Spinal Diseases (Cervical Spondylosis)

Cervical spondylosis is a disease, also known as cervical osteoarthritis, in which the joints of the neck are affected as a result of repeated minor trauma with aging. It usually occurs in people over the age of 40 and progresses with age. It is most common in the most mobile regions of the cervical (neck) vertebrae ( C4-C5, C5-C6, C6-C7 ). Both sexes are affected equally, although it appears at an earlier age in men than in women. As people age, the bones and cartilage that make up our back and neck spine undergo progressive degeneration, and sometimes irregular bony projections called osteophytes form as a result. Although this finding is detected on radiological imaging studies in many people, it may sometimes cause no complaints at all. In cervical spondylosis, compression of one or more of the nerves emerging from the cervical spinal cord causes a condition called radiculopathy. Bony projections called osteophytes can narrow the spinal canal and expose the spinal cord to compression. As a result, spinal cord injury called myelopathy may occur. Trauma such as a fall from height or a traffic accident may suddenly increase spinal cord injury in cases of cervical spondylosis that had not previously produced symptoms.

Findings:

• Stiff and painful neck
• Shoulder and arm pain
• Numbness and tingling in the arms, hands, legs and feet
• Weakness in the arms, hands, legs and feet
• Loss of coordination
• Difficulty walking
• Abnormal deep tendon reflexes
• Urinary and fecal incontinence or retention

Risk Factors:

• Aging
• Repeated minor trauma
• Major trauma suffered in the past ( traffic accident, fall from height )

When should you consult a physician?

• If there is no reduction in pain despite the pain-relieving treatments being used
• If pain gradually worsens
• If numbness and weakness appear in the arms and legs

Diagnosis: The diagnosis of the disease is made after taking the complaints and history, with the help of a neurological examination and the radiological imaging methods requested accordingly. To determine whether the spinal cord and nerve roots are under compression, reflexes, muscle strength of the arms and legs, and sensory examinations must be performed. Cervical spondylosis may also cause restriction of neck movements, which can be detected on examination. Among imaging tests, cervical plain radiography, cervical computed tomography (CT) and cervical magnetic resonance imaging (MRI) may be requested, and diagnosis can be reached by identifying the bony projections detected on them, compression of the spinal cord and nerve roots, or disc herniations between the vertebrae.
Treatment: Depending on the severity of the clinical condition in each case, non-surgical (medical-conservative) treatment or surgical treatment is preferred.

Non-Surgical Treatment:

• Wearing a cervical collar restricts neck movements and reduces nerve irritation
• Using pain medications (especially non-steroidal anti-inflammatory drugs)
• Exercises to strengthen the neck muscles and physical therapy
• Using muscle relaxant medications
• Injection of corticosteroid and local anesthetic into the joints between the vertebrae (facet joints)

Surgical Treatment: Surgical intervention is considered if conservative medical treatments are ineffective, the patient's neck pain does not go away, or neurological findings worsen. The surgical procedure to be performed varies according to the pathology causing the patient's current condition. The most commonly used surgical approaches are anterior (from the front) and posterior (from the back) approaches.

Anterior approach: An incision on the front of the neck is used to reach the cervical vertebrae by retracting the esophagus (oesophagus) and trachea (windpipe). At this point, the surgeon removes the herniated disc between the vertebrae or the bony projections, depending on the underlying pathology. With this approach, the two discs and the vertebra between them are removed (corpectomy) to relieve compression of the spinal cord. The resulting space can be supported with an implant (corpectomy cage) or with bone graft taken from the patient or synthetic bone graft.

Posterior approach: This approach is based on relieving the spinal cord canal by removing the posterior elements to relieve narrowing of the spinal canal extending over one or several levels. (Laminectomy)
If deemed necessary, posterior stabilization with titanium screws is performed after removal of the posterior elements so that spinal stability is not disturbed.

Risks of Surgery: Such surgical procedures may be associated with problems such as infection, bleeding during and after surgery, cerebrospinal fluid leakage due to tearing of the dura mater surrounding the spinal cord during surgery, and deep vein thrombosis and related complications that may develop due to prolonged immobility in bed after surgery.