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