Symptoms and treatment of arthrosis of the cervical spine

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Do you suffer from aching and dull pain in the neck?
Has it become difficult to turn and tilt your head? Do you occasionally experience cervical subluxations? Don't put off visiting a specialist! Perhaps the cause of these symptoms is osteoarthritis of the cervical spine - a pathology that causes inevitable degenerative changes and threatens with dangerous complications.

Causes of cervical osteoarthritis

Osteoarthritis is a pathological process that gradually affects the cartilage tissue separating the vertebrae. The causes of the development of osteoarthritis of the cervical spine may be:

• Sedentary lifestyle, excess weight
• Incorrect posture and uncomfortable back position at work, school and at home
• Frequent and excessive physical activity
• Back injuries in the cervical region
• Other pathologies: Poliomyelitis
• Flat feet
• Mineral metabolism disorders

Unfortunately, modern lifestyle largely influences the development of this pathology, which often occurs in adults and older people. It is all the more important to identify the disease at the earliest stage. To do this, you need to consult a doctor at the first symptoms of the disease!
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At the MART clinic on Vasilyevsky Island

• Evidence-based medicine
• Experienced specialists
• Monitoring of patients for 6 months.
• Diagnostics (MRI, ultrasound, tests)
• Daily 8:00 – 22:00

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Spondyloarthrosis - symptoms and treatment

The prognosis of the disease depends on its identified form and stage. At earlier stages of damage, a significant restoration of the motor functions of the intervertebral joints and relief of pain is possible. Stage IV is considered irreversible, so the main task in this case is to stop further structural destruction and form adaptive functioning mechanisms to maintain the patient’s ability to work and everyday activities.

Prevention of spondyloarthrosis primarily consists of:

• conducting regular medical examinations of the spine;
• maintaining physiological body weight;
• rational professional and everyday motor mode;
• eliminating physical overload (including sports);
• regular physical activity (adequate fitness programs with an instructor);
• timely qualified treatment of inflammatory diseases.

Nutrition for spondyloarthrosis, as well as for most other diseases, should be balanced and as natural as possible. Since most people suffering from spondyloarthrosis are overweight, a review of food preferences should be aimed at less calorie foods. In general, it is necessary to remember a fairly simple rule of all dietary programs for weight loss: the amount of energy expended must be greater than the amount of energy consumed.

The widespread recommendation of many specialists to “monitor your posture” in this disease certainly has a right to exist, but the practical effectiveness of such a recommendation is often reduced to zero. Even a relatively healthy person is not able to observe his back position during the day due to numerous professional and everyday distractions. Moreover, a patient with spondyloarthrosis will not be able to monitor his posture, since he strives to take the most painless position.

The formation of the most physiological posture occurs through regular exercise therapy (fitness rehabilitation) with a qualified instructor for at least six months. During this period, the most adequate paravertebral muscle tone is formed, which makes it possible to give the spine the most physiological position without attention control.

Fitness rehabilitation programs should be an integral part of the treatment of patients with spondyloarthrosis. Under the supervision of the attending physician, an individual set of therapeutic exercises is selected taking into account the stage of the disease and the general condition of the patient. Early initiation of correction of movement disorders and training in the correct movement pattern contributes to faster recovery of working capacity.[1][7][9]

Symptoms of osteoarthritis of the cervical spine

How to suspect that you have cervical osteoarthritis? Check for the following symptoms:

• Pain syndrome in the neck: Aching and dull pain
• Often occurs in the morning
• The pain gradually spreads to the arms and shoulder blades

Common situation? Make an appointment with a neurologist today! Remember: the sooner you detect pathology, the higher the chance of a successful and quick recovery!

Diagnosis of spinal osteoarthritis

Vertebrologists at the Yusupov Hospital diagnose the disease using a clinical examination of patients and additional examination methods. Upon examination, smoothness of the cervical or lumbar lordosis (curvature of the spine facing forward), rotation or curvature of the spine in the cervicothoracic or lumbosacral regions is visible. On the sore side, there is tension in the paravertebral muscles and quadratus dorsi muscles. Local tenderness may be detected over the affected joint. When palpated, muscle tension around the intervertebral joint is determined. Sometimes in chronic cases, neurologists detect some weakness of the erector spinae and popliteal muscles.

X-ray examination and computed tomography reveal an increase in intervertebral joints and the presence of bone growths (osteophytes) on them. Using radionuclide scintigraphy in active osteoarthritis, accumulation of the isotope in the intervertebral joints is detected. The final diagnosis is made after a diagnostic periarticular block with local anesthetic. Reduction of back pain after blockade confirms the diagnosis of spinal osteoarthritis.

