Degenerative cervical spine disease [Neurosurgery Wiki]

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====== Degenerative cervical spine disease ======

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see [[Degenerative cervical myelopathy]].

Degenerative [[cervical spine disease]] refers to the progressive deterioration of the structures in the [[cervical spine]], including [[intervertebral disc]]s, [[facet joint]]s, [[ligament]]s, and [[vertebral body]]. It is a common condition associated with [[aging]], but it can also be influenced by genetic factors, [[lifestyle]], and [[mechanical stress]].

===== Pathophysiology =====

[[Degeneration]] begins with the loss of [[hydration]] and [[elasticity]] in the [[intervertebral disc]]s, leading to decreased [[disc height]], [[annular tear]]s, and [[disc]] [[bulging]]. This can result in:

- **Disc herniation** → Compression of nerve roots or spinal cord (radiculopathy or myelopathy).

- **Facet joint arthropathy** → Hypertrophy, osteophyte formation, and reduced range of motion.

- **Ligamentous changes** → Thickening of the ligamentum flavum, contributing to spinal stenosis.

- **Spondylotic changes** → Osteophytes and endplate sclerosis can cause foraminal or central stenosis.

===== Clinical Presentation =====

1. **[[Cervical Spondylosis]]** (General degeneration)
   - Neck pain and stiffness
   - Reduced range of motion
   - Occasional headaches (occipital neuralgia)

2. **[[Cervical Radiculopathy]]** (Nerve root compression)
   - Unilateral neck pain radiating to the upper limb
   - Numbness, tingling, and weakness in a dermatomal distribution
   - Positive Spurling’s test

3. **[[Cervical Myelopathy]]** (Spinal cord compression)
   - Gait disturbances (spasticity, imbalance)
   - Upper limb weakness, clumsiness (difficulty with fine motor skills)
   - Hyperreflexia, positive Hoffman’s sign, Babinski sign
   - Urinary urgency or incontinence (in severe cases)

===== Diagnosis =====

- **Clinical evaluation**
  - Neurological examination to assess motor, sensory, and reflex abnormalities.
- **Imaging**
  - **[[Cervical Spine Radiography]]**: Loss of disc height, osteophytes, kyphotic deformity.
  - **[[Cervical Spine Magnetic Resonance Imaging]]** (Gold standard): Shows spinal cord compression, disc herniation, and soft tissue pathology.
  - **[[Cervical spine computed tomography]]**: Useful for bony abnormalities, particularly foraminal stenosis.
  - **[[Electromyography]] (EMG)/Nerve conduction studies**: Helps differentiate radiculopathy from peripheral neuropathy.

===== Treatment =====

[[Degenerative cervical spine disease treatment]]


==== Prognosis ====

- Many patients with cervical spondylosis remain asymptomatic.
- Cervical radiculopathy often resolves with conservative treatment.
- Cervical myelopathy is usually progressive and may require surgical decompression for functional preservation.