Cervical Spondylosis

Narrowing of the cervical canal or neural foramina due to degeneration of the intervertebral disk and the annulus and to formation of bony osteophytes.

Persons with a congenitally narrow cervical canal are at increased risk. Narrowing leads to spinal cord compression, which typically causes a progressive myelopathy, characterized by a spastic gait. If a painful cervical root syndrome predominates, radicular signs often indicate the most involved dermatome, usually one between C-5 and C-6 or between C-6 and C-7. Neural foraminal root compression causes arm weakness and atrophy with segmental reflex loss; spinal cord compression causes hyperreflexia, increased tone, vibratory impairment, and plantar extensor responses in the legs.

Spinal x-rays, including oblique views of the neural foramina, reveal degeneration with osteophytes and disk-space narrowing. If the sagittal diameter of the cervical canal is < 10 mm, spinal cord compression is likely. CT defines the diameter of the canal, and myelography determines the level and extent of the epidural compression, but MRI is rapidly becoming the diagnostic test of choice.

Occasionally, signs improve spontaneously. Conservative therapy includes a soft collar, cervical traction, anti-inflammatory drugs, and mild analgesics. Decompressive laminectomy is used sparingly to halt disease progression or to stabilize the myelopathy.