Clinical Review

Cervical spondylosis and neck pain

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39127.608299.80 (Published 08 March 2007) Cite this as: BMJ 2007;334:527
  1. Allan I Binder, consultant rheumatologist
  1. Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire SG1 4AB
  1. Correspondence to: allan.binder{at}nhs.net

    Most patients who present with neck pain have “non-specific (simple) neck pain,” where symptoms have a postural or mechanical basis. Aetiological factors are poorly understoodw1 and are usually multifactorial, including poor posture, anxiety, depression, neck strain, and sporting or occupational activities.w2 Neck pain after whiplash injury also fits into this category, provided no bony injury or neurological deficit is present.w3 When mechanical factors are prominent, the condition is often referred to as “cervical spondylosis,” although the term is often applied to all non-specific neck pain. Mechanical and degenerative factors are more likely to be present in chronic neck pain.

    In cervical spondylosis, degenerative changes start in the intervertebral discs with osteophyte formation and involvement of adjacent soft tissue structures. Many people over 30 show similar abnormalities on plain radiographs of the cervical spine, however, so the boundary between normal ageing and disease is difficult to define.w4 Even severe degenerative changes are often asymptomatic, but can lead to neck pain, stiffness, or neurological complications.

    I will concentrate on the diagnosis of cervical spondylosis and the evidence available for the different treatments. I will also mention some practical measures that are thought to be important but have not yet been studied. Specific conditions like fibromyalgia, disc prolapse, and whiplash will not be considered, although some patients with these conditions may have been included in therapeutic studies.

    Summary points

    • The diagnosis of cervical spondylosis is usually based on clinical symptoms

    • Patients need detailed neurological assessment of upper and lower limbs as cervical degeneration is often asymptomatic, but can lead to pain, myelopathy, or radiculopathy

    • “Red flag” symptoms identify the small number of patients who need magnetic resonance imaging, blood tests, and other investigations

    • The best treatments are exercise, manipulation, and mobilisation, or combinations thereof

    • Radiculopathy has a good prognosis and may …

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