Cervical Spondylosis Workup

Updated: Mar 30, 2018
  • Author: Hassan Ahmad Hassan Al-Shatoury, MD, PhD, MHPE; Chief Editor: Dean H Hommer, MD  more...
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Workup

Laboratory Studies

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  • Usually, no specific findings are present.

  • Other findings may include those related to an underlying etiologic or pathogenetic disorder that initiates the spondylotic changes.

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Imaging Studies

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  • 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. [12]

    • Because myelography method is invasive, most physicians depend on MRI in diagnosing cervical spondylosis. [12]

    • 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

    • Noninvasiveness

    • 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. [13]

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. [14]

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Other Tests

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  • 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. [15]

  • Cortical motor evoked potentials (MEP) may be more sensitive than SSEPs in evaluating spinal cord dysfunction. [16, 17]

  • 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).

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Histologic Findings

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.

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