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 Cervical spondylosis

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PostSubject: Cervical spondylosis   Cervical spondylosis EmptyThu Jan 20, 2011 12:30 pm

Cervical spondylosis
Filed under: Boomer's Health
Cervical spondylosis is a general term for age-related wear and tear
affecting the disks in your neck. These changes later contribute to the
development of cervical osteoarthritis in the joints that link your neck
bones (facet joints).

Cervical spondylosis and osteoarthritis are most common in people older than age 55, and both conditions progress with age.

Many people with signs of cervical spondylosis and osteoarthritis on
X-rays manage to escape associated symptoms, which include pain,
stiffness and muscle spasms. When symptoms do occur, nonsurgical
treatments often are effective.

©
Symptoms

Cervical spondylosis typically affects only the neck, causing pain and
stiffness. When nerve compression also is present, signs and symptoms of
cervical spondylosis may include:

* A stiff, painful neck
* Shoulder, arm or chest pain
* Tingling and pinprick sensations in your arms, hands, legs or feet
* Numbness and weakness in your arms, hands, legs or feet
* Lack of coordination
* Difficulty walking
* Abnormal reflexes
* Loss of bladder or bowel control, or urinary or bowel retention

When to see a doctor
Call 911 or your local emergency number if you develop neck pain along with:

* Sudden or unexplained changes in bowel or bladder control
* Sudden or unexplained weakness in your arms or legs

Call your doctor for an immediate appointment if you develop neck pain along with:

* A fever of 100.4 F (38 C) or greater that lasts 48 hours or longer
* Pain that doesn't let up at night or when you're resting
* Pain that's new within the last six weeks, is getting worse and occurs along with numbness or weakness below the knee
* Worsening neurological problems, such as difficulty speaking, balance problems, visual problems and difficulty thinking

Call your doctor for an appointment if you develop neck pain that:

* Is related to an exertion injury, such as from lifting, digging or reaching
* Is similar to neck pain that you've seen a doctor for in the past
* Lasts longer than six weeks
* Doesn't respond to over-the-counter (OTC) pain medications
* Occurs along with unexplained weight loss of more than 10 pounds in six months

Also call for an appointment if you develop neck pain and are older than age 50 or have a history of cancer.

©
Causes

As you age, the bones and cartilage that make up your backbone and neck
gradually deteriorate, sometimes forming irregular bony outgrowths
called bone spurs. These changes, which are characteristic of cervical
spondylosis, eventually occur in everyone's spine.

Age-related wear and tear is probably the basic cause of cervical
spondylosis. By age 30, many people show signs of vertebral and disk
degeneration on X-ray, although symptoms usually don't appear until
later in life. Specific changes occurring with age include:

* Drying and loss of elasticity in the spinal disks
* Bulging and sometimes herniation of disks so that disk material protrudes from between two vertebrae
* Stiffening of the ligaments connecting neck bones and muscles

©
nRisk factors

Aging and wear and tear on your spine are the major risk factors for
cervical spondylosis. You may be more likely to develop cervical
spondylosis if you've had a neck injury.

©
Complications

Cervical spondylosis is the most common cause of spinal cord dysfunction in older adults.

In a small percentage of cases, cervical spondylosis may compress one or
more of the spinal nerves — a condition called cervical radiculopathy.
Bone spurs and other irregularities caused by cervical spondylosis also
may reduce the diameter of the canal that houses the spinal cord. When
the spinal canal narrows to the point that it causes spinal cord injury,
the resulting condition is referred to as cervical myelopathy. Both
cervical radiculopathy and cervical myelopathy can lead to permanent
disability.

©
Preparing for your appointment

Make an appointment with your doctor if you have signs and symptoms
common to cervical spondylosis. After an initial evaluation, your doctor
may refer you to a doctor or physical therapist who specializes in the
diagnosis and treatment of spine disorders.

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

* Write down your symptoms, including when they first started and how often they occur.
* Write down your key medical information, including any previous
neck injuries and other health conditions with which you've been
diagnosed.
* List all the medications you're currently taking, including
prescription and over-the-counter drugs as well as any vitamins or
supplements.
* Take a family member or friend along, if possible. Someone who
accompanies you can help remember information that you missed or forgot.
* Write down questions to ask your doctor. Creating your list of
questions in advance can help you make the most of your time with your
doctor.

