Neck Arthritis

In this article you will find out everything you need to know about neck arthritis and the most effective ways the treat the condition.

Our neck is one of the most important regions of our body. It connects our head to the rest of our body, whereas internally, it performs the complex task of continuing as an extension of the brain in the form of the spinal cord.

While the neck may be the most mobile and flexible part of our body, as it offers a wide range of motion to move and rotate about, it is also one of the most vulnerable in terms of getting sprained, strained, or injured. 

Several other reasons could cause the neck to be held in a compromised state and thus affect the cervical spine internally, or vice versa. Among such compromising and uncomfortable conditions involving the neck, arthritis in the neck is one of the most prevalent conditions. It seems to be growing in incidence over the years due to several underlying reasons. 

Cervical Spondylosis – Neck Arthritis

Arthritis is one of the most common conditions that affect the bones and joints of people worldwide. Arthritis is known to be a disease of the elderly, yet every person in their middle ages somehow becomes predisposed to develop arthritis over the years. [1]

The underlying reasons behind the development of arthritis could be Estrogen deficiency in postmenopausal females and a decrease in bone density that ultimately leads to the development of osteoarthritis (OA) in both males and females, which is the most common variant of arthritis overall. 

Other people have an autoimmune factor, so they develop Rheumatoid Arthritis. There are several other uncommon variants of arthritis, too, with each one of them having a significant cause that ultimately leads to their development in the body. [2]

However, when it comes to the neck, then it is ‘Cervical Spondylosis’ that is given a proper term for arthritis involving the neck. 

Cervical Spondylosis is arthritis of the neck that occurs due to age-related degenerative changes. These degenerative changes are considered to be a normal part of one’s body that occurs during the process of aging. However, when they exceed the normalcy rate and start occurring at an abnormal speed, that is when they start doing more harm than they initially intended to over time. [3]

The most common symptom, or rather the presentation of cervical spondylosis, is in the form of neck pain of varying severity, which ultimately leads to the diagnosis when a doctor evaluates it. [4]

Causes of Cervical Spondylosis

Apart from the age-related degenerative factor, some internal changes predispose the affected person’s neck to such a vulnerable extent that it becomes prone to develop cervical spondylosis over time.  

Degenerative Changes In And Around The Neck:

Perhaps the most inevitable or known cause that leads to the slow but sure development of cervical spondylosis is the degeneration of the structures around the neck. 

These structures include the ligamentum flavum, posterior longitudinal ligament, facet joints, and vertebral joints. The problem arises when all these structures start to age and lose their actual strength and flexibility that was otherwise holding the neck into position. [5]

When this happens, ultimate stress is placed on the spinal cord, its vasculature, and the nerve roots that sprout out from the spinal cord. 

All these changes occur due to several reasons, and some of the common risk factors for getting predisposed to this condition include: 

• Direct or indirect trauma to the spinal cord that is significant enough to cause an impact on the cervical structures and spinal cord, 

• A narrow vertebral canal that is most commonly present at birth (a congenital defect),
• Spinal stenosis that leads to the narrowing of the spinal canal, 

• Dystonic Cerebral Palsy that directly affects the cervical neck musculature, 

• Soccer, rugby, and other athletic activities exert an exaggerated response on the neck and thus, affect it. 

All these causes have been seen to impact the neck in such a way that after it gets affected by arthritis, it soon becomes a much more restricted organ, giving rise to disability. 

As a result, neck pain and arthritis in the neck are responsible for the fourth leading cause of disability that affects people all around the world. [6]

How Does Neck Arthritis Present In A Patient? 

All the features that were mentioned above give rise to arthritis of the neck, which presents itself in different forms in the affected people. Although the symptoms of cervical spondylosis are the same in all the patients, the severity, intensity, and frequency of symptoms vary from patient to patient. 

