Cervical Spondylosis

What is cervical spondylosis?

Cervical spondylosis describes the natural wearing of the bones and discs in your neck as you get older, sometimes described as arthritis of the neck. It's an extremely common part of ageing and doesn't necessarily mean you'll have any pain or other symptoms as a result.

What are the symptoms of cervical spondylosis?

Many people with cervical spondylosis notice nothing at all, and scans often show these changes in people with no symptoms whatsoever. Where symptoms do develop, they may include:

• pain or stiffness in the neck that comes and goes in waves, sometimes spreading towards your shoulders or the base of your skull
• stiffness that's often at its worst first thing after waking
• headaches that start low at the rear of the head and travel forward
• clicking, popping or grinding sounds when you move your neck, which are usually harmless

Symptoms tend to flare up from time to time, for example after overusing your neck or straining a muscle, rather than staying constant.

What are the causes of cervical spondylosis and who is at risk?

Cervical spondylosis develops as the discs between your neck bones gradually dry out and thin with age, while the bone edges nearby can develop small rough patches called osteophytes. It's a completely natural ageing process, often likened to the spine developing its own wrinkles and grey hairs.

You may be more prone to it, or to it causing symptoms, if you've previously injured your neck or have close relatives with the condition. Work that involves looking up or down for hours at a time, carrying excess weight, or regularly lifting heavy loads awkwardly can also play a part, and smoking is linked to it too.

Are there different types of cervical spondylosis?

For most people, cervical spondylosis stays as simple wear and tear that causes little or no trouble. In a smaller number of cases, it can progress to put pressure on nearby nerves or the spinal cord itself, leading to two distinct complications.

Cervical radiculopathy happens when a nerve root gets pinched as it leaves your spine, causing pain, numbness or a tingling sensation that spreads down one arm. Cervical myelopathy is rarer and more serious, arising when the spinal cord itself comes under load, which can make your hands less dexterous, or affect your walking and bladder control.

How is cervical spondylosis diagnosed?

A healthcare professional will usually ask about your symptoms and examine your neck, checking things like how far it moves, your strength, and your reflexes. They may also watch you walk and test the sensation and power in your limbs.

Imaging like an X-ray or MRI scan isn't usually needed to diagnose straightforward cervical spondylosis, since many people over 40 show these changes without having any symptoms at all, meaning a scan often wouldn't change your treatment. Scans become more useful if there's a suspicion of radiculopathy or myelopathy, to see exactly where a nerve or the spinal cord is under pressure.

How is cervical spondylosis treated?

For most people, treatment focuses on staying active and managing pain rather than fixing the underlying wear and tear, which can't be reversed:

• Keeping your neck gently moving, with regular exercises rather than resting it completely
• Carrying on with your usual activities and getting back to work when you feel able to, since this tends to support recovery
• Taking painkillers such as paracetamol or ibuprofen, with stronger options or a low-dose medicine for nerve-related pain available from a doctor if needed
• Doing physiotherapy, along with practical measures such as good posture and a supportive pillow.

If a scan confirms a pinched nerve or spinal cord pressure that hasn't settled with these measures, surgery may be considered. It isn't guaranteed to fix things completely, but it can help stop symptoms from getting worse.

When should I see a doctor?

See a GP if your neck pain or stiffness hasn't settled after a few weeks, or is clearly worse when you move.

Seek an urgent same-day GP appointment, or call 111, if you notice any of the following:

• Neck pain that's severe, sudden, or rapidly getting worse
• Heaviness or weakness affecting an arm or leg
• Tingling running down an arm together with pain in that arm or your neck
• Pain that sits between your shoulder blades
• Dizziness or blackouts brought on by turning or bending your neck.

Call 999 immediately if you notice any of the following, as they can point to a medical emergency:

• New difficulty walking
• Losing control of your bladder or bowels
• Sudden clumsiness or loss of coordination

One side of the face drooping Being unable to lift both arms and hold them up Slurred or garbled speech.