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1. Cervical
spondylitis
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2. Cervical spondylitis
Cervical spondylitis is a common degenerative condition of
the cervical (neck) spine that most likely is caused by
age-related changes (wear and tear) in the intervertebral
disks and vertebrae of the neck. Research has shown that
CSM (cervical spondylotic myelopathy) is the most
common cause of non-traumatic weakness in limbs and a
persistent stiffness and nagging pain in the neck.
'Spondylo' is a Greek word-meaning vertebra. Spondylitis
(or Spondylosis) means changes in the vertebral joint
characterized by increasing degeneration of the
intervertebral disc with subsequent changes in the bones
and soft tissues.
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3. Most often in people above the age of 40, the
intervertebral discs get progressively
dehydrated and they become more
compressible and less elastic. Mineral
deposition starts occurring in the intervertebral
disc resulting in secondary changes. Although
majority of individuals over 40 years of age
demonstrate significant radiological evidence of
the above changes, only a small percentage
develop symptoms of the same. Another
noteworthy point is that sometimes the
degenerative changes in the cervical spine can
be visible on the X-ray as early as in 30’s but it
does not call for any treatment if the patient is
not symptomatic.
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5. • This is basically a mechanical disorder.
• Very stiff muscles in the cervical region can, over the
years, cause a kinking of the cervical spine to the front.
• Bad posture and lack of exercise to the cervical region are the
key factors which are responsible in a majority of the patients.
• Lying in bed with several pillows propping up the neck into an
unnatural position can affect the alignment of the cervical
column, causing a forward inclination.
• Reclining on sofas with the spine hunched and the neck pushed
forward is bad for cervical alignment.
• Hunching over the computer for many hours, occupational
hazards such as those of a writer, an illustrator or a painter, all
cause the spine to be bent forward all the time.
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6. • Positioning the body to the same side during
sleep, with the shoulder muscles and the neck
compressed, also develops faulty alignment in the
cervical spine. In due course the spine is bent, the
front surface of the bones and disc are excessively
pressurised and damage occurs.
• The so-called executive chairs are ill-designed and
push the neck out of alignment. No chair should
reach over the head. The level should be up to the
shoulder blades so that the chest can stretch over
the edge keeping the body upright.
• In India, railway porters carry heavy loads on their
heads but they do not suffer from cervical pain (as
one would expect) from the heavy load they carry
every day. Only in the group of people who never
exercise their bodies does this occur most
frequently.
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9. • Neck pain and stiffness is one of the earliest presentations of cervical
spondylitis. Some of the characteristic features of this condition are:
• Chronic or episodic pain and stiffness in the neck and shoulder region
• The pain tends to get worse over a period of time
• There may be periods initially when the pain disappears completely; later as
the disease advances the pain may remain persistent
• Pain may radiate (travel) from neck to shoulders, arms, forearms, hands, lower
part of the head, upper back
• Coughing, sneezing, other movements of the neck may worsen symptoms
• Along with pain, there may be abnormal sensations (tingling numbness), loss
of sensation, weakness in any of the above regions
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10. • There may be non-specific headaches in the
lower part of the back of head
• Sensation of loss of balance
• Loss of control over the bladder or bowels (if the
spinal cord is compressed)
• Occasionally there may be atypical pain
presenting as chest pain or breast pain (false
angina)
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11. The doctor may find certain clear pointers
to this disease on examination of the
patient:
• Spasm of the neck muscles
• Limited range of movements of the neck – bending
forward, backward, sideways, rotating the head are all limited
• Weakness of muscles of the arms, forearms
• Altered sensation in the shoulder region, arms, forearms, neck, etc.
• Reflexes are often reduced
• poorly localised tenderness,
• limited range of motion,
• minor neurological changes.
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12. • Imaging tests
A variety of imaging tests can provide
details to guide diagnosis and
treatment. Examples include:
• Neck X-ray. An X-ray may show
abnormalities, such as bone
spurs, that indicate cervical
spondylosis. It is ordered primarily as
a screening test to look for
rare, serious causes for neck pain and
stiffness — such as tumors, infections
or fractures.
• Computerized tomography (CT scan).
This test takes X-rays from many
different directions and then
combines them into a cross-sectional
view of the structures in your neck. It
can provide much finer details than a
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13. • Magnetic resonance imaging (MRI). MRI uses a magnetic
field and radio waves and can produce detailed, cross-
sectional images of both bone and soft tissues. This can help
pinpoint areas where nerves may be getting pinched.
• Myelogram. This test involves generating images using X-rays
or CT scans after dye is injected into the spinal canal. The dye
makes areas of your spine more visible.
