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118: CERVICAL SPONDYLOSIS

Eric Shamus, PhD, DPT, PT, CSCS; Eric J. Chaconas, DPT, PT, FAAOMPT

CONDITION/DISORDER SYNONYMS

  • Cervical osteoarthritis

  • Spinal osteoarthritis

ICD-9-CM CODES

  • 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

ICD-10-CM CODES

  • 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

FIGURE 118-1

Short neck extension. (From Dutton M. Dutton’s Orthopedic Survival Guide: Managing Common Conditions. http://www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 118-2

Cervical active range of motion with passive overpressure. (From Dutton M. Dutton’s Orthopedic Survival Guide: Managing Common Conditions. http://www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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PREFERRED PRACTICE PATTERNS

  • 4B: Impaired Posture1

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Format Range of Motion Associated with Connective Tissue Dysfunction2

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation3

PATIENT PRESENTATION

A 72-year-old woman presents with neck and bilateral upper extremity pain. She reports worsening of symptoms over the past 2 months and increased numbness into the bilateral hands. Magnetic resonance imaging (MRI) reveals stenosis of the spinal canal at the C6 level along with myelopathy. Diminished sensation is noted in the bilateral thumbs along with weakness of the wrist extensors. Balance impairments are noted, and the patient reports increasing difficulty with ambulation.

KEY FEATURES

Description

  • 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 affect lower extremities if central and severe

  • Pressure on the nerve root can cause radiculopathy

Essentials of Diagnosis

  • X-ray

  • Acute painful flare-ups, chronic persistent pain

  • Relief with nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Morning stiffness

General Considerations

  • 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

Demographics

  • Common in adults aged 60 years and older

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • 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 ...

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