Cervical Spondylosis

(Neck Arthritis)

Have you ever experienced neck pain? Did you know that nearly 85% of people over the age of 65 are affected by neck pain caused by cervical spondylosis, a general term for the age-related wear and changes of the neck (arthritic changes)? Using your neck every day will cause changes over time to the anatomical structure that can cause symptoms such as pain and headaches.

Cervical Spondylosis: What is it?

As your body ages on the outside, so does your bony structures on the inside. Using your neck each and every day, along with other factors, can contribute to degeneration. A part of the arthritic change of the spine come from the facet joint (the joint that allows motion in your spine) losing the cartilage that coats it, which allows for your joints to start to rub together. Another part of the cervical spine arthritic changes come from the intervertebral discs (which lie between each vertebral body). These discs will start to lose water, dehydrate and collapse over time, allowing your bones to get closer together, as well as putting more pressure on the facet joints. This disc narrowing will contribute to the loss of a person’s overall height. It can also lead to the formation of bone overgrowth and bone spur formation.

Woman in red sweater working at laptop with neck pain, neck discomfort, back pain, coffee, papers on desk

Neck pain can sometimes be relived by massage, younger woman works to loosen stiff muscles in neck and shoulder massage

Symptoms: What does Cervical Spondylosis feel like?

The symptoms of neck arthritis can vary person to person but the most common symptom is localized neck pain. The pains overall can range from mild to severe varying from person to person.
Headaches are a common symptom.
Hearing a grinding, popping, or clicking from your neck is common as the facet joints and discs wear away.
Periods of immobility and inactivity can cause feelings of neck stiffness. People may feel worse in the morning and at the end of the day.
You may feel you have limited range of motion of your neck.
The muscles in your neck may become tight, fatigued, or even spasm.
The arthritis in your neck can also lead to pinching of the nerves in your neck, which can cause arm pain, numbness and tingling of your upper extremities, and sometimes arm weakness.
Neck arthritis can sometimes lead to feelings of clumsiness with walking, balance issues, or weakness in your upper or even lower extremities.

Causes

The degenerative changes of your neck are often multifactorial and some people are at a higher risk of developing it.

Genetics/Anatomy: Your genetic make-up plays a role in your spine arthritis. If your parents or siblings have neck arthritis, there is a chance you will also. Your anatomical make up can cause for a tighter spinal canal, which can lead to symptoms of arthritic changes sooner.

Age and Use: Using your body each day is a contributing factor. Age is the most common factor in neck arthritis and it’s often seen in people beginning in their 5th decade of life.

Previous Trauma or Surgery: Previous injury or surgery can add to stress of your spine and joints, which can cause breakdown more rapidly.

Smoking: Smoking tobacco has been linked to neck pain/arthritis.

Autoimmune disorders: Diseases where your body is fighting against itself, such as rheumatoid arthritis and ankylosing spondylitis can affect your neck and its joints causing degeneration or destruction.

Occupation: Repetitive motions of the neck or stress can play a role in spine degeneration.

Evaluation: How is Cervical Spondylosis diagnosed?

To begin, your doctor will ask about your symptoms and evaluate your risk factors. A physical examination will also be performed to evaluate your neck and neurological function (testing the nerves in your neck which allow you to have strength and sensation to your arms).

Radiographs: X-rays are a helpful tool in looking at bony changes. The joints and vertebrae can be visualized and assessed for any visible changes such as facet arthritis, disc collapse, bony spurs, and spine curvature.

MRI: An MRI is an advanced image that not only allows the bones to be visualized, but also the intervertebral discs and nerves. The nerves may become pinched and cause arm symptoms if you have arthritis in your neck. It can also evaluate the spinal cord, which if pinched can cause symptoms of weakness and clumsiness to your legs.

CT: A CT looks closer are the bony make up of your spine and can give finer detail of bone changes or arthritis.

Bloodwork: If an autoimmune component is suspected, then labs may be drawn which can help diagnose different disorders.

Treatment

Non-operative treatment

These types of treatments do not take the arthritis away from your neck, but can make the symptoms of the arthritis dissipate or subside.

Physical Therapy: Learning techniques to strengthen the musculature around your spine, which can offload the stress when using it. There are also techniques included that teach stretching or range of motion, and treatments such as ultrasound and electrical stimulation. Traction, which temporarily takes pressure off your arthritic joints, can also be helpful.
Anti-inflammatories: Medications can help with the inflammation around your arthritic joints and neck, which can ease or take away the pain.
Activity Modifications/Rest: Changes in activities that stress your neck, such as repetitive motions and heavy lifting, can help ease symptoms.
Injections: There are different types of injections depending on the type of symptoms you are having.
1. Epidural steroid injections: This type of injection is good for people whose arthritis is causing pinched nerves and arm symptoms (pain, numbness/tingling, weakness, etc.). The injection is performed by a trained provider and a needle is placed into the epidural space near the nerve that is being pinched. A steroid (cortisone) is placed near the nerve to decrease inflammation.
2. Facet Injections: These injections are actually placed into the facet joint/joints that are thought to be causing pain from arthritis. A steroid and/or numbing medication is used to help with the inflammation caused by the arthritic joints rubbing together.
3. Medial Branch Blocks and Rhizotomy: This is typically a step-wise procedure beginning with the medial branch blocks. This procedure numbs the arthritic joints and degenerative disc. If the person gets hours of significant relief from the medial branch blocks then the second part of the process can take place. This is the rhizotomy, which entails burning or stunning the nerves in your joints, so that you no longer feel the arthritic joints rubbing together. The nerves that are burned will regenerate, but very slowly, which allows for some lasting pain relief for 9-12 months.
Other treatment options: Acupuncture, dry needling, trigger point injections, and chiropractor care are just some of the alternatives that can be utilized in treating symptoms of back arthritis. Other medication options that can be helpful include Tylenol for pain relief. If there is nerve involvement, there are nerve medications that can be used.

