnamon Intake Medicine,2013 plasma levels of IL-6 caused by eccentric exercise in female
on Inflammation martial athletes, and 3 g of ginger also effectively reduced muscle
and Muscle soreness and inflammation.
Soreness Endued
by Exercise in
Iranian Female
Athletes
Nafiseh Shokri
Mashhadi et al
Title Journal Conclusion
Effect Of Indian journal of The patient was given naturopathy treatments in form of cold
Naturopathy physiology and spinal pack followed by some yogic practices consisting of asanas,
Treatments And pharmacology,2015 pranayama and relaxation for 30 minutes for a period of one month
Yogic Practices On shows significant improvement in symptoms of cervical
Cervical spondylosis.
Spondylosis--A
Case Report
Rajiv Rastogi, Priti
Bendore.
Title Journal Conclusion
EFFECT OF World Journal of This case report encourages the effects of naturopathy therapy and
NATUROPATHY Pharmaceutical therapeutic yogic practices in patients suffering from cervical
TREATMENTS Research,2020 spondylosis.
AND The hydrotherapy treatment and hot mustard pack application help in
THERAPEUTIC reducing muscle pain and spasm.
YOGIC
PRACTICES IN
PATIENTS
SUFFERING
FROM CERVICAL
SPONDYLOSIS –
A CASE REPORT
Dr. Bhuvaneshwari
Basvanayak
 ACUPUNCTURE

Title Journal Conclusion

Cervical Acupuncture plus movement therapy is effective in treating
spondylosis Journal of traditional cervical spondylosis.
treated by Chinese Medicine 2010 (In sitting position, a 1.5 cun needle of No.28–30 was used to
acupuncture at puncture the point for 30 minutes for 10 days)
Ligou (LR 5)
combined with
movement
therapy
Ben-hua Luo et al.
An evaluation of Journal of Pain Acupuncture using seven acupoint( PC-6, PC-7,Ex-HN 5, GV-20,
the effectiveness of Research ,2019 GV-16, GB-20, Sp-6 for 30 mins for 5 days)-penetrating needles
acupuncture with combined with traction was more effective, reduced neck pain, and
seven acupoint- improved sleep quality in patients with cervical spondylosis.
penetrating needles
on cervical
spondylosis
Chun-Lei Gu et al.
 CUPPING THERAPY

Title Journal Conclusion

Wet Cupping Chinese Journal of Integr WCT for 10 mins could improve analgesic effects in patients with
Therapy ative Medicine NT-CS, which might be related to increasing local blood perfusion
Improves Local ,2018 of acupuncture points.
Blood Perfusion
and Analgesic
Effects in Patients
with Nerve-Root
Type Cervical
Spondylosis
Xiang-Wen Meng
et al.
 YOGA THERAPY

Title Journal Conclusion

Effect of selected We conclude that the yogic practices “Specific Group of Asana”
group of asana Journal of Ayurveda and done for eight weeks on home-based programs when added to
when used as an Integrative Medicine, conventional medications helps in reduction of pain and disability
adjunct in 2021 in people suffering from cervical spondylosis
management of
cervical
spondylosis of
mild to moderate
severity: An
observational study
MantuJain et al.
DIET CHART FOR CERVICAL SPONDYLOSIS
Thank You!