Neck pain can be caused by many things—but is most often related to getting older. Like the rest of the body, the disks and joints in the neck (cervical spine) slowly degenerate as we age. Cervical spondylosis, commonly called arthritis of the neck, is the medical term for these age-related, wear-and-tear changes that occur over time.
Cervical spondylosis is extremely common. More than 85 percent of people over the age of 60 are affected. The condition most often causes pain and stiffness in the neck—although many people with cervical spondylosis experience no noticeable symptoms. In most cases, cervical spondylosis responds well to conservative treatment that includes medication and physical therapy.
Your spine is made up of 24 bones, called vertebrae, that are stacked on top of one another. These bones connect to create a canal that protects the spinal cord.
The seven small vertebrae that begin at the base of the skull and form the neck comprise the cervical spine.
Other parts of your spine include:
Spinal cord and nerves. These "electrical" cables travel through the spinal canal carrying messages between your brain and muscles. Nerve roots branch out from the spinal cord through openings in the vertebrae (foramen).
Intervertebral disks. In between your vertebrae are flexible intervertebral disks. They act as shock absorbers when you walk or run.
Intervertebral disks are flat and round and about a half inch thick. They are made up of two components:
Annulus fibrosus. This is the tough, flexible outer ring of the disk
Nucleus pulposus. This is the soft, jelly-like center of the disk.
Cervical spondylosis arises from degenerative changes that occur in the spine as we age. These changes are normal and they occur in everyone. In fact, nearly half of all people middle-aged and older have worn disks that do not cause painful symptoms.
Disk Degeneration and Bone Spurs
As the disks in the spine age, they lose height and begin to bulge. They also lose water content, begin to dry out and weaken. This problem causes settling, or collapse, of the disk spaces and loss of disk space height.
As the facet joints experience increased pressure, they also begin to degenerate and develop arthritis, similar to what may occur in the hip or knee joint. The smooth, slippery articular cartilage that covers and protects the joints wears away.
If the cartilage wears away completely, it can result in bone rubbing on bone. To make up for the lost cartilage, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth — called bone spurs — may narrow the space for the nerves and spinal cord to pass through (stenosis).
Age is the most common risk factor for cervical spondylosis. The condition is extremely common in patients who are middle-aged and older.
Other factors that may increase your risk for developing cervical spondylosis and neck pain include:
Genetics—a family history of neck pain and spondylosis
Smoking—clearly linked to increased neck pain
Occupation—jobs with lots of repetitive neck motion and overhead work
Depression or anxiety
Previous injury or trauma to the neck
For most people, cervical spondylosis causes no symptoms. When symptoms do occur, they typically include pain and stiffness in the neck. This pain can range from mild to severe. It is sometimes worsened by looking up or looking down for a long time, or by activities in which the neck is held in the same position for a prolonged period of time—such as driving or reading a book. The pain usually improves with rest or lying down.
Other symptoms may include:
Grinding or popping noise or sensation when you turn your neck
In some cases, cervical spondylosis results in a narrowing of the space needed for the spinal cord or nerve roots. If this occurs, your symptoms may include numbness and weakness in the arms, hands, and fingers
Trouble walking, loss of balance, or weakness in the hands or legs
Muscle spasms in the neck and shoulders
After discussing your medical history and general health, your doctor will conduct a thorough examination of your neck, shoulders, arms and, frequently, your legs. He or she will conduct a number of tests, looking for problems or changes in:
Strength—in your arms, hands, and fingers
Flexibility—in your neck and arms
Gait (the way you walk)
Your doctor may also gently press on your neck and shoulders—feeling for trigger (tender) points or swollen glands. He or she will also ask questions to understand more about your symptoms and any injuries that may have occurred to your neck. These questions may include:
When did the pain start?
When does the pain occur? Is it continuous or does it come and go?
Do certain activities make the pain worse?
Have you ever had pain before?
Have you ever been treated for pain?
Were you ever involved in an accident or had an injury to your neck?
Your doctor may order diagnostic tests to help confirm the diagnosis of cervical spondylosis. These tests may include:
X-rays. These provide images of dense structures, such as bone. An x-ray will show the alignment of the bones along your neck. It can also reveal degenerative changes in your cervical spine—such as the loss of disk height or the presence of bone spurs.
Magnetic resonance imaging (MRI) scans. These studies create better images of the body's soft tissues, such as muscles, disks, nerves, and the spinal cord. An MRI can help determine whether your symptoms are caused by damage to soft tissues—such as a bulging or herniated disk.
Computed tomography (CT) scans. More detailed than a plain x-ray, a CT scan can help your doctor better view your spinal canal and any bone spurs.
Myelogram. This is a special type of CT scan. In this procedure, a contrast dye is injected into the spinal canal to make the spinal cord and nerve roots show up more clearly.
Electromyography (EMG). Electromyography measures the electrical impulses of the muscles at rest and during contractions. Nerve conduction studies are often done along with EMG to determine if a spinal nerve is functioning properly.
Other tests. In some cases, your doctor may order a blood test to determine whether a rheumatoid factor—or any other antibody indicative of inflammatory arthritis--is present.