Below are some basic questions to ask a doctor who is examining you for
possible cervical spondylosis. If any additional questions occur to you
during your visit, don't hesitate to ask.

* What is likely causing my symptoms or condition?
* Are there other possible causes for my symptoms or condition?
* What kinds of tests do I need?
* What treatment approach do you recommend?
* Are surgical treatments an option for me? Why or why not?
* What self-care steps are likely to help improve my symptoms?
* Do I need to follow any activity restrictions?
* How much do you expect my symptoms will improve with treatment?
* Am I at risk of complications from this condition?
* How often will you see me for follow-up visits?
* Should I see a specialist?

Don't hesitate to ask any additional questions that occur to you during your medical evaluation.

What to expect from the doctor
A doctor who sees you for neck pain may ask:

* What are your symptoms?
* When did you first begin experiencing these symptoms?
* Have your symptoms gotten worse over time?
* Where is your pain located?
* What makes your pain worse or better?
* How severe is your pain?
* Have you had previous episodes of similar pain that eventually went away?
* Do your symptoms include any changes in your bladder or bowel control?
* Do your symptoms include any tingling or weakness in your arms, hands, legs or feet?
* Do your symptoms include difficulty walking?
* What treatments or self-care measures have you tried so far?
* Have any treatments or self-care measures helped?
* Have you ever had a neck injury?
* Have you ever been treated for neck pain?
* Have you ever had physical therapy?
* What other medical treatments, including medications and surgical or nonsurgical procedures, have you had in the past?
* Have you been diagnosed with any other medical conditions?
* What medications are you currently taking, including vitamins and supplements?
* What is your occupation?
* What are your hobbies and recreational activities?

What you can do in the meantime
In the time leading up to your appointment, try self-care measures at
home. You may find relief from a heating pad and over-the-counter pain
relievers, such as aspirin, ibuprofen (Advil, Motrin, others) or
acetaminophen (Tylenol, others).

Until your doctor evaluates you, try to find a comfortable way to
exercise while avoiding activities that cause you pain. When needed,
rest for short periods of time.

©
Tests and diagnosis

Your symptoms and history, along with an examination, may suggest that
you have cervical spondylosis. You may also have imaging tests. The
work-up may include:

* Neck flexibility assessment. Cervical spondylosis limits the range
of motion in your neck. To observe this effect, your doctor may have
you tilt your head toward each of your shoulders and rotate your neck
from side to side.
* Neurological exam. To find out if there's pressure on your spinal
nerves or spinal cord, your doctor will test your reflexes and make sure
you have sensation all along your arms and legs. He or she may watch
you walk to see if spinal compression is affecting your gait.
* Neck or spinal X-ray. An X-ray may show abnormalities, such as bone spurs, that indicate cervical spondylosis.
* Computerized tomography (CT) scan or magnetic resonance imaging
(MRI). A CT scan of your spine uses X-ray technology, but produces a
more detailed image than X-ray can. MRI uses a magnetic field and radio
waves and can produce detailed, cross-sectional images of your spine.
These tests may help your doctor determine the extent of damage to your
cervical spine.
* 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 your spine more visible.
* Electromyogram (EMG). This test measures the electrical activity
in your nerves as they transmit messages to your muscles when the
muscles are contracting and when they're at rest. The purpose of an EMG
is to assess the health of your muscles and the nerves that control
them.
* Nerve conduction study. For this test, electrodes are attached to
your skin above the nerve to be studied. A small shock is passed through
the nerve to measure the strength and speed of nerve signals.

©
Treatments and drugs

Without treatment, the signs and symptoms of cervical spondylosis
usually decrease or stabilize. Occasionally, they may worsen. The goal
of treatment is to relieve pain, help you maintain your usual activities
as much as possible, and prevent permanent injury to the spinal cord
and nerves.

Treatment of mild cases
Mild cases of cervical spondylosis may respond to:

* Wearing a neck brace (cervical collar) off and on throughout the
day to help limit neck motion and reduce nerve irritation.
* Taking OTC pain relievers, such as aspirin, ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others).
* Doing exercises prescribed by a physical therapist to strengthen
neck muscles and stretch the neck and shoulders. Low-impact aerobic
exercise, such as walking or water aerobics, is strongly recommended.
* Applying heat and ice to relieve pain. You may also get some
relief from menthol- or camphor-based creams, massage or stretching.