Diagnosis of cervical osteoarthritis

Comprehensive and timely diagnosis is the key to successful treatment. Therefore, the MART Clinic approaches diagnostic measures with special attention and responsibility. So, to diagnose cervical osteoarthritis, the following is used:

• Neurological examination
• Blood chemistry
• MRI of the cervical spine

The high qualifications of our specialists and expert-class equipment allow us to obtain the most accurate disease data in the shortest possible time!

If you have any questions, ask our specialist! Ask a Question

Diagnostics

Diagnosis and treatment of cervical spondyloarthrosis is carried out by orthopedists, neurologists and vertebrologists. To confirm the diagnosis, the following imaging techniques are prescribed:

• Radiography. Performed in two main and additional projections. Informative in the presence of pronounced changes in the joints. Images of the cervical spine reveal deformations of the articular surfaces, the presence of osteophytes, and narrowing of the joint space.
• CT scan. It is more sensitive and allows you to diagnose spondyloarthrosis at the initial stages. Well reflects changes in hard structures - bones and cartilage.
• Magnetic resonance imaging. It is prescribed, if necessary, to assess the condition of the surrounding soft tissues. Visualizes atrophy, fibrous degeneration, signs of inflammation.
• Ultrasonography. To assess the state of cerebral circulation and exclude vertebral artery syndrome, Doppler ultrasound (USDG of the vessels of the head and neck) is prescribed.

During a neurological examination, concomitant sensory and movement disorders are identified. If indicated, an extensive neurological examination is performed using instrumental techniques.

Treatment of cervical osteoarthritis at the MART Clinic

To successfully treat cervical osteoarthritis, the MART Clinic uses an integrated approach aimed at solving the problem rather than masking the symptoms. Thus, our experienced neurologists select an individual course of treatment, which may include:

• Drug treatment
• Physiotherapy
• Massage and manual therapy
• Exercise therapy
• Surgical intervention and others

Help yourself get better! Make an appointment with a neurologist at the MART Clinic today!

Make an appointment with a neurologist at the MART medical center in St. Petersburg (see map) by calling 8 or leave a request on the website.