Surgery

Depending on your specific situation and symptoms, there may be different surgical options offered by your orthopedic spine surgeon. Most people who have surgery for their arthritis of their spine have better outcomes when it is performed for nerve pinching symptoms rather than for neck pain. Surgery can be approached from the front or the back of your neck depending on what your surgeon decides.

Recovery: What Can Be Expected?

This will depend on if a surgical intervention is offered and thought to be helpful in your specific case. There are a bevy of surgical interventions that can be performed when it comes to neck arthritic changes, thus recovery may vary. If spine surgery is offered, common restrictions and recovery periods may be as listed:

Follow up in clinic in 2-3 weeks for incisional check.
Neck pain is common over the first few weeks while you are beginning your recovery period. The pain will dissipate over time as you continue your recovery
Restrictions of no lifting greater than 10-15 lbs for up to three months.
No excessive bending and twisting during the recovery period, or motions that can put more stress on your neck.
No driving while on narcotic pain medications, which may be required for pain control over the first few weeks. No driving while wearing neck brace if prescribed by your surgeon.
Physical therapy will be started when appropriate, which is usually at 2 weeks. The requirements initially consist of being able to walk distances and avoid sitting or standing in positions for longer than one hour periods.

Frequently asked questions about Cervical Spondylosis

Is there anything I can do to reverse the arthritis in my neck?

Unfortunately, no there is not anything that can reverse the damage to your discs or regrow your cartilage. There are different surgeries that can help with arthritic pains or nerve pinching by surgically removing bone and/or disc. There are also surgeries that the goal is to fuse your bones together so there is no longer motion at the arthritic joints.

Is there anything I can do to slow down arthritis from occurring?

Staying active may not necessarily slow arthritis down, but can help with keeping your symptoms at bay.

Can you replace my joints in my spine?

The joints are not replaced. For surgery, there is a fusion surgery that can occur to help the joints from moving and causing more pain and more arthritis. There is also a surgical procedure, for the right patient demographic, where replacing the disc is the right option.

Is chiropractor care recommended?

Many patients have found chiropractor care beneficial in treatment of their neck pain. If your pain is decreasing and you have a positive outcome with treatments, then it can certainly provide benefit. If there are concerns, you can always discuss this with your chiropractor and/or your orthopedic physician.

Physicians

The following physicians specialize in the treatment of Cervical Spondylosis:

Gregory F. Alvine, MD

James T. Brunz, MD

K. C. Chang, MD

Matthew K. Wingate, MD

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Testimonials

I first saw Dr. Chang 14 years ago …I had nerve conduction studies, followed by 8 acupuncture treatments, and was pain-free after years of chronic sciatica back pain. I then joined a local fitness center to continue the healing, as I was actually able to exercise again! I have never even had to go back for any more treatments for that health problem! His gifts of healing, experience, and expertise have changed my life forever for the better! He is compassionate, caring, kind, thorough, and so intelligent.

I returned to him years later for a very painful neck and shoulder, with the same successful results. I am now seeing him for the third time … once again for acupuncture for pain relief of a new problem area. All of my 3 treatment periods over the past 14 years have been consistent of the highest quality.

We are blessed to have Dr. Chang here in Sioux Falls. I tell others about him all the time, and try to help promote acupuncture as a viable option for pain relief. I had a “needle phobia” most of my life, so it took ALOT for me to decide to try this. If you are worried about the needles, don’t be! You will be fine!

My pain is so much better; I owe that to Dr. Baumgartner professional knowledge. He was most courteous, so was the entire staff. Even the X-ray nurse. Now my PT will get me back on track to more strength in my arms. Taking my shower, wiping off with a towel was so much easier, the very next day. I have better strength to do my daily walks, n chores, get dressed easier too. My immune system is not overwhelmed like it was when I had so much pain & inflammation in my arms, shoulders, & neck. I sleep better too.

I’ve only seen Dr. Wingate once. He was extremely thorough in studying my history with neck and back problems and the treatments I’d had over the years. While there are very few procedures available to me surgically, he offered me the possibility of some alleviation that had not been attempted previously. We are in the process of checking this out.

OI has outstanding staff and Dr’s. They are with you every step of the way-before and after surgery. It has been YEARS since I felt this good- Thanks to TEAM WINGATE (including the Spine Therapy dept) performing a successful ACDF C6/7. I definitely recommend. And… thank you Dr. Windgate!

Kelly Trapp

The staff at OI are very professional and helpful and the surgeons are the best at what they do. Had foot surgery a few years ago and have also been seen for my spine and my daughter was seen for a knee injury. They’re not knife-happy, they treat conservatively and do surgery when necessary. I appreciate the time they and their PAs take to answer questions and make sure the patient knows the plan of action. The PT staff is awesome too. Very thorough and they all know what they’re doing.

Liz Hansen

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