Treatment of more serious cases
For more severe cases, nonsurgical treatment may include:

* Traction on the neck for a week or two to reduce the pressure on
spinal nerves. If your physical therapist determines that traction helps
you, he or she may recommend a home traction unit for as-needed use.
* Modified exercise with intermittent rest. People who stay active
are likely to avoid deconditioning and recover more quickly. Choose an
activity that doesn't worsen your pain, and allow yourself to take short
rest breaks in a comfortable position.
* Taking muscle relaxants, nerve pain pills or painkillers such as
methocarbamol (Robaxin) or cyclobenzaprine (Flexeril), particularly if
neck muscle spasms occur. Your doctor may prescribe newer medications
specifically for nerve pain, such as gabapentin (Neurontin), pregabalin
(Lyrica) or duloxetine (Cymbalta). In some cases, your doctor may
recommend a short course of traditional pain medications, such as
tramadol (Ultram) or drugs that contain hydrocodone (Vicodin, Lortab,
others) or oxycodone (Percocet, Roxicet, others). Remember that these
traditional pain medications often also contain acetaminophen.
* Injecting corticosteroid medications around the disk and nerves
between the vertebrae. The injection combines corticosteroid medication
with local anesthetic to reduce pain and inflammation. These medications
may help prevent the need for surgery.
* Hospitalization for intravenous pain control may be needed in rare cases when other nonsurgical treatments fail.

Surgery
If conservative treatment fails or if your neurological signs and
symptoms, such as weakness in your arms or legs, are getting worse, you
may need surgery. The surgical procedure will depend on your underlying
condition, such as bone spurs or spinal stenosis. The most common
surgical options include:

*

Frontal approach (anterior). Your surgeon makes an incision in the
front of your neck and moves aside the windpipe (trachea) and
swallowing tube (esophagus) to expose the cervical spine. Your surgeon
can then remove a herniated disk or bone spurs, depending on the
underlying problem. Sometimes, with disk removal, your surgeon will fill
the gap with a graft of bone or other implant.

With the anterior approach, your surgeon can relieve pressure on
your spinal cord from bone or from multiple disk protrusions by removing
two disks and the bone between them (corpectomy). Then, to support your
head and neck, your surgeon reconstructs the area with bone from your
body or a bone bank or with an implant made of metal combined with bone.
*

Back approach (posterior). Your surgeon may opt to remove or
rearrange bone from the back of your neck, especially if several
portions of the channel that houses the cord have narrowed. The
operation, called a laminectomy, removes the back part of the bone over
the spinal canal through an incision in the back of your neck.

Laminoplasty, an alternative to laminectomy, involves cutting and
moving pieces of vertebrae to make more room for the spinal cord.
Although laminoplasty takes longer, it is less likely to leave the neck
unstable.

Risks of surgery
Risks of these procedures include infection, a tear in the membrane that
covers the spinal cord at the site of the surgery, bleeding, a blood
clot in a leg vein and neurological deterioration. In addition, the
surgery may not eliminate all the problems associated with your
condition.

©
Lifestyle and home remedies

For mild neck pain or stiffness:

* Take a long, hot shower every day
* Take over-the-counter pain relievers
* Wear a cervical collar (which you can buy in a drugstore) off and on during the day
* Regularly walk or engage in low-impact aerobic activity

Follow these self-care steps for six to eight weeks as long as your
symptoms don't get worse and you don't develop new symptoms, such as
bowel or bladder problems or weakness in your arms and legs.

©
Prevention

You may not be able to prevent cervical spondylosis. However, you may be
able to reduce your risk by following these suggestions:

* Get regular physical exercise, following just about any fitness program that suits you
* Skip high-impact activities, such as running, if you have any neck pain
* Do exercises to maintain neck strength, flexibility and range of motion
* Take breaks when driving, watching TV or working on a computer to
keep from holding your head in the same position for long periods
* Practice good posture, with your neck aligned over your shoulders
* Protect your neck from injury by using a seat belt when in a car

©

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