Neck pain: causes and treatment approaches

The prevalence of degenerative diseases of the spine, osteochondrosis and osteoarthritis is known to increase with age. X-ray signs of osteochondrosis of the cervical spine (reduced height of intervertebral discs, osteophytes, degenerative changes in intervertebral joints) are found in half of people over 50 years of age and in 75% over 65 years of age. But these findings are often found in young 30-year-old people [1]. Therefore, it is quite difficult to establish the boundary between normal aging of the spine and the onset of a pathological process, especially since the relationship between neuroimaging findings and clinical symptoms is not always obvious. The pathogenesis of such pain is usually complex, and in addition to age-related degenerative changes, postural factors and a sedentary lifestyle, anxiety and depression, constant tension of the neck muscles, industrial and sports injuries play a certain role in it [2]. Degenerative-dystrophic changes in the cervical spine can lead to the development of four main syndromes: local pain (cervicalgia), pain radiating from the neck to the arm (cervicobrachialgia), to the head (cervicocranialgia) or chest (cervicothoracalgia), radicular syndrome (radiculopathy) and spinal cord damage (myelopathy) [5]. Cervicalgia with osteochondrosis is usually dull, aching, less often acute, more often one-sided and localized in the back of the neck. Tension of the neck muscles and limitation of movements are also detected. The pain often appears after a long stay in an uncomfortable position, for example in the morning after sleep, it can intensify with movement, and decreases with rest and warmth. Upon examination, pain in the intervertebral joints and limited mobility of the cervical spine are detected. Cases of acute neck pain, or acute torticollis, are quite common. This is a fixed position of the neck due to muscle spasm and severe pain. Usually this condition lasts from several days to 2 weeks. Most often, acute torticollis occurs between the ages of 12 and 30 years. The reasons for its occurrence are not fully known; presumably, these are microdamages of the intervertebral discs and joints that are not visible during radiographic examination. When examining such a patient, one notices the forced position - the head is tilted and slightly turned in the direction opposite to the pain, the extension of the head is limited, the muscles are tense and painful, the pain is usually localized in the neck and does not radiate. Acute torticollis most often occurs in the morning after sleep [6]. Radiculopathy occurs when a spinal nerve root is compressed or irritated. This is a fairly common cause of neck pain; the annual incidence is 83.2/100 thousand people. The disease most often occurs in the 5th–6th decade of life. Changes in the intravertebral disc are the cause of approximately 20% of cases of the disease, mainly a combination of discogenic and spondylogenic disorders is found. The onset of pain is associated with physical activity or injury in less than 15% of patients [7]. Manifestations of radiculopathy at the cervical level include neck pain, paresthesia, and radicular pain. The lower cervical region is most often affected. Sensory symptoms are usually present in the dermatome and myotome, most often at the level of the dermatome of the C4 (60% of cases), C6 (35% of cases), C7 (34.2% of cases). Pain in the scapula area is detected in approximately half of the cases [8]. Physical examination is characterized by pain in the cervical spine, limited range of motion, and suppression of deep tendon reflexes (biceps, supinator, and triceps) [1]. Weakness in the upper extremities is found in 15% of cases, decreased sensitivity in 1/3 of patients. Muscle wasting is much less common (less than 2% of cases). The most typical level of damage in this case is C7 (40–46% of cases) and C6 (17–42% of cases). Bilateral involvement occurs in 5–36% of cases [7]. Hernias, bone spurs, thickened spinal ligaments and other signs of age-related degeneration can narrow the spinal canal and cause compression of the spinal cord, i.e. myelopathy. Usually, myelopathy develops gradually, it is not always accompanied by pain, paresthesia and numbness of the extremities, weakness and clumsiness in the arms, gait disturbance due to sensory ataxia or spastic paraparesis of the lower extremities appear. Increased tone may be seen in the arms and legs, but decreased muscle strength is more typical in the upper extremities. Changes in tendon reflexes are very characteristic. Plantar reflexes are strengthened, clonus and a positive Hofmann sign are possible. Sensory changes may include decreased vibration sensitivity and deep muscle feeling. Disorders of the pelvic organs are quite rare [1]. The duration and course of pain due to degenerative changes in the cervical spine can vary. There are acute (less than 4 weeks), subacute (1–4 months) and chronic (more than 4 months) pain. For example, pain from acute torticollis usually goes away within a few days. However, a significant portion of pain tends to recur or become chronic. It is believed that about 10% of cases of acute neck pain are chronic [2]. One study conducted in the UK showed that 58% of patients presenting with neck pain still had this complaint after a year [9]. In Norway, out of 10 thousand patients surveyed, 34% had experience of cervicalgia in previous years [10]. A review of studies suggests that among patients with chronic neck pain undergoing retreatment, 20–78% of patients experience a recurrence of symptoms regardless of therapy. A history of episodes of cervicalgia significantly worsens the prognosis of the current pain syndrome [1]. Injuries to intervertebral joints and discs, muscles, ligaments and the vertebrae themselves quite often cause neck pain. One example is whiplash injury [11]. This injury most often occurs in car accidents, and similar injuries can occur in divers. The incidence of whiplash is as high as the incidence of motor vehicle accidents. The mechanism of injury is a sharp two-stage whiplash movement of the neck. A rear