Cervical Spondylosis (Neck Arthritis)

What happens in cervical spondylosis

The neck (cervical spine) has seven vertebrae, separated by cushioning discs and linked by small facet joints at the back. With age:

• discs dry out and shrink, losing height and sometimes bulging or herniating
• facet joints develop osteoarthritis, with thinning cartilage
• bone spurs (osteophytes) grow at the edges of the vertebrae as the body tries to stabilize them
• ligaments thicken and stiffen

These changes are part of normal aging. They become a problem when they cause pain, or narrow the spaces through which nerves and the spinal cord pass.

Symptoms

Neck pain and stiffness

The most common symptoms are a dull ache and stiffness in the neck, often worse in the morning or after holding the head in one position (reading, screens, driving). Pain may spread to the shoulders and between the shoulder blades. You may hear or feel grinding (crepitus) when turning the head. Neck stiffness often comes and goes in flares.

Headaches

Pain from the upper neck joints can cause headaches at the back of the head that spread forward (cervicogenic headache).

Pinched nerve (cervical radiculopathy)

When a bone spur or disc narrows the opening where a nerve root exits, it causes cervical radiculopathy:

• sharp or burning pain from the neck down one arm
• tingling or numbness in specific fingers
• weakness in certain arm or hand muscles
• reduced reflexes

Spinal cord compression (cervical myelopathy)

When the spinal canal becomes narrow enough (cervical stenosis), the spinal cord itself can be squeezed. Degenerative cervical myelopathy develops gradually and is often missed. Signs include:

• clumsy hands, difficulty with buttons, keys, coins or handwriting
• numbness in the hands
• unsteady walking and poor balance
• electric shock sensations down the spine when bending the neck (Lhermitte sign)
• in later stages, bladder problems

Myelopathy needs prompt specialist assessment because nerve damage can become permanent.

Risk factors

• age, the biggest factor
• previous neck injury, such as whiplash
• jobs or activities with repetitive neck movement, awkward posture or overhead work
• genetics and family history
• smoking, which accelerates disc degeneration

Diagnosis

A doctor will ask about pain, arm and hand symptoms, walking, and bladder function, and examine neck movement, strength, sensation and reflexes in the arms and legs.

• X-rays show disc narrowing and bone spurs, but these are common in people without symptoms, so X-ray findings alone do not explain pain.
• MRI shows discs, nerves and the spinal cord, and is needed if there are nerve or cord symptoms or before surgery.
• CT scan shows bone detail, sometimes with dye (CT myelogram) if MRI is not possible.
• Nerve conduction studies and EMG help separate a pinched neck nerve from carpal tunnel syndrome or other nerve problems.

Treatment

Self-care and exercise

• Stay active and keep the neck moving. Gentle range-of-motion exercises several times a day reduce stiffness.
• Strengthen the deep neck flexors and upper back muscles, ideally with a physical therapist's program.
• Posture: raise screens to eye level, avoid long periods looking down, take breaks every 30 to 45 minutes.
• Heat before exercise and ice after flares.
• A supportive pillow that keeps the neck level.
• Pain relief: NSAIDs such as ibuprofen or naproxen, or acetaminophen (paracetamol), following the label dose. Topical NSAIDs are an option.

Soft collars are only for short periods during a severe flare; prolonged use weakens neck muscles.

Medical treatment

• Physical therapy: manual therapy, exercise programs and posture training.
• Medicines for nerve pain: such as gabapentin, pregabalin or duloxetine for radiculopathy.
• Short courses of oral steroids for severe nerve pain.
• Injections: epidural steroid injections for radiculopathy, or facet joint injections and radiofrequency ablation for joint pain in selected people.

Surgery

Surgery is considered for:

• cervical myelopathy, particularly moderate or progressive, to stop further damage
• radiculopathy with significant or worsening weakness, or severe pain despite 6 to 12 weeks of non-surgical treatment

Common operations are anterior cervical discectomy and fusion (ACDF), cervical disc replacement, and posterior laminoplasty or laminectomy for multilevel compression.

Outlook

Most people with cervical spondylosis have intermittent neck pain that is managed well with exercise and self-care. Radiculopathy improves without surgery in most cases over weeks to months. Myelopathy tends to progress slowly; surgery usually stops progression and often improves symptoms.

Frequently asked questions

What is cervical spondylosis?

Cervical spondylosis is age-related wear and tear of the neck's discs and joints, with bone spur formation. It is a form of osteoarthritis. It often causes no symptoms, but can cause neck pain and stiffness, and sometimes pinched nerves or spinal cord compression.

What are the symptoms of cervical spondylosis?

Common symptoms are neck pain and stiffness, grinding, and headaches at the back of the head. If a nerve is pinched, pain, tingling or weakness spread down an arm. Spinal cord compression causes clumsy hands and unsteady walking.

What exercises help cervical spondylosis?

Gentle neck range-of-motion exercises (turning, tilting and chin tucks), deep neck flexor strengthening, shoulder blade squeezes and upper back stretches help most people. A physical therapist can tailor a program. Avoid forcing painful movements.

Can cervical spondylosis cause dizziness?

Some people with neck arthritis report dizziness, sometimes linked to neck position or muscle tension. Dizziness has many other causes, including inner ear and blood pressure problems, so it should be assessed rather than assumed to come from the neck.

Is cervical spondylosis serious?

Usually not. Most cases cause only intermittent neck pain. It becomes serious when it compresses the spinal cord (myelopathy), causing clumsy hands, balance problems or bladder changes. These symptoms need prompt specialist assessment.