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Condition/Disorder Synonyms

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  • Cervical spondylosis

  • Spinal osteoarthritis

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ICD-9-CM Code

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  • 721 Spondylosis and allied disorders

  • 721.0 Cervical spondylosis without myelopathy

  • 721.1 Cervical spondylosis with myelopathy

  • 721.9 Spondylosis of unspecified site

  • 721.90 Spondylosis of unspecified site without myelopathy

  • 721.91 Spondylosis of unspecified site with myelopathy

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ICD-10-CM Code

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  • M47.12 Other spondylosis with myelopathy, cervical region

  • M47.812 Spondylosis without myelopathy or radiculopathy, cervical region

  • M47.819 Spondylosis without myelopathy or radiculopathy, site unspecified

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Preferred Practice Patterns

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Key Features

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Description

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  • Osteoarthritis of the cervical spine

  • Chronic degeneration

  • Progressive arthritis of the cervical spinal joints

  • As space between the vertebrae decreases, there may be compression onto the nerve roots

  • Arthritis can be central- or lateral-foramen based

    • Central: usually bilateral symptoms

    • Lateral: usually unilateral

  • Pain, paresthesia, and weakness in the upper extremities, can effect lower extremities if central and severe

  • Pressure on the nerve root can cause radiculopathy

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Essentials of Diagnosis

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  • X-ray

  • Acute painful flare-ups, chronic persistent pain

  • Relief with NSAIDs

  • Morning stiffness

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General Considerations

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  • Begins with intermittent pain

  • Pain and stiffness at rest/sleep

  • Improved with low-level activity

  • May have rapid and severe onset

  • Vertebrobasilar insufficiency is secondary problem

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Demographics

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  • Common in adults aged 60 years and older

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Clinical Findings

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Signs and Symptoms

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  • Fatigue

  • Stiffness

  • Heaviness in the upper extremities

  • Loss of range of motion and joint play

  • Intermittent pain, increases with weight bearing

  • Paresthesia

  • Tingling sensation in the upper extremity

  • Diminished reflexes

  • Lower motor neuron dysfunction

  • Muscle weakness in the arm

  • Radiculopathy

  • Characteristics of the different syndromes of cervical spondylotic myelopathy

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Functional Implications

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  • Limited mobility in cervical motion

  • Difficulty looking over shoulder while driving

  • May have difficulty washing hair at hair dresser due to cervical spine extension

  • Increased symptoms with increased weight-bearing

  • Aerobic endurance limitation

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Possible Contributing Causes

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  • Family history of osteoarthritis

  • Bone spurs

  • Instability

  • Weakness

  • Poor posture

  • Limited flexibility

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Differential Diagnosis

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  • Spinal stenosis

  • Disc herniation

  • Reiter's syndrome (reactive arthritis)

  • Whipple's disease

  • Facet joint arthritis

  • Rheumatoid arthritis

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Means of Confirmation or Diagnosis

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Imaging

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  • X-ray of the cervical spine

  • MRI of the cervical spine

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Findings and Interpretation

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  • Decreased space between the cervical vertebrae on X-ray

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Treatment

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Medication

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  • NSAIDs

  • Corticosteroids

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