A 67 years old lady presents to your clinic with complaints of pain and stiffness of the neck, pain in shoulders , tingling, numbness and weakness in arms , hands and feet.
You order an X ray of cervical spine lateral view which is shown below:
1. What are the findings in the X-ray?
2. What is the diagnosis?
3. What are the risk factors for this condition?
4. What are the complications of this condition?
5. What further investigations need to be done?
6. What are the management options of this condition?
Answers given in comments section.
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2. Diagnosis :
Cervical spondylosis:
Age related wear and tear affecting spinal discs in the neck. As the discs dehydrate and shrink, signs of osteoarthritis develop, including bony projections around the edges of bone, called as bony spurs.
Cervical spondylosis is very common and worsens with age .
More than 85 percent of people older than age 60 years are affected by Cervical spondylosis.
3. What are the risk factors for this condition? Risk factors for cervical spondylosis include:
Age. Cervical spondylosis is a normal part of aging.
Occupation. Jobs that involve repetitive neck motions, awkward positioning or a lot of overhead work put extra stress on the neck.
Neck injuries.
Previous neck injuries appear to increase the risk of cervical spondylosis.
Genetic factors. Some individuals in certain families will experience more of these changes over time, while others will not.
Smoking. Smoking has been linked to increased neck pain.
4. What are the complications of this condition?
Complications
If spinal cord or nerve roots become severely compressed as a result of cervical spondylosis, the damage can be permanent.
5. What further investigations need to be done?
Diagnosis
A physical exam will be consduced by the doctor that includes:
Checking the range of motion in the neck.
Testing for reflexes and muscle strength to find out if there's pressure on spinal nerves or spinal cord.
Watching the patient walk to see if spinal compression is affecting gait of the patient.
Imaging tests:
Imaging tests can provide detailed information to guide diagnosis and treatment.
Neck X-ray. An X-ray can show abnormalities, such as bone spurs, that indicate cervical spondylosis. Neck X-ray can also rule out rare and more serious causes for neck pain and stiffness, such as tumors, infections or fractures.
CT scan.
A CT scan can provide more detailed imaging, particularly of bones.
MRI.
MRI can help pinpoint areas where nerves might be pinched.
Myelography.
A tracer dye is injected into the spinal canal to provide more detailed X-ray or CT imaging.
Nerve function tests
These tests are done to determine if nerve signals are traveling properly to the muscles. Nerve function tests include:
Electromyography.
This test measures the electrical activity in nerves as they transmit messages to the muscles when the muscles are contracting and at rest.
Nerve conduction study.
Electrodes are attached to skin above the nerve to be studied. A small shock is passed through the nerve to measure the strength and speed of nerve signals.
6. What are the management options of this condition?
Treatment
Treatment for cervical spondylosis depends on the severity of signs and symptoms. The goal of treatment is to relieve pain, help patient maintain their usual activities as much as possible, and prevent permanent injury to the spinal cord and nerves.
Medications
If over-the-counter pain relievers aren't enough, the doctor might prescribe:
Nonsteroidal anti-inflammatory drugs. to relieve the pain and inflammation associated with cervical spondylosis.
Corticosteroids.
A short course of oral prednisone might help ease pain. If pain is severe, steroid injections may be helpful.
Muscle relaxants. Certain drugs, such as cyclobenzaprine, can help relieve muscle spasms in the neck.
Anti-seizure medications.
Some epilepsy medications, such as gabapentin (Neurontin, Horizant) and pregabalin (Lyrica), can dull the pain of damaged nerves.
Antidepressants. Certain antidepressant medications have been found to help ease neck pain from cervical spondylosis.
Therapy
A physical therapist can teach exercises to help stretch and strengthen the muscles in neck and shoulders. Some people with cervical spondylosis benefit from the use of traction, which can help provide more space within the spine if nerve roots are being pinched.
Surgery:
If conservative treatment fails or if neurological signs and symptoms — such as weakness in arms or legs — worsen, surgery may be needed to create more room for spinal cord and nerve roots.
The surgery might involve:
Removing a herniated disk or bone spurs
Removing part of a vertebra
Fusing a segment of the neck using bone graft and hardware
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