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Year : 2016 | Volume : 4 | Issue : 2 | Page : 77 - 79  


Original Articles
Radiological profile of patients with Cervical Spondylosis

Ajay Anirudh Jadhav 1, Shaik Abdul Rahim2

1Professor, Department of Radio-Diagnosis, Malla Reddy Medical College for Women, Hyderabad

2Associate Professor, Department of Radio-Diagnosis, Malla Reddy Medical College for Women, Hyderabad

Corresponding Author

Dr. Ajay Anirudh Jadhav

Email: draajadhav@gmail.com

 

Abstract:

Background: Cervical spondylosis is a common disease of advancing age arising form the effects of a progressive degenerative changes affecting single or multiple inter vertebral disco and consequent hypertrophy, spurring and deformities of the discs and foramina.

Objective: To study radiological profile of patients with cervical spondylosis

Methods: A hospital based cross sectional study was carried out among 150 patients. Institutional Ethics Committee permission was obtained. From each and every patient, the informed consent was taken. A detailed history and thorough clinical examination was carried out. Data was entered and analyzed.

Results: The maximum age of patient studied was 72 years, minimum age of patient studied was 16 years. Maximum patients were in 2nd and 4th decade of life. Maximum No. of cases were found in a group of sedentary workers (Doctors/Teachers/Clerks). Almost all cases present with symptom of neck pain followed by symptoms like Brachialgia, Para spinal muscle spasm, Paraesthesia. While difficulty in walking found in only 14 cases of cervical spondylosis.

Conclusion: Cervical spondylosis was common in the 4th decade of life. Sedentary work was the risk factor for cervical spondylosis. Neck pain was the most common presenting symptom.

Key words: Radiological profile, patients, neck pain

INTRODUCTION:

 

Cervical spondylosis is a common disease of advancing age arising from the effects of a progressive degenerative changes affecting single or multiple inter vertebral disco and consequent hypertrophy, spurring and deformities of the discs and foramina. In the past this condition has been called as osteoarthritis, cervical spondylitis, Herniated disc syndrome, chondroma etc. The term Spondylosis was coined by Sir Elliot in 1926. And this has been accepted universally. The important cause is that it is a degenerative process rather than an inflammatory or neoplastic condition. 1

Clinically this entity presents with neck pain and is often associated with brachial neuralgia, headache and sometimes vertebro-basilar insufficiency and rarely it presented with spinal cord compression. Basic Pathology is lose of elasticity of disc characterized by reduction in height of disc space leading to secondary osteo arthritic changes in apophyseal joints and joints of Luschka and formation of osteophytes and spure. These spure encroach upon inter vertebral foramina, compress nerve roots or posterior protrusion of disc reduces the antero posterior diameter of spinal canal leading to cord compression and myelopathy. 2 It is well known that subjects with all radiological features of cervical spondylosis may be symptom free. On other hand manifest cervical myelopathy may occur in presence of modest cervical radiological changes. This discrepancy between symptoms and radiological findings seem to be attributed mainly to difference in initial sagittal diameter of cervical canal. 3

MATERIAL AND METHODS

 

Type of study: Hospital based cross sectional study

Sample size: 150 patients

Ethical considerations: Institutional Ethics Committee permission was obtained. From each and every patient, the informed consent was taken.

A detailed history and thorough clinical examination was carried out. Data was entered and analyzed.

RESULTS

 

Table 1: Incidence of cervical spondylosis in various age groups and sex (Total cases 100)

Sr. No

Age Group in Years

Sex

Total

Male

Female

1

Below 20

3

2

5

2

21-30

7

11

18

3

31-40

23

11

34

4

41-50

20

11

31

5

51-60

5

5

10

6

61-70

1

--

1

7

Above 70

1

--

1

 

Total

60

40

100

 

The maximum age of patient studied was 72 years, minimum age of patient studied was 16 years. Maximum patients were in 2nd and 4th decade of life.

Table 2: Distribution of cases according to occupation (Total cases 100)

Sr. No.

Occupation

No. of cases

Percentage

1

Agricultural workers

30

30

2

House wife

14

14

3

Professionals

10

10

4

Sedentary workers (Doctors/Teacher/Clerks)

46

46

 

Maximum No. of cases were found in a group of sedentary workers (Doctors/Teachers/Clerks).

Table 3: Clinical symptoms in cases of cervical spondylosis (Total cases 100)

Sr. No

Symptoms

No. of cases

Percentage

1

Neck Pain

90

90

2

Brachialgia

50

50

3

Para spinal muscle spasms

48

48

4

Restricted movements of neck

45

45

5

Occipital Pain

10

10

6

Paraesthesia

48

48

7

Giddiness/Syncope

29

29

8

Difficulty in walking

14

14

 

Almost all cases present with symptom of neck pain followed by symptoms like Brachialgia, Para spinal muscle spasm, Paraesthesia. While difficulty in walking found in only 14 cases of cervical spondylosis.

