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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

  • 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

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 effect 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 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

Signs and Symptoms

Functional Implications

  • 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

Possible Contributing Causes

  • Family history of osteoarthritis
  • Bone spurs
  • Instability
  • Weakness
  • Poor posture
  • Limited flexibility

Differential Diagnosis

Imaging

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

  • Decreased space between the cervical vertebrae on X-ray

Medication

  • NSAIDs
  • Corticosteroids

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

  • Mobility
  • Functional rotation and bending

  • Cervical spine AROM

  • Education in gentle range of motion to maintain mobility
  • Exercise: flexibility and stability strengthening to decrease stress ...

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