Disc degeneration and cervical spondylosis are common causes of neck pain. An estimated 50 percent of people over the age of 50 and 75 percent of those over 65 have radiologic evidence of cervical spondylosis, most of them without symptoms.
Cervical spondylosis comprises the process in which wear and tear of the cervical spine results in disc degeneration, calcification, new bone formation, and osteophyte formation. The bone formation may lead to intervertebral foramen narrowing, with nerve-root irritation or spinal-canal narrowing with cord compression.
The process starts with disc degeneration, which occurs with aging as the vascular supply and nutritional supply to the disk are compromised. Nerve roots most often involved with nerve-root compression are C5 and C6, which represent the locale of maximum mobility, angulation, and degeneration of the cervical spine.
The manifestations of cervical disk degeneration and cervical spondylosis encompass a wide spectrum:
- Brachial radiculopathy
- Suboccipital neuralgia
- Localized neck pain
- Cord compression
- Vertebral basilar-ischemic symptoms.
Symptoms may be acute and associated with minor trauma or of a more chronic and progressive nature.The patient who presents with neck pain or cervical-radicular symptoms but with normal neurologic and radiographic findings may be treated conservatively.
Therapeutic modalities include a soft cervical collar, analgesics, anti-inflammatories, local heat, possibly traction , and isometric exercises.
Secondary myofascial trigger points or occipital neuralgia may be treated with injection of local anesthetics, possibly mixed with steroids.
Surgery usually is recommended for progressive neurologic deficits or signs of cord compression however, surgery for pain alone is controversial.