DISCUSSION

 

Cervical spondylosis is a symptom complex commonly occurring in elderly age group involving bony spinal canal, causing degenerative changes in the inter vertebral discs, spurring and deformities of disc and foramina. The diagnosis of cervical spondylosis is made chiefly on plain Radiographs. In general, diagnosis of cervical spondylosis is made by findings in plain Radiographs which show narrowing of the disc spaces and osteophytes formation on the vertebral bodies. If neurological symptoms occur in addition, they may be attributed to spondylotic lesion.

On other hand, as has already been related, such symptoms when associated with minimal radiological changes of cervical spondylosis may be mistaken for other space-occupying lesion or for motor neuron disease. To avoid the wrong diagnosis, the important step of measurement of the cervical spinal canal has cervical spinal canal has to be followed, & establish the relationship between the size of the cervical spinal canal & the encroachment of the spinal canal with degenerative changes e.g. PID, osteophytes etc. As Hinck 1 and Sachdev (1966) pointed out, the antero – posterior (sagittal) diameter is best guide for detecting stenosis produced by cervical spondylosis.

Nurick 2 (1972) in his study concluded that. Cervical myelopathy was always associated with a narrow canal although a narrow canal (sagittal diameter) did not always lead to cervical myelopathy. I. Murone 3          (1924) in the study of fifty-one adult Japanese men, he concluded that, the average initial diameter (sagittal diameter) in cases of spondylosis without neurological symptoms was greater than that of myelopathy cases which suggests that the increased space round the cord help to avoid compression.

In this study, it was observed that age incidence of cervical spondylosis ranged between 16 yrs to 72 yrs, but the maximum age incidence was seen in 3rd and 4th decade of life which was well observed by Brain 4 (1951), Veidilnger 5 (1981). In present study, for cervical spondylosis M:F ratio appears to be 1.5:1. Brain 4 at el found 69% cases in male & 31% in female. Wilkinson 6 gives ratio of M:F as 2.4:1.

There were no satisfactory explanation for male predilection, through the association of repeated trauma and strain in cervical spondylosis can explain the finding observed. In the present series the distribution of cases according to occupation was as follows: Sedentary workers including teachers, clerks, etc. 46 percent; agricultural workers 30 percent; professional 10 percent.

Neck Pain:

Pain in the neck in cervical spondylosis may be produced in several ways. An acute disc protrusion is likely to be associated with severe pain, muscular spasm and rigidity. In chronic cervical spondylosis pain is only rarely severe. 90 percent of patients in present study, had pain in neck. The wide variation in the symptomatology in different series can be explained as explained as symptoms are quite subjective. 50 Percent of the patients in the present study had pain in one or both upper extremities. 10 percent of patients in this study had occipital pain, whereas. In the present study, 48 percent of patients had suffered from paraesthesia in one or both extremities. In present study, 29 percent of patients had suffered from attacks of giddiness and syncope. In the present study, 48 percent of patients had got painful and restricted movements. Palles 7 et al noted restriction of neck movements of their cases. Taylor 8 (1953) reported in majority of cases, initially there was dysfunction of pyramidal tract, followed later by, spino-thalamic tract; with the posterior white columns, either escaping or showing minor changes of dysfunction. Paul Teng 9 (1960) in his study of 20 patients found that, pain was prominent symptom (13 patients); dysesthesia in involved arm, hand, and fingers noted in 10 patients; tingling or a sensation like an electric shook passing along spine whenever the neck was hyper extended (2 patients); 3 patients were paraplegic and 1 was quadriplegic.

 

REFERENCES:

 

  1. Hink VC, Sachdev NS. Developmental stenosis of cervical spinal canal. Brain 1966;89:27,.
  2. Nurick S. Pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 1972;95:87-108.
  3. Murone I. The Importance of the sagittal diameter of the cervical spinal canal in relation to spondylosis and myelopathy. J Bone Joint Surg 1977;56-B:30-361977.
  4. Brain WE, Northfield DW, Wilkinson M. The neurological manifestation of cervical spondylosis. Brain 1951;75:187-92.
  5. Veidlinger OF, Smyth DT, Colwill JC. Cervical Myelopathy.
  6. Wilkinson HA, Lemay ML, E.J. : Radiographic Co-relation in cervical spondylosis. Am J Roentogenol 1969;105:370-74.
  7. Pallies, Jones, Spillane. Cervical spondylosis. Brain 1954;77:274-89.
  8. Taylor AR. Mechanism and treatment of spinal cord disorders associated with cervical spondylosis. Lancet 1953;1:717-20.
  9. Paul Teng. Spondylosis of cervical spine with compression of the spinal cord and nerve roots. J Bone Joint Surg. 1960:42-A(3):392-407.




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