The cervical spine, or neck, is unique for its exceptional range of motion. This mobility makes it prone to age-related wear, frequently leading to a degenerative condition known as spondylosis. Cervical spondylosis describes the gradual wear and tear affecting the bones and discs in the neck. While this wear is a natural part of aging, when it becomes widespread and symptomatic, it requires a more specific diagnosis. This article breaks down the anatomical and clinical specifics of multilevel cervical spondylosis.
Defining Multilevel Cervical Spondylosis
The condition is best understood by dissecting its three main components: cervical, spondylosis, and multilevel. “Cervical” refers to the seven vertebrae (C1 through C7) that constitute the neck region of the spine. Spondylosis is an umbrella term for age-related degenerative changes, essentially a form of osteoarthritis affecting the spinal joints and discs.
The primary change involves the dehydration and shrinking of the intervertebral discs, which normally act as cushions between the vertebrae. As discs lose fluid, the space between the bones narrows, increasing stress on the vertebral endplates. In response to this instability, the body attempts stabilization by forming abnormal bony growths called osteophytes, or bone spurs. These structural changes cause the ligaments connecting the vertebrae to stiffen, limiting the spine’s flexibility.
The designation “multilevel” indicates that these degenerative changes affect two or more adjacent vertebral levels or discs, rather than being confined to a single segment. This widespread nature means the condition has a greater potential to impact the spinal canal and the exiting nerve roots. Multilevel cervical spondylosis signifies a more extensive form of arthritis within the neck.
Causes and Contributing Factors
Age is the primary factor driving the development of cervical spondylosis, as these degenerative changes are a common part of the natural aging process. More than 85% of individuals over the age of 60 show evidence of cervical spondylosis on imaging, though many remain asymptomatic. The cumulative stress and strain placed on the cervical motion segments over decades contribute to the breakdown of the discs and joints.
Several other elements can accelerate this process or increase its severity beyond simple wear and tear. Activities involving repetitive neck motions, heavy lifting, or prolonged poor posture place extra mechanical stress on the neck structures. Previous traumatic injuries, such as whiplash, can predispose a person to earlier or more severe spondylotic changes.
Genetic factors also play a role, as a family history may indicate an inherited predisposition to spinal degeneration. Lifestyle choices, including smoking, have been associated with increased neck pain and faster disc degeneration. These secondary factors often determine who develops symptomatic spondylosis and the extent of its multilevel involvement.
Common Symptoms and Clinical Presentation
The symptoms of multilevel cervical spondylosis can range from localized neck discomfort to severe neurological impairment, depending on which structures are compressed. The most common presentation involves chronic neck pain and stiffness, often worsening with movement or at the end of the day. This pain may radiate into the shoulders or the back of the head, sometimes causing tension headaches.
A more concerning presentation occurs when bone spurs or disc material compresses the spinal nerve roots, a condition known as cervical radiculopathy. Radiculopathy causes pain, weakness, numbness, or a tingling sensation that travels down one arm, corresponding to the affected nerve root. The most frequently impacted nerve roots are C6 and C7, leading to symptoms in the forearm and hand.
The most severe complication is cervical myelopathy, which results from compression of the spinal cord within the narrowed spinal canal. Myelopathy symptoms involve motor function, presenting as clumsiness in the hands or difficulty with fine motor tasks like buttoning a shirt. Patients may also experience gait instability, stiffness or heaviness in the legs, and a loss of balance. These signs indicate a high risk of progressive neurological deficit.
Diagnostic Procedures
The evaluation begins with a comprehensive physical examination and medical history review. The physician checks the neck’s range of motion and tests for signs of nerve or spinal cord compression by checking muscle strength, reflexes, and sensation in the arms and legs. Observing the patient’s gait is important to check for signs of myelopathy.
Imaging studies are used to confirm the diagnosis and determine the extent of degenerative changes. Plain X-rays are usually the first step, as they clearly show bone spurs, disc space narrowing, and vertebral alignment. However, X-rays cannot visualize soft tissues like the discs, spinal cord, or nerve roots.
For a detailed assessment of neural structures, Magnetic Resonance Imaging (MRI) is considered the gold standard. MRI provides high-resolution images of the spinal cord, showing the degree of compression and identifying disc herniations or ligament thickening. A Computed Tomography (CT) scan is sometimes used to gain a clearer picture of the bony anatomy. A CT myelogram, which involves injecting dye into the spinal fluid, may be utilized if an MRI is contraindicated.
Treatment Approaches
For most patients, initial management focuses on conservative, non-surgical approaches. Physical therapy is a primary component, aiming to improve neck strength, flexibility, and posture through specific exercises and sometimes mechanical traction. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed to manage pain and reduce inflammation associated with the condition.
Other conservative strategies include using a soft cervical collar for short periods to allow the neck muscles to rest, and targeted pain management techniques. If pain persists, corticosteroid injections may be administered into the epidural space or facet joints to deliver anti-inflammatory medication directly to the source of irritation. These non-operative treatments are typically attempted for several months and are often successful in relieving symptoms.
Surgery is generally reserved for cases where conservative treatment fails to relieve persistent radiculopathy or when there is progressive neurological compromise from myelopathy. Common surgical procedures aim to decompress the neural elements by removing the source of pressure.
Surgical Procedures
For disease affecting one to three levels, an anterior cervical discectomy and fusion (ACDF) is a frequent choice, involving removing the damaged disc and fusing the vertebrae. When the disease involves four or more levels, a posterior approach like a laminectomy or laminoplasty may be preferred to create more space for the spinal cord.