Cervical Spondylosis Workup
- Author: Hassan Ahmad Hassan Al-Shatoury, MD, PhD, MHPE; Chief Editor: Dean H Hommer, MD more...
See the list below:
- Usually, no specific findings are present.
- Other findings may include those related to an underlying etiologic or pathogenetic disorder that initiates the spondylotic changes.
See the list below:
- Plain cervical radiography is routine in every patient with suspected cervical spondylosis.
- This examination is valuable in evaluating the uncovertebral and facet joints, the foramen, intervertebral disk spaces, and osteophyte formation.
- In select circumstances, flexion-extension views may be needed to detect instability.
- Myelography, with computed tomography (CT) scanning, was previously considered to be the imaging test of choice for assessing spinal and foraminal stenosis. However, with advances in MRI and CT scanning technology, myelography is now performed in selected patients.
- Because myelography method is invasive, most physicians depend on MRI in diagnosing cervical spondylosis.
- Myelography adds anatomic information in evaluating spondylosis.
- Myelography may be especially useful in visualizing the nerve root takeoff.
- CT scanning, with or without intrathecal dye, can be used to estimate the diameter of the canal.
- CT scans may demonstrate small, lateral osteophytes and calcific opacities in the middle of the vertebral body.
- MRI is a considerable advance in the use of imaging to diagnose cervical spondylosis. It offers the following advantages:
- Direct imaging in multiple planes
- Better definition of neural elements
- Increased accuracy in evaluating intrinsic spinal cord diseases
- Myelogramlike images
- High–signal-intensity lesions can be seen on magnetic resonance images of spinal cord compression; this finding indicates a poor prognosis.
- False-positive and false-negative MRI results occur frequently in patients with cervical radiculopathy; therefore, MRI results and clinical findings should be used when interpreting root compression.
A study by Banaszek et al indicated that diffusion tensor imaging (DTI) can demonstrate spinal cord impairment in patients with early stage cervical spondylosis before such impairment is visible on plain MRI scans. The study involved 132 symptomatic patients with varying degrees of cervical spondylosis, as well as 25 control subjects. Examining spinal segments from C2/C3 to C5/C6, the investigators found significant differences in fractional anisotropy values between the control subjects and the patients with cervical spondylosis, including early stage patients who did not yet show spinal cord compression on plain MRI scans. According to the investigators, the mean fractional anisotropy values were significantly associated with the anteroposterior diameter of the spinal canal and with space available for the spinal cord index.
See the list below:
- Electromyography is useful in evaluating radiculopathy caused by spondylosis when the diagnosis of radiculopathy is in question, but it may have only limited value in assessing myelopathy.
- In myelopathy, somatosensory evoked potential (SSEP) responses are delayed or have a low amplitude.
- Cortical motor evoked potentials (MEP) may be more sensitive than SSEPs in evaluating spinal cord dysfunction.[12, 13]
- As an invasive procedure, cervical diskography is not commonly used in the evaluation of cervical spondylosis.
- Urodynamic studies may be helpful in evaluating bladder incontinence (see Other Treatment).
Thinning and fragmentation of the articular cartilage may be observed. The normal smooth, white articular surface becomes irregular and yellow. Continued loss of articular cartilage leads to exposure of areas of subchondral bone, which appear as shiny foci on the articular surface (eburnation). Fibrosis, increased bone formation, and cystic changes frequently occur in the underlying bone. Loss of articular cartilage stimulates new bone formation, usually in the form of nodules (osteophytes) at the bone edges.
Epstein N. Posterior approaches in the management of cervical spondylosis and ossification of the posterior longitudinal ligament. Surg Neurol. 2002 Sep-Oct. 58(3-4):194-207; discussion 207-8. [Medline].
Epstein N. Ossification of the cervical posterior longitudinal ligament: a review. Neurosurg Focus. 2002 Aug 15. 13(2):ECP1. [Medline].