So far, cervical spondylosis gives rise to three types of major changes in the neck, and those include: 

Axial Neck Pain:

The word ‘axial’ arises from the ‘Axis’ vertebra, which is the C2 cervical vertebra. It is on this C2 vertebra that the atlas (C1) rests. C1 carries the head on it and, using C2 (Axis) as its pivot point, rotates about its allowed range of motion. 

The patients who suffer from axial neck pain experience severe pain or soreness arising from the posterior neck muscles. In some cases, this pain radiates to the occiput (the base of the skull) or the shoulder regions. In other cases, there is also a headache that the patient experiences, although not every patient needs to experience it. [7]

However, in the cases of axial pain, it is also important to exclude any other causes that might be causing it. Apart from the degeneration-related changes, there are some other pathologies whose visceral (referred) pain is felt in the axial neck region. 

Cervical Myelopathy: 

Cervical Myelopathy refers to spinal cord compression due to neck arthritis in the cervical spine. 

There are several symptoms that the person experiences while suffering from cervical myelopathy. However, an interesting fact is that all these symptoms get exaggerated when the affected person tries extending their neck. This is because the spinal cord gets shortened or ‘extended’ in response to the neck’s movements. [8]

Some of the common presenting symptoms of cervical myelopathy include weakness, loss of balance and coordination, loss of sensation in the extremities, spasticity, decreased fine motor skills, and radiculopathy. 

Cervical Radiculopathy:  

Cervical radiculopathy is also the name given to the presentation of pain and numbness due to compression of the nerve roots of the spinal cord, also sometimes referred to as a ‘pinched nerve.’ [9]

Radiculopathy leads to muscle weakness and the loss of deep tendon reflexes in the affected individuals. The pain seems to follow a pathway from the neck to the shoulders down to the arms of the affected person. 

How Is Neck Arthritis Diagnosed And Evaluated? 

A detailed medical history and physical exam can easily guide the healthcare professional toward the diagnosis of this condition. More often than not, the affected person is seen to present with any of the symptoms that correspond to cervical radiculopathy, cervical myelopathy, and axial neck pain. [10]

However, the leading symptoms that lead to the diagnosis of neck arthritis are: 

• Increasing axial neck pain leads to the immobility and stiffness of the head and neck,

• The presence of tender points in the neck muscles, 

• The involvement of the spinal nerve roots, especially if the pain radiates from the neck down towards the arms, also causes back pain in some cases,  

• Electrical, shock-like sensations that often occur down the spinal area. 

The doctor will need to evaluate the condition further in all areas by ordering some radiographic imagings. Some of the popularly ordered imaging tests include: 

• X-rays: 

An x-ray is a simple and first-line investigation that is ordered to diagnose the internal changes taking place inside the neck region. 

With an x-ray, it becomes easy to identify the early changes such as the appearance of osteophytes or bone spurs, narrowing of the disc plate, sclerosis of the endplate, and the degenerative changes that have started appearing around the facet and intervertebral joints of the cervical vertebrae. In other instances, a CT Scan can also be used. 

• Magnetic Resonance Imaging (MRI): 

An MRI is often used to visualize the soft tissue changes without exposing the person to unwanted beams of radiation. 

An MRI has been especially helpful in identifying changes such as spinal cord and nerve compression, which signifies that the pain is due to problems within the cervical spine. The resultant pain is not a referred one from some other body region. 

• Electromyography (EMG): 

Electromyography is a specific test for cervical radiculopathy. It helps differentiate between the former diagnosis and other causes of numbness, such as diabetic neuropathy, entrapment neuropathy, and other neuropathies. 

How Is Cervical Spondylosis Treated? 

There are two main approaches to dealing with this problem. Firstly, the orthopaedic doctor needs to evaluate whether this pain is a short-term or new one or a chronic pain that the patient has been having for quite a long time. According to these, there are different treatment options that could be implemented on the patient. 

If the pain is new or acute, it is better to proceed with the non-surgical means of therapy to treat it. In the other cases, when the pain is chronic, it is better to surgically intervene and treat the case. 