impact results in a sudden hyperextension followed by a sharp flexion of the neck; in a frontal collision, on the contrary, first flexion and then extension occurs. These movements primarily damage the intervertebral joints, as well as muscles, ligaments, discs and spinal roots. Symptoms usually develop within a day: pain appears in the neck and shoulders, which can radiate to the back of the head, arms and interscapular area, head movements are limited. A prolonged headache may occur, usually in the back of the head, sometimes radiating to the temple and eye socket, as well as dizziness and nausea. If during an injury there is damage to the roots or the formation of a hernia with compression of the root, then radicular pain develops. Clinical manifestations of injury can be very severe and come to the fore, masking the source of pain. The consequences of whiplash injury are varied: visual impairment, dysphagia, dizziness, neurosis, post-traumatic osteoarthritis, etc. In other cases, with a milder injury, the injury may go undetected during clinical and radiological examination. Such patients may suffer from chronic neck pain of unknown etiology for a long time. They can be difficult to diagnose even with the help of neuroimaging methods. In many of these patients, along with chronic whiplash injury, abnormalities of the vertebral joints or brachial plexus are detected. It is still unclear whether degenerative changes that existed before injury influence the course and outcome of traumatic pain [1,11]. Differential diagnosis of neck pain is aimed at excluding symptomatic pain, which may be caused by severe somatic pathology. Thus, neck pain occurs in various immune diseases, for example, with ankylosing spondylitis, polymyalgia rheumatica, arthritis of various natures (rheumatoid, psoriatic; arthritis caused by inflammatory bowel diseases, Reiter's syndrome; reactive arthritis) [1,5]. Neck pain, accompanied by fever, chills, leukocytosis and other signs of inflammation, can be caused by an infectious process. Examples are damage to bone tissue due to osteomyelitis and tuberculosis, inflammation of the lymph nodes - lymphadenitis, inflammation of the thyroid gland - acute thyroiditis, polio, tetanus, herpes zoster, meningitis, etc. [1]. Long-term, constant pain in the neck can be caused by a tumor of the cervical spine. Such tumors require a thorough oncological search, since they are usually metastatic. Most often, breast and prostate cancer, lung cancer metastasize to the spine, and somewhat less frequently - melanoma, kidney and thyroid cancer. Referred pain in the neck area is characteristic of heart disease (pain in the front of the neck) and esophagus, lung cancer, intracranial space-occupying formations, hemorrhages and abscesses [1]. Diffuse pain in the neck, limbs and torso is characteristic of fibromyalgia; they are usually accompanied by depression, sleep disturbances, morning stiffness, and fatigue. Palpation reveals pain points of a certain localization characteristic of this disease [1]. Considering the wide range of causes that cause neck pain, their diagnosis should include a detailed collection of complaints and anamnesis, physical examination, laboratory and instrumental studies. First of all, the nature and location of pain, its intensity, connection with movement and physical activity, and accompanying symptoms are clarified. It is necessary to carefully question the patient about the presence of concomitant diseases, his general condition, and a history of injuries. Physical examination includes: examination of the neck, assessment of the position of the head and shoulders, voluntary movements in the cervical spine, palpation of the cervical vertebrae and muscles, lymph nodes, thyroid gland and assessment of active movements and their volume. A neurological examination is necessary to exclude radicular syndrome and myelopathy. Of the laboratory indicators, special attention is paid to general blood count, ESR, rheumatoid factor, HLA-B27 antigen. The HLA-B27 antigen plays an important role in the diagnosis of ankylosing spondylitis and Reiter's syndrome, as well as other autoimmune diseases. If HLA-B27 antigen is not detected, ankylosing spondylitis and Reiter's syndrome are unlikely. To determine the cause of neck pain, instrumental research methods are quite informative: radiography of the spine, CT of the spine, CT with myelography (indicated before surgery for a herniated disc), bone scintigraphy, MRI. Treatment of neck pain Most back pain responds well to conservative methods [12]. When choosing a therapeutic approach, it is important to correctly assess the risk factors and possible complications of available treatment methods individually for each patient. An integrated approach using medicinal and non-medicinal methods is mainly used. Non-drug treatment methods include: compliance (warmth and rest), orthopedic therapy, physical therapy, physiotherapy, manual therapy. A large number of studies devoted to the treatment of acute and chronic pain in the neck indicate a good therapeutic effect of mobilization physiotherapy and/or manual manipulation and exercise therapy [2,13,14]. The combination of these techniques gives particularly good results. The addition of psychotherapeutic influences brings certain benefits. The effectiveness of acupuncture, traction and electrical stimulation methods turned out to be less obvious and requires evidence-based research [1,15,16]. Early initiation of mobilization physiotherapy and timely return to normal physical activity after traumatic effects are good prevention of the development of chronic pain syndrome [17]. Drug therapy for neck pain is usually combined, it includes non-steroidal anti-inflammatory drugs (NSAIDs) and non-opioid analgesics, drugs that relieve muscle spasms - muscle relaxants (baclofen, tizanidine, tolperisone, botulinum toxin), tricyclic antidepressants (amitriptyline), microcirculation stimulants ( pentoxifylline, actovegin, nicotinic acid) and antioxidants (vitamins C, E, thioctic acid, mexidol). If there are triggers in the muscles, injections into trigger points of local