Ozer AF, Oktenoglu T, Cosar M, et al. Long-term follow-up after open-window corpectomy in patients with advanced cervical spondylosis and/or ossification of the posterior longitudinal ligament. J Spinal Disord Tech. 2009 Feb. 22(1):14-20. [Medline].
Wang MC, Kreuter W, Wolfla CE, et al. Trends and variations in cervical spine surgery in the United States: Medicare beneficiaries, 1992 to 2005. Spine. 2009 Apr 2. [Medline].
Wang C, Tian F, Zhou Y, He W, Cai Z. The incidence of cervical spondylosis decreases with aging in the elderly, and increases with aging in the young and adult population: a hospital-based clinical analysis. Clin Interv Aging. 2016. 11:47-53. [Medline]. [Full Text].
Miranda P, Gomez P, Alday R. Acute traumatic central cord syndrome: analysis of clinical and radiological correlations. J Neurosurg Sci. 2008 Dec. 52(4):107-12; discussion 112. [Medline].
Patel AA, Spiker WR, Daubs M, Brodke DS, Cannon-Albright LA. Evidence of an inherited predisposition for cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2012 Jan 1. 37(1):26-9. [Medline]. [Full Text].
Kuijper B, Tans JT, van der Kallen BF, Nollet F, Lycklama A Nijeholt GJ, de Visser M. Root compression on MRI compared with clinical findings in patients with recent onset cervical radiculopathy. J Neurol Neurosurg Psychiatry. 2011 May. 82(5):561-3. [Medline].
Banaszek A, Bladowska J, Szewczyk P, et al. Usefulness of diffusion tensor MR imaging in the assessment of intramedullary changes of the cervical spinal cord in different stages of degenerative spine disease. Eur Spine J. 2014 Jul. 23(7):1523-30. [Medline].
Tsiptsios I, Fotiou F, Sitzoglou K, et al. Neurophysiological investigation of cervical spondylosis. Electromyogr Clin Neurophysiol. 2001 Jul-Aug. 41(5):305-13. [Medline].
Weber M, Eisen A. Are motor evoked potentials (MEPs) helpful in the differential diagnosis of spondylotic cervical myelopathy (SCM)?. Suppl Clin Neurophysiol. 2000. 53:419-23. [Medline].
Stetkarova I, Kofler M. Cutaneous silent periods in the assessment of mild cervical spondylotic myelopathy. Spine. 2009 Jan 1. 34(1):34-42. [Medline].
Uribe JS, Sangala JR, Duckworth EA, et al. Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up. Eur Spine J. 2009 Feb 12. [Medline].
Ramzi N, Ribeiro-Vaz G, Fomekong E, et al. Long term outcome of anterior cervical discectomy and fusion using coral grafts. Acta Neurochir (Wien). 2008 Dec. 150(12):1249-56; discussion 1256. [Medline].
Epstein NE. Laminectomy for cervical myelopathy. Spinal Cord. 2003 Jun. 41(6):317-27. [Medline].
Wang MY, Shah S, Green BA. Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy. Surg Neurol. 2004 Dec. 62(6):487-92; discussion 492-3. [Medline].
Fehlings MG, Smith JS, Kopjar B, Arnold PM, Yoon ST, Vaccaro AR, et al. Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study. J Neurosurg Spine. 2012 Feb 10. [Medline].
Seebach CL, Kirkhart M, Lating JM, Wegener ST, Song Y, Riley LH 3rd, et al. Examining the role of positive and negative affect in recovery from spine surgery. Pain. 2012 Mar. 153(3):518-25. [Medline].
Wang MC, Chan L, Maiman DJ, et al. Complications and mortality associated with cervical spine surgery for degenerative disease in the United States. Spine. 2007 Feb 1. 32(3):342-7. [Medline].
Alexander JT. Natural history and nonoperative management of cervical spondylosis. Menezes AH, Sonnatage VH, eds. Principles of Spinal Surgery. New York, NY: McGraw-Hill; 1996. 547-57.
Binder AI. Cervical spondylosis and neck pain. BMJ. 2007 Mar 10. 334(7592):527-31. [Medline].