Non-surgical Treatment: 

The non-surgical treatment of cervical spondylosis includes physical therapy under the supervision of a physical therapist. They order specific back and neck exercises meant to strengthen the neck and upper and lower back muscles for pain relief. 

Along with them, a couple of medicines are also prescribed to the affected people. These include over-the-counter muscle relaxants for occasional muscle spasms in the affected region (Baclofen, Dantrolene), non-steroidal anti-inflammatory drugs or NSAIDs (Ibuprofen, Naproxen), and oral corticosteroids (Prednisolone), and other antidepressants as well. [11]

Sometimes, steroid injections are also given to contain the pain. 

Surgical Treatment 

Patients with resistant cervical spondylosis or symptoms that worsen over time are advised to get surgically treated for the condition. 

Surgical treatment involves a cervical discectomy or corpectomy. Both anterior and posterior cervical discectomy is preferred in the patients, depending on the extent of their damage and the progression of the degeneration that has led to the onset of symptoms. [12]

This leads to a decrease in the neck, back, and shoulder pain that occurs as part of the condition and ultimately leads to the resolution of symptoms. 

The bottom line about arthritis in the neck

The presence of arthritis in the neck is a common age-related change. It occurs when the cervical vertebrae get subjected to the changes occurring in the neck region, leading to the development of erosion of the bony structures present there. 

The patients present with varying degrees of pain and mostly present themselves only when severe pain is resistant to drugs or non-surgical treatments. 

Surgical treatment often leads to a good prognosis, but it also depends on the patient’s factors such as age, other coexisting diseases, and the extent of arthritis. However, this is not exactly a life-threatening condition; people can easily live with it by taking appropriate treatment, physical therapy, and medications. 

References

1. Senthelal S, Li J, Goyal A, et al. Arthritis. [Updated 2022 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518992/
2. Poudel P, Goyal A, Lappin SL. Inflammatory Arthritis. [Updated 2022 Apr 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507704/
3. Kuo DT, Tadi P. Cervical Spondylosis. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551557/
4. Binder A. I. (2007). Cervical spondylosis and neck pain. BMJ (Clinical research ed.), 334(7592), 527–531. https://doi.org/10.1136/bmj.39127.608299.80
5. Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J., … & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC musculoskeletal disorders, 23(1), 1-13.
6. Wu, A., Dong, W., Zeng, X., Xu, X., Xu, T., Zhang, K., … & Zhou, M. (2021). Neck pain is the leading cause of disability burden in China: Findings from the Global Burden of Disease Study 2017. Annals of Translational Medicine, 9(9).
7. Liu, S., Yang, D. L., Zhao, R. Y., Yang, S. D., Ma, L., Wang, H., & Ding, W. Y. (2019). Prevalence and risk factors of axial neck pain in patients undergoing multilevel anterior cervical decompression with fusion surgery. Journal of Orthopaedic Surgery and Research, 14(1), 1-8.
8. Donnally III CJ, Hanna A, Odom CK. Cervical Myelopathy. [Updated 2022 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482312/
9. Magnus W, Viswanath O, Viswanathan VK, et al. Cervical Radiculopathy. [Updated 2022 Mar 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441828/
10. Bakhsheshian, J., Mehta, V. A., & Liu, J. C. (2017). Current Diagnosis and Management of Cervical Spondylotic Myelopathy. Global spine journal, 7(6), 572–586. https://doi.org/10.1177/2192568217699208
11. Hirpara, K. M., Butler, J. S., Dolan, R. T., O’Byrne, J. M., & Poynton, A. R. (2012). Nonoperative modalities to treat symptomatic cervical spondylosis. Advances in orthopedics, 2012.
12. Hsu, W., Dorsi, M. J., & Witham, T. F. (2009). Surgical management of cervical spondylotic myelopathy. Neurosurgery quarterly, 19(4), 302.