Multilevel cervical spondylosis is a common age-related condition impacting the cervical spine, the segment of your spine located in your neck. It involves degenerative changes within this area.
Understanding Multilevel Cervical Spondylosis
Cervical spondylosis is a general term for age-related wear and tear affecting the spinal discs in the neck. This process often begins after age 50, with over 85% of individuals older than 60 experiencing it. The term “cervical” refers to the seven vertebrae in the neck, designated C1 through C7.
“Spondylosis” describes degenerative changes in the spine, often likened to arthritis of the neck. These changes include intervertebral discs losing hydration and shrinking, reducing cushioning between vertebrae. Bone spurs (osteophytes) can form along bone edges, and ligaments within the spine may thicken.
The term “multilevel” indicates these degenerative changes affect more than one level in the cervical spine. This widespread degeneration can lead to a narrowing of the spinal canal or the openings where nerve roots exit, known as spinal stenosis. The combined effect of disc degeneration, bone spur formation, and ligament thickening can reduce the space available for the spinal cord and nerve roots.
Identifying the Manifestations
Multilevel cervical spondylosis can manifest in various ways, though many people experience no symptoms. When symptoms do occur, they often include localized neck pain and stiffness. This discomfort may worsen with movement or at the end of the day.
If nerve roots become compressed, individuals might experience radicular symptoms, which involve pain, numbness, tingling, or weakness that radiates into the shoulders, arms, hands, or fingers. The specific area affected depends on which nerve root is experiencing pressure. Headaches, particularly occipital headaches, can also be a symptom.
More severe symptoms can arise if the spinal cord is compressed, a condition known as cervical myelopathy. These myelopathic symptoms might include difficulty walking, loss of balance, or weakness in both arms and legs. In severe cases, there could be a loss of bladder or bowel control.
Diagnostic Approaches
Diagnosis typically begins with a clinical evaluation and physical examination. The provider assesses the neck’s range of motion, reflexes, sensation, and muscle strength in the arms and legs to identify signs of nerve or spinal cord compression. Observing a person’s gait can also reveal if spinal compression affects their balance or walking pattern.
Imaging studies provide detailed views of spinal structures. X-rays can show changes like bone spurs and narrowing of disc spaces, indicative of cervical spondylosis. Magnetic Resonance Imaging (MRI) offers a detailed view of soft tissues, such as discs, the spinal cord, and nerve roots, helping to pinpoint areas where nerves might be pinched. Computed Tomography (CT) scans provide detailed bone structure information, and a CT myelogram (injecting dye into the spinal canal) can offer precise images of the spinal cord and nerve roots.
Nerve studies can further assess nerve function. Electromyography (EMG) measures electrical activity in muscles to determine if nerves are transmitting signals properly. Nerve conduction studies (NCS) measure the speed and strength of nerve signals as they travel along nerves, helping to identify nerve compression.
Management Strategies
Management of multilevel cervical spondylosis typically begins with conservative treatments. Medications often include over-the-counter pain relievers like NSAIDs to reduce pain and inflammation. Muscle relaxants, such as cyclobenzaprine, may be prescribed for muscle spasms, and certain anti-seizure medications can help alleviate nerve pain. In some cases, steroid injections can be administered into the affected area to reduce inflammation and pain.
Physical therapy is a common and effective approach, focusing on exercises to strengthen neck and shoulder muscles, improve flexibility, and correct posture. Therapists may also use manual techniques like massage or mobilization to enhance mobility and relieve discomfort. Temporary use of a soft cervical collar can provide support and pain relief, though prolonged use is discouraged to prevent muscle weakening.
Lifestyle adjustments play a role in managing symptoms, including ergonomic changes to reduce neck strain and the application of heat or cold therapy to ease muscle soreness. When conservative treatments are insufficient or if there is severe nerve or spinal cord compression, surgery might be considered. Surgical options aim to decompress the spinal cord and nerve roots, sometimes involving procedures to remove bone spurs or portions of vertebrae, or spinal fusion to stabilize segments of the neck.