Cervical disc syndromes(spondylosis)types, symptoms,investigation, treatment

 The cervical region consists of seven cervical vertebrae with their intervening disks. The disk is made up of central nucleus pulpsus and annulus fibrosus at the periphery. The disk functions as an effective shock absorber and also gives the cervical spine more mobility. If the disk material herniates because of trauma or old age it gives rice to cervical dick syndrome.

More than 90% of the disk lesions in the cervical spine occur at the C5 and C6 levels as these are the most mobile segments.

Types:-

• Soft disk lesion It is common in young adults and is usually following trauma. In this there is only a nuclear herniation through the wide annulus fibrosus of the disk.
• Hard disk lesions This is more common than the First, seen in older age group, gradual in onset and is usually due to cervical spondylosis. Rarely large posterior osteophytes may cause pressure on the anterior portion of the spinal cord produces mixed symptoms of the upper limb nerve root pain and lower extremity weakness (cervical spondylosis with myelopathy)

Clinical features:-

Symptoms:-Patient complaint of pain in the neck which is gradual or acute in onset. There is history of morning stiffness. Extension of neck increases pain. Tingling and numbness develops if the nerve root is compressed but it does not follow the dermatomal pattern. Patient may also complain of radiating pain along the neck, shoulder upper arm, forearm and hand.

Signs:-Movement of the neck are decreased due to pain. Pain increases on hyperextension. There is localized tenderness over the spinous process. Trigger point tenderness at the scapular region is present. Pressure against the top of the head increases pain. if the nerve root is compressed by the disk herniation sensory, motor and reflex changes occur and follow the dermatomal pattern. Rarely symptoms referable to the lower limbs develop due to pressure of posterior osteophytes on the anterior portion of the cervical cord. This symptoms complex appears as a combination of cervical roots and cord symptoms [LMN upper limbs + UMN lower limbs]

Investigations:-

X-ray-->Normal in soft lesion but in hard lesions it shows, narrowing of disk space, anterior and posterior osteophyte formation, and narrowing of intervertebral foramen

Myelography--> It helps in localizing the lesion but is invasive.

MRI-->This is useful, as it is non-invasive, and helps localize the lesion, but its high cost is prohibitive.

CT scan--> It is more useful in evaluating traumatic conditions of the neck than degenerative conditions.

EMG, discography, thermography is occasionally used.

Treatment:- 

Conservative treatment is the more accepted form of treatment in cervical disk syndrome. It consists of rest which allows soft parts to heal by reducing the inflammation. NSAIDs once a day usually preferred. 

Surgical treatment Less than 5 % of the cases of cervical spondylosis require surgery and is usually indicated in cases of chronic pain, failed conservative treatment and neurological deficits due to root or cord compressions.

This surgical procedure usually consists of removal of the cervical disk through an anterior approach and cervical interbody fusion by placing an autologous iliac bone graft. Excision of large osteophytes can also be done through this route. Excision of one or two cervical bodies ( Corpectomy) may be justified in multiple level disk pathology. (Laminectomy) usually does not produce the desired results.

Physiotherapy treatment:-

Measures to Reduce Cervical pain, Spasm and inflammation 

The aim of these measures is to reduce pain and spasm in the neck and thus provide the all important relaxation of the neck muscles. The modalities are:

• Thermotherapy This is heat therapy and could be either superficial or deep.

            --Superficial These are IFT TENS, infrared rays and hydro collator packs

            --Deep This is provided by the ultrasound and the SWD, and the microwave.

•  Cryotherapy This consists of ice packs and ice massage.
• Massaging by the way of friction circular kneading, etc. to the local area pain , considerably reduces pain and induces relaxation

Measures to Strengthen and Mobilize the neck

Exercises play a pivotal role in strengthening the neck muscles an mobilizing the neck once the pain has subsided after employing the above methods.

• Exercises to strengthen the neck muscles  Strong isometrics helps to achieve this when movement is contraindicated.
• Exercises to improve the weak muscles This weak muscles of the neck could be strengthened by active assisted exercises to the neck
• Exercises to Strengthen the neck muscles The active self-resisted isometric exercises help considerably by strengthen the neck muscles
• The relaxed active passive exercises for all the neck movements helps achieve this goal
• Combination exercises All the above exercises combine together in the PNF technique.

Caution  Exercises should not be over done lest it causes pain to the patients.

Cervical Traction 

Whether it is sprain, strain, fracture, dislocation, infection, etc., in the neck, cervical traction has a role to play in each of these troublesome neck problems.

The various types of cervical traction and their significance are as follows.

1. Continuous Traction 

Indications

• To reduce fractures and dislocation of the cervical vertebrae.
• To reduce cervical disk prolapse
• to relieve pressure on the compressed cord and nerve roots.

Methods It is given 24 hours a day with a weight  of 5 to 15lbs.

2. Static traction 

Indications

• Minor disk prolapse.
• Neurological deficits either due to fractures or disk prolapse.

Method Hear the traction is applied for 20-30min with weights ranging from 10-3-lbs.

3. Intermittent traction

Indications

• To relieve pain spasm.
• To prevent and break the adhesions in the joints of the neck.

Method This is the most popular method of cervical traction Due to alternating traction and relaxation, it provides an effect of massaging and relaxation of the neck muscles, thereby reducing pain, spasm and inflammation.

4. Polyaxial cervical traction This provides a pull on a particular segment of the cervical vertebrae.

Role of Manipulation

It has a limited but definite role in reduction of the intra-articular displacement in a mild or moderate cervical spondylosis. Manipulation is usually carried out during strong traction and is maintained by a neck collar.

Cervical Collar 

This use of cervical collar is on the decline. But it is indicated in the following situations:

• Acute disk prolapse.
• Acute pain due to sprain, strain, fracture and dislocations.
• Temporarily immobilization during driving, walking, etc.

Concept of butterfly pillow in cervical spondylosis

A soft thin pillow is tried loosely in the center. The constricted central portion supports the head and neck. While the butterfly portion of the pillow supports the neck on either side while sleeping.