Cervical spondylosis

Definition

A degenerative disorder of the cervical spine characterised by age-related wear of the intervertebral discs, facet joints, and other surrounding structures. It commonly leads to osteophyte formation, disc narrowing, and ligamentous thickening, which can impinge on nerve roots or the spinal cord.

Presentation

Pain:

• Often presents as a dull, aching discomfort in the suboccipital region and may radiate unilaterally to the neck and shoulders. Some patients experience tension-type headaches

Range of motion:

• Restricted neck rotation or lateral flexion due to pain or stiffness. Pain may worsen after prolonged neck positions (e.g. computer or desk work)

Neurological involvement:

• Upper limb paraesthesia following a dermatomal pattern. Cervical radiculopathy (root compression) can lead to arm pain, while cervical myelopathy (spinal cord compression) can cause gait disturbance, hand clumsiness, or bowel/bladder issues in advanced cases

Spurling’s test:

• Performed by extending the neck, laterally flexing and rotating it towards the symptomatic side, then applying gentle downward pressure. A positive test reproduces limb pain or paraesthesia, suggesting nerve root irritation

Investigations

• MRI of the cervical spine: The imaging of choice when red flags (e.g. motor weakness, malignancy, infection) are present, or if conservative measures fail. It is sensitive for detecting neural element compression, disc herniation, and soft-tissue changes

• Plain X-ray: Demonstrates degenerative changes such as osteophytes, disc space narrowing, and spondylolisthesis. Often an initial screening tool but less sensitive for nerve root or cord pathology

• Nerve conduction studies or electromyography: Consider if MRI is unavailable, or to further clarify nerve root involvement, especially in complicated or atypical presentations

Management (when no severe neurological deficits)

Lifestyle and postural advice:

• Avoid prolonged neck flexion or extension (e.g. extended computer use without breaks)

• Encourage ergonomic assessment in the workplace

Pain relief:

• NSAIDs can be used first-line for musculoskeletal neck pain, and short courses of oral corticosteroids may help in acute radicular episodes.

• Paracetamol can be added or substituted if NSAIDs are contraindicated

Physiotherapy:

• Tailored exercises focusing on neck-strengthening, mobilisation, and postural training.

• Techniques may include gentle manual therapy and advice on maintaining flexibility and core neck stability

  
  

Soft cervical collar:

• Can be used briefly for acute exacerbations, though prolonged use is generally discouraged to avoid neck muscle deconditioning

Steroid injections:

• Epidural or facet joint injections can be considered for persistent radicular pain or localised facet joint inflammation.

• Ultrasound or fluoroscopic guidance may improve accuracy and efficacy

Follow-up:

• Review at 6–8 weeks to assess improvement in pain and function.

• Escalation to advanced imaging or specialist referral is recommended if there is clinical deterioration, persistent severe pain, or developing neurological deficits

Additional considerations

• Red flags prompting urgent imaging or specialist review include progressive neurological deficits, suspected cervical myelopathy (e.g. unsteady gait, hyperreflexia, bowel/bladder dysfunction), history of malignancy, weight loss, or severe unremitting night pain

• Physiotherapists and exercise physiologists can provide home-based exercise programmes to improve neck strength and mobility, with an emphasis on posture correction and activity modification

• Adjunct measures, such as topical analgesics or neuropathic pain agents (in radicular pain), may be utilised according to clinical judgement

• Prognosis varies depending on the degree of degenerative change and nerve involvement, but most mild-to-moderate cases respond well to conservative measures over weeks to months