Cervical Spondylosis (Degenerative Disc Disease)

Normal Anatomy

• Intervertebral disc– Annulus fibrosus– Nucleus pulposus

• Gel type substance• Shock absorber

Pathophysiology

• Disc degenerates (normal process)– Water loss

• Changes height of IVD• Changes orientation of joints• Leads to instability or

increase shear stress• Increase shear stress

irritates facet joints leading to OA

• Increased stress and strain on soft tissue

Pathophysiology

• Osteophytes form to in response to increase facet apposition and instability

• Pain is not caused by the degeneration itself– Soft tissue and joint

irritation source of nociceptive input

Mechanism Of Injury

• Insidious onset– Normal change with

ageing

• NEVER traumatic• History of traumatic

sports can accelerate degeneration

Associated Pathologies

• Osteoarthritis• Stenosis• Disc Herniation• Radiculopathy

Subjective• 60% of people over 45, 85% of

people over 65• Insidious onset pain• Intermittent neck and shoulder

pain• Stiffness first thing in the morning• Occasional night pain• Worse with movement (small

amounts can ease symptoms)• Pain sitting for long periods• Pain with rotations, extension or

sustained flexion• +/- paraesthesia

Objective

• Instability catch from flexion to neutral (dependent on stage)

• Pain with extension• Reduced side flexion and

rotation (capsular pattern)• Reduced Thoracic ROM• Poor Scapular stabilisation• Pain and stiffness joint play• Tenderness palpation soft

tissue

Special Tests

• Instability Catch• Capsular pattern

Further Investigation

• X-ray• MRI – Rule out serious

pathology

General Management

• Directed at Soft Tissue and Joint Stiffness• Degeneration of IVD is non reversible• Management of symptoms rather than a cure• Instability vs Fusion• ?Long term maintenance• Emphasis on self management

Conservative - Management

• Pain Relief– NSAID’s, Ice or Heat, Massage

• Restore ROM – Cervical AND Thoracic– Cervical Rotation, Extension, Thoracic Extension and

Rotation– Soft Tissue, Joint Mobilisations

• Restore Normal Muscle Activation– Deep cervical flexors, Deep cervical Extensors, Scapular

upward rotators and posterior tilt• Restore Normal Dynamic Stability and Proprioception

Plan B - Management

• Only considered for neurological compromise• Facet Injections rare due to high risk• Fusion rarely completed