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  • 721 Spondylosis and allied disorders
  • 721.0 Cervical spondylosis without myelopathy
  • 721.1 Cervical spondylosis with myelopathy
  • 721.2 Thoracic spondylosis without myelopathy
  • 721.3 Lumbosacral spondylosis without myelopathy
  • 721.4 Thoracic or lumbar spondylosis with myelopathy
  • 721.41 Spondylosis with myelopathy, thoracic region
  • 721.42 Spondylosis with myelopathy, lumbar region
  • 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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  • M47.12 Other spondylosis with myelopathy, cervical region
  • M47.14 Other spondylosis with myelopathy, thoracic region
  • M47.16 Other spondylosis with myelopathy, lumbar region
  • M47.812 Spondylosis without myelopathy or radiculopathy, cervical region
  • M47.814 Spondylosis without myelopathy or radiculopathy, thoracic region
  • M47.817 Spondylosis without myelopathy or radiculopathy, lumbosacral region
  • M47.819Spondylosis without myelopathy or radiculopathy, site unspecified

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Description

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  • Osteoarthritis of the spine
  • Chronic degeneration
  • Progressive arthritis of the spinal joints
  • As the space between the vertebrae decreases, there can 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 extremities
  • 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 pain that is intermittent
  • Pain and stiffness at rest/sleep
  • Improved with low-level activity
  • Could have rapid and severe onset
  • Secondary problem is vertebrobasilar insufficiency

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Demographics

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  • Common in adults ages 60 and older

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Signs and Symptoms

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  • Fatigue
  • Stiffness
  • Heaviness
  • Loss of ROM and joint play
  • Pain that is intermittent, increased with weight-bearing activities
  • Paresthesia
  • Tingling sensation in the extremity
  • Diminished reflexes
  • Lower motor neuron dysfunction
  • Muscle weakness
  • Radiculopathy
  • Characteristics of the different syndromes of cervical spondylotic myelopathy

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Functional Implications

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  • Limited mobility
  • Increased symptoms with increased weight-bearing exercises
  • 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
  • Forestier disease
  • Reiter’s syndrome (reactive arthritis)
  • Whipple’s disease
  • Yersinia arthritis
  • Facet joint arthritis
  • Psoriatic arthritis
  • Rheumatoid arthritis

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Imaging

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  • Decreased space on x-ray between the vertebrae

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Medication

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  • NSAIDs
  • Corticosteroids

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  • Rheumatologist to assess underlying complications
  • Surgical consult
  • Orthopedic surgeon

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  • Mobility
  • Functional rotation and bending

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  • Straight leg raise
  • Sit and reach test
  • Slump test
  • Reflexes
  • Myotomes
  • ...

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