anesthetics, corticosteroids, NSAIDs, botulinum toxin or injections with a dry needle are used [18,19]. For both acute and chronic pain, local treatments are used: applications, ointments with NSAIDs, warming ointments and patches. NSAIDs occupy a leading position in the relief of pain in degenerative diseases of the musculoskeletal system. Their obvious advantage is the presence of not only analgesic, but also anti-inflammatory effect. The main therapeutic effects of NSAIDs are analgesic, anti-inflammatory and antipyretic, based on reducing the synthesis of prostaglandins from arachidonic acid through inhibition of the enzyme cyclooxygenase (COX). COX exists in 2 forms: COX-1 is constantly present in all tissues, COX-2 is synthesized against the background of inflammation. The drug OKI (lysine salt of ketoprofen) is a non-selective NSAID; it inhibits COX-1 and COX-2, suppressing the synthesis of prostaglandins. OKI has anti-bradykinin activity, stabilizes lysosomal membranes and delays the release of enzymes from them that contribute to tissue destruction during chronic inflammation, reduces the release of cytokines, and inhibits the activity of neutrophils. The lysine salt of ketoprofen has anti-inflammatory, analgesic and antipyretic properties with a rapid onset of action (after 15–20 minutes), a duration of action of up to 8 hours and good tolerability. The rapid onset of action is explained by the higher solubility of the lysine salt of ketoprofen compared to unchanged ketoprofen. High solubility contributes to faster and more complete absorption of the active substance, which leads to peak concentrations in the blood plasma after oral administration after 15 minutes. (Fig. 1), while regular ketoprofen reaches a maximum after 60 minutes. after administration [20]. OKI reduces pain due to a unique triple mechanism of analgesic action (peripheral - due to blockade of the arachidonic acid cycle and two central ones - a decrease in the sensitivity of brain receptors and blockade of impulse transmission in the spinal cord). On the domestic market, the drug OKI is available in the form of granules for the preparation of a solution for oral administration, rectal suppositories with different dosages for children and adults, and a solution for rinsing. The variety of forms of release of the drug expands the range of its use. OCI taken orally or rectally has a systemic anti-inflammatory and analgesic effect and is used for the treatment of a variety of inflammatory processes that are manifested by acute pain, including: dorsalgia, myalgia, arthralgia, acute pain in inflammatory and rheumatic diseases of the joints, headache, toothache, etc. P. When prescribing NSAID therapy, special attention is always paid to the side effects characteristic of this group of drugs, and above all this concerns the gastrointestinal and hematopoietic systems. Abdominal pain, diarrhea, exacerbation of gastritis or peptic ulcer, liver reactions - this is not a complete list of possible adverse events. In this aspect, the lysine salt of ketoprofen has advantages over ketoprofen, since it causes side effects much less often. Due to its chemical composition, OCI quickly dissolves at a neutral pH and, as a result, almost does not irritate the gastrointestinal tract. The tolerability of OKI is 1.6 times better compared to ketoprofen. In Fig. Figure 2 shows the general and local tolerance of the gastric mucosa (according to gastroscopy) of the OKI drug during a 10-day administration in comparison with placebo. According to doctors, the general and local tolerability of the OCI drug was comparable to placebo [21]. The optimal alternative to systemic tablet forms is Artrosilene (lysine salt of ketoprofen) for the local treatment of acute and chronic pain in the joints, back, muscles and ligaments, with injuries and inflammation, with various pathologies of the musculoskeletal system. Local forms of Artrosilene spray 15% and gel 5% have the highest effective concentration among NSAIDs and speed of action. Such a high concentration and special form (spray foam for improved penetration through the skin) allows for a faster therapeutic effect. Sometimes the action occurs as quickly as with intravenous administration. An effective concentration in the focus of inflammation (120 μg/ml) and in soft tissues is achieved after 15–20 minutes, and the small size of the particles determines a high degree of penetration into pockets, cavities and other inaccessible places on the skin. In experimental studies, it was shown that the analgesic and anti -inflammatory effect of the arthroside of the spray is stronger than Diclofenac Gel. The method of use is convenient and fast - to apply 2-3 rubles/day. On intact skin. Arthroside gel and spray do not cause irritation and dry skin due to the low content of ethyl alcohol (alcohol 0.3%), and due to low systemic absorption (0.38%) do not have side effects. A special place in the fight against pain in the neck is the prevention of their appearance or exacerbation. In the emergence of cervicalgia, one of the key is the postural factor [1]. The correct organization of daily physical activity, workplace, sports should be selected individually for each patient. However, there are a number of simple general rules that help eliminate factors that provoke pain: • Sit right while reading, writing, work on the computer; • take breaks with gymnastic exercises for the neck and shoulder girdle; • monitor posture; • sleep on a small elastic or orthopedic pillow, high pillows are excluded; • do not throw back your head for a long time and do not tilt it during weight lifting; • remove excess weight; • engage in physical education and swimming. The therapeutic prognosis of acute pain in the neck is usually good, but it becomes less predictable if pain acquires chronic character. Conducting preventive measures and complex therapy of chronic pain in the neck using both medicinal and non -valley methods of exposure give good results and in most cases can get rid of pronounced pain and significantly improve the patient's condition.

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