Degenerative Disease of the Cervical Spine

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Osteoarthritis, the most common member of this group, affects men more often than women. Not well understood is its tendency to worsen abruptly and to induce symptoms of radicular disease. This suggests trauma or an inflammatory joint change, but evidence for either is usually lacking. The usual symptoms are cervical aching pain radiating into the occiput, shoulder, and upper arms and restriction of movement of the head. With advanced disease and the formation of bony ridges (ossification of protruded disc material), the spinal cord may be compressed (cervical spondylosis), resulting in spastic weakness and loss of position and vibratory sense in the legs. Osteophytic spur formation in and around the vertebral foramina may cause symptoms and signs of root compression. In patients with congenital narrowing of the cervical spinal canal (less than 10 to 11 mm in anteroposterior diameter), relatively mild trauma or osteoarthritic changes may result in cord and root compression. Temporizing, using analgesic medications, and particularly immobilization of the neck (soft collar, traction) frequently relieves the symptoms. Failure of conservative therapy may require surgical measures (see discussion of cervical spondylosis, Chap. 43).

Rheumatoid arthritis of the cervical spine, in its advanced form, may give rise to a number of acute and chronic spinal cord syndromes. The most serious is acute spinal cord compression due to vertebral subluxation, particularly atlantoaxial subluxation with odontoid displacement.

Thoracic outlet syndrome (cervical rib syndrome, anterior scalene syndrome) is a relatively infrequent condition seen often in women with drooping shoulders and poor muscle tone. The lower trunk of the brachial plexus, the subclavian vein, and the subclavian artery, together or in various combinations, are compressed in the lateral cervical region by a cervical rib, fascial bands, or possibly the anterior and medial sca lene muscles. Shoulder and usually medial arm pain, slight weakness and atrophy of muscles in an ulnar distribution, dusky discoloration of the hand and forearm, venous distention, and ischemic changes in the hand and arm are the usual clinical manifestations. Definitive diagnosis depends on EMG findings (see the Principles for details and treatment).

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