Nerve function tests-
In some cases, it may be helpful to determine if nerve signals
are traveling properly to your muscles. Nerve function tests
include:
• Electromyogram (EMG). This test measures the electrical
activity in your nerves as they transmit messages to your
muscles when the muscles are contracting and when they're
at rest. The purpose of an EMG is to assess the health of your
muscles and the nerves that control them.
• Nerve conduction study. For this test, electrodes are attached
to your skin above the nerve to be studied. A small shock is
passed through the nerve to measure the strength and speed
of nerve signals.
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14. • To arrive at an accurate diagnosis, it is critical for
the physician to consider other disorders that have
similar symptoms as cervical spondylotic
myelopathy (a "differential diagnosis"). Other
conditions associated with neck pain and arm
pain, motor-sensory-reflex changes, and signs of
spinal cord dysfunction include:
• Progressive forms of multiple sclerosis
• Amyotrophic lateral sclerosis (Lou Gehrig's
disease)
• Hereditary spastic paraplegia
• Subacute combined degeneration of the spinal
cord associated with vitamin B12 deficiency
• Certain spinal cord tumors
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• Combined system disease
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15. • Rheumatoid
Arthritis
• Cervical Sprain and
Strain
• Osteoporosis and
Spinal Cord Injury
• Frozen Shoulder
• Metabolic diseases
- Paget's
disease, osteoporo
sis, gout or pseudo-
gout Infections -
osteomyelitisor
tuberculosis
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16. • MEDICAL
• PHYSIOTHERAPY
• RELAXATION
• ERGONOMICS
• DO’s AND DONT’s
• HOMEOPATHIC APPROACH
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17. • Usually Analgesics and muscle relaxants are advised . In more
severe cases the orthopaedic doctor may suggest cortisone
injections near the joints of the vertebral bodies to ease the
swelling of the nerves and relieve pain.
•
Surgical Treatment
If the medical treatment and
physiotherapy fails, and the condition is severe, where the nerves
are affected, surgery may be required.. Decompression of the nerve
is done to relieve the nerve which is compressed by the bones and
the disc.
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18. • Physiotherapy
The goal of physiotherapy
treatment is to relieve pain, and
enhance movements of the neck.
• Shortwave Diathermy - A disc or
heating pad is placed over the
back of the neck. The warmth
obtained from the shortwave
diathermy current relaxes the
muscle and the pain is relieved.
Cervical Traction - Traction is a
mechanical device, which
supports the head and chin. It is
used to relieve the nerve
compression by a bone.
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19. • Posture correction - Simple
postural exercises can be taught
to correct the faulty position of
the neck.
Motivation is given to maintain
the erect posture:
Collars - Two types of collars can
be prescribed:
Soft Collar - Soft collar is used
during night times to prevent
awkward position of the neck
during sleep.
Firm Collar - Firm collar steadies
the neck and relieve
pain, especially during traveling
or work. It is removed when the
pain subsides.
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20.  Relaxation
Relaxation is essential part of treatment. Tension in
neck and shoulder muscle, pain, anxiety are all
relieved by relaxation.
Relaxation can be done in two ways:
Physical Relaxation.
Mental Relaxation.
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21. • Physical Relaxation:
The whole body is relaxed by free suitable and comfortable
positions, so that the muscles are freed from tension and the pain
is relieved. For eg., position of relaxation - when you are lying flat
on your back.
One pillow under the head
One cushion for the shoulder and
One under knees.
The pillow should be firm and thin
This position will allow relaxation for your body while lying down.
Relaxation while sitting.
The head, neck and shoulder are supported by high backed
chair, with a small pillow at lower back.
Feet supported on stool or low bench
Arm, resting on arm of chair or pillow
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22. • Ergonomics
Ergonomics
concentrates on the
architectural design of
furnitures like
desk, chairs, tables etc.
The design of the
furniture should be
such that it should
support the body
structure without
causing any undue
strain to the muscles of
the back and neck .
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23. • Do's and Dont's
If you are prone to cervical spondylosis, Avoid bad roads, if
travelling by two or four wheelers
Do not sit for prolonged period of time in stressful postures
Do use firm collars while traveling
Do not lift heavy weights on head or back
Do not turn from your body but turn your body moving your feet
first
Do turn to one side while getting up from lying down
Do the exercises prescribed regularly
Do use firm mattress, thin pillow or butterfly shaped pillow
Do not lie flat on your stomach.
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24. • Yogasanas for cervical spondylitis:
• Here are some of the most useful Yoga asanas for
cervical spondylitis. Before practicing these Yogasanas
you should seek guidance of your health provider and
should only practice under guidance of an Yoga
expert.
• Sarpasana
• Dhanurasana
• Shalabhasan
• Dandasana
• Bhujangasan
• Tadasana
• Makarasan
• Neck excercises ( forward bending and backward
bending)
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