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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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  • 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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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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Signs and Symptoms

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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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Imaging

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  • X-ray of the cervical spine
  • MRI of the cervical spine

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  • Decreased space between the cervical vertebrae on X-ray

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Medication

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  • NSAIDs
  • Corticosteroids

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  • To rheumatologist to assess underlying complications
  • To orthopedic surgeon for surgical consult

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  • Mobility
  • Functional rotation and bending

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  • Cervical spine AROM

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  • Education in gentle range of motion to maintain mobility
  • Exercise: flexibility and stability strengthening to decrease stress on the joints
  • Joint protection education
  • Postural training
  • Heat or ...

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