Cervical Spondylosis

KEY FACTS

Terminology

• Spinal canal and neural foraminal narrowing in cervical spine secondary to multifactorial degenerative changes

Imaging

• Completely effaced cerebral spinal fluid in cervical spine at disc levels

• Cervical spine, ventral epidural, centered at disc levels

• Sagittal diameter of cervical canal < 13 mm

• Disc osteophyte complex protruding into canal and compressing thecal sac and cord

• Completely effaced subarachnoid space at disc levels in cervical spine → “washboard spine”

• Variable degrees of cord compression

• Disc disease: Disc herniations, osteophytes, disc bulges

Top Differential Diagnoses

• Ossification of posterior longitudinal ligament

• DDx of abnormal cord signal

  • Cord tumor

  • Syrinx

  • Multiple sclerosis

  • Motor neuron disease

Pathology

• Multilevel disc degeneration with decreased disc hydration and fissures

• Disc herniation, bulge with associated broad osteophytes

• Uncovertebral joint osteoarthritic change with foraminal stenosis

Clinical Issues

• Acquired spinal stenosis (cervical) has no pathognomic symptoms or signs

  • Can exhibit both central AND peripheral findings

• Spastic paraparesis commonly seen

• Upper extremity numbness, weakness (“myelopathic hand”)

• Natural history of insidious onset, periods of static disability, and episodic worsening

TERMINOLOGY

IMAGING