Cervical spondylosis is a common progressive disorder in the aging cervical spine. Microscopic and biochemical studies have shown that degenerative changes occur in the intervertebral discs with involvement of the collagen in the annulus. With aging, the disc comprised of a nucleus pulposus surrounded by an annular fibrosus changes as collagen and proteoglycans are replaced with fibrous tissue and calcium deposits. As the nucleus pulposus becomes dehydrated, more fibrotic, and less distinct from the annulus fibrosis, calcification develops with ensuing collapse of the disc space. The zygapophyseal joints along with the edges of the vertebral bodies also undergo degenerative changes with aging giving rise to osteophyte formation and narrowing of the neuroforamen through which the cervical nerve root exits. Diagnostic studies demonstrate a collapse of the intervertebral disc space, osteophyte formation, and hypertrophy of the facet joint, which results in stenosis of the neuroforamen and compression of the exiting nerve. Compression of the cervical nerve root secondary to the neuroforaminal stenosis results in cervical radiculopathy. Symptomatology includes pain along the cervical dermatome with associated sensory abnormalities, motor dysfunction expressed as weakness, and/or changes in motor reflex activity.
Treatment for symptomatic cervical radiculopathy includes the use of nonsteroidal anti-inflammatory medication, physical therapy with cervical traction and McKenzie exercise regimen, use of cortisone injections into the facet joints or foraminal space, and surgery for decompression of the degenerative changes to relieve pressure on the cervical nerve root.