Braddom RL. Management of common cervical pain syndromes. DeLisa JA, ed. Rehabilitation Medicine: Principles and Practice. Philadelphia, Pa: Lippincott Williams & Wilkins; 1993. 1036-46.
Carr RG. The physiatrist and cervical spondylosis. Saunders RL, Bernini PM, eds. Cervical Spondylotic Myelopathy. Boston, Mass: Blackwell Scientific; 1992. 96-109.
Chan CW. Spinal cord injury. Sinaki M, ed. Basic Clinical Rehabilitation Medicine. Minneapolis, Minn: Mosby-Year Book; 1993. 183-94.
Clark CR. Degenerative conditions of the spine: differential diagnosis and non-surgical treatment. Frymoyer JW, ed. The Adult Spine: Principles and Practice. New York, NY: Raven Press; 1991. 1154-64.
Fiscgrund JS, Herkowitz HN. Cervical spondylotic radiculopathy, natural history and pathophysiology. Herkowitz HN, Rothman RH, Simeone FA, eds. Rothman-Simeone, the Spine. 4th ed. Philadelphia, Pa: WB Saunders; 1999. 461-5.
Fouyas IP, Statham PF. Operative treatment of cervical spondylosis. Br J Neurosurg. 1998 Dec. 12(6):594-5. [Medline].
Hoff JT, Panadopoulos SM. Cervical disc disease and cervical spondylosis. Wilkins RH, Rengachary SS, eds. Neurosurgery. New York, NY: McGraw-Hill; 1996. 3756-74.
Iwabuchi M, Kikuchi S, Sato K. Pathoanatomic investigation of cervical spondylotic myelopathy. Fukushima J Med Sci. 2004 Dec. 50(2):47-54. [Medline].
Jumah KB, Nyame PK. Relationship between load carrying on the head and cervical spondylosis in Ghanaians. West Afr J Med. 1994 Jul-Sep. 13(3):181-2. [Medline].
Kadanka Z, Mares M, Bednarík J, et al. Predictive factors for mild forms of spondylotic cervical myelopathy treated conservatively or surgically. Eur J Neurol. 2005 Jan. 12(1):16-24.
Kadanka Z, Mares M, Bednarík J, et al. Predictive factors for spondylotic cervical myelopathy treated conservatively or surgically. Eur J Neurol. 2005 Jan. 12(1):55-63.
Kawaguchi Y, Kanamori M, Ishihara H, et al. Pathomechanism of myelopathy and surgical results of laminoplasty in elderly patients with cervical spondylosis. Spine. 2003 Oct 1. 28(19):2209-14. [Medline].
Kimura R, Park YS, Nakase H, et al. Syringomyelia caused by cervical spondylosis. Acta Neurochir (Wien). 2004 Feb. 146(2):175-8. [Medline].
Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain. 1972. 95(1):87-100. [Medline].
Papadopoulos CA, Katonis P, Papagelopoulos PJ, et al. Surgical decompression for cervical spondylotic myelopathy: correlation between operative outcomes and MRI of the spinal cord. Orthopedics. 2004 Oct. 27(10):1087-91. [Medline].
Rao RD, Currier BL, Albert TJ, et al. Degenerative cervical spondylosis: clinical syndromes, pathogenesis, and management. J Bone Joint Surg Am. 2007 Jun. 89(6):1360-78. [Medline].
Sakaura H, Hosono N, Mukai Y, et al. Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation: a comparative study of laminoplasty and anterior spinal fusion. Spine. 2005 Apr 1. 30(7):756-9. [Medline].
Sari-Kouzel H, Cooper R. Managing pain from cervical spondylosis. Practitioner. 1999 Apr. 243(1597):334-8. [Medline].
Singh A, Crockard HA, Platts A, et al. Clinical and radiological correlates of severity and surgery-related outcome in cervical spondylosis. J Neurosurg. 2001 Apr. 94(2 Suppl):189-98. [Medline].