Cervical spondilytis slide share

Cervical spondylitis

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Cervical spondylitis is a common degenerative condition of the cervical (neck) spine that most likely is caused by age-related changes (wear and tear) in the intervertebral disks and vertebrae of the neck. Research has shown that CSM (cervical spondylotic myelopathy) is the most common cause of non-traumatic weakness in limbs and a persistent stiffness and nagging pain in the neck.

'Spondylo' is a Greek word-meaning vertebra. Spondylitis (or Spondylosis) means changes in the vertebral joint characterized by increasing degeneration of the intervertebral disc with subsequent changes in the bones and soft tissues.

Cervical spondylitis



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Most often in people above the age of 40, the intervertebral discs get progressively dehydrated and they become more compressible and less elastic. Mineral deposition starts occurring in the intervertebral disc resulting in secondary changes. Although majority of individuals over 40 years of age demonstrate significant radiological evidence of the above changes, only a small percentage develop symptoms of the same. Another noteworthy point is that sometimes the degenerative changes in the cervical spine can be visible on the X-ray as early as in 30’s but it does not call for any treatment if the patient is not symptomatic.




• This is basically a mechanical disorder.• Very stiff muscles in the cervical region can, over the years,

cause a kinking of the cervical spine to the front. • Bad posture and lack of exercise to the cervical region are the

key factors which are responsible in a majority of the patients. • Lying in bed with several pillows propping up the neck into an

unnatural position can affect the alignment of the cervical column, causing a forward inclination.

• Reclining on sofas with the spine hunched and the neck pushed forward is bad for cervical alignment.

• Hunching over the computer for many hours, occupational hazards such as those of a writer, an illustrator or a painter, all cause the spine to be bent forward all the time.

CAUSES




• Positioning the body to the same side during sleep, with the shoulder muscles and the neck compressed, also develops faulty alignment in the cervical spine. In due course the spine is bent, the front surface of the bones and disc are excessively pressurised and damage occurs.

• The so-called executive chairs are ill-designed and push the neck out of alignment. No chair should reach over the head. The level should be up to the shoulder blades so that the chest can stretch over the edge keeping the body upright.

• In India, railway porters carry heavy loads on their heads but they do not suffer from cervical pain (as one would expect) from the heavy load they carry every day. Only in the group of people who never exercise their bodies does this occur most frequently.Powered by-

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• Neck pain and stiffness is one of the earliest presentations of cervical spondylitis. Some of the characteristic features of this condition are:

• Chronic or episodic pain and stiffness in the neck and shoulder region• The pain tends to get worse over a period of time • There may be periods initially when the pain disappears completely; later as

the disease advances the pain may remain persistent • Pain may radiate (travel) from neck to shoulders, arms, forearms, hands, lower

part of the head, upper back• Coughing, sneezing, other movements of the neck may worsen symptoms • Along with pain, there may be abnormal sensations (tingling numbness), loss

of sensation, weakness in any of the above regions

SYMPTOMS




• There may be non-specific headaches in the lower part of the back of head

• Sensation of loss of balance • Loss of control over the bladder or bowels (if the

spinal cord is compressed) • Occasionally there may be atypical pain

presenting as chest pain or breast pain (false angina)




The doctor may find certain clear pointers to this disease on examination of the patient:

• Spasm of the neck muscles• Limited range of movements of the neck – bending forward, backward,

sideways, rotating the head are all limited• Weakness of muscles of the arms, forearms • Altered sensation in the shoulder region, arms, forearms, neck, etc. • Reflexes are often reduced

• poorly localised tenderness, • limited range of motion, • minor neurological changes.

EXAMINATION OF THE PATIENT




• Imaging testsA variety of imaging tests can provide details to guide diagnosis and treatment. Examples include:

• Neck X-ray. An X-ray may show abnormalities, such as bone spurs, that indicate cervical spondylosis. It is ordered primarily as a screening test to look for rare, serious causes for neck pain and stiffness — such as tumors, infections or fractures.

• Computerized tomography (CT scan). This test takes X-rays from many different directions and then combines them into a cross-sectional view of the structures in your neck. It can provide much finer details than a plain X-ray, particularly of the bones.

DIAGNOSIS




• Magnetic resonance imaging (MRI). MRI uses a magnetic field and radio waves and can produce detailed, cross-sectional images of both bone and soft tissues. This can help pinpoint areas where nerves may be getting pinched.

• Myelogram. This test involves generating images using X-rays or CT scans after dye is injected into the spinal canal. The dye makes areas of your spine more visible.

Nerve function tests-In some cases, it may be helpful to determine if nerve signals are traveling properly to your muscles. Nerve function tests include:

• Electromyogram (EMG). This test measures the electrical activity in your nerves as they transmit messages to your muscles when the muscles are contracting and when they're at rest. The purpose of an EMG is to assess the health of your muscles and the nerves that control them.

• Nerve conduction study. For this test, electrodes are attached to your skin above the nerve to be studied. A small shock is passed through the nerve to measure the strength and speed of nerve signals.




• To arrive at an accurate diagnosis, it is critical for the physician to consider other disorders that have similar symptoms as cervical spondylotic myelopathy (a "differential diagnosis"). Other conditions associated with neck pain and arm pain, motor-sensory-reflex changes, and signs of spinal cord dysfunction include:

• Progressive forms of multiple sclerosis• Amyotrophic lateral sclerosis (Lou Gehrig's disease)• Hereditary spastic paraplegia• Subacute combined degeneration of the spinal cord

associated with vitamin B12 deficiency• Certain spinal cord tumors• Combined system disease

DIFFERENTIAL DIAGNOSIS




• Rheumatoid Arthritis• Cervical Sprain and

Strain• Osteoporosis and

Spinal Cord Injury• Frozen Shoulder• Metabolic diseases -

Paget's disease, osteoporosis, gout or pseudo-gout Infections - osteomyelitisor tuberculosis




• MEDICAL• PHYSIOTHERAPY• RELAXATION• ERGONOMICS• DO’s AND DONT’s• HOMEOPATHIC APPROACH

MANAGEMENT




• Usually Analgesics and muscle relaxants are advised . In more severe cases the orthopaedic doctor may suggest cortisone injections near the joints of the vertebral bodies to ease the swelling of the nerves and relieve pain.

•Surgical Treatment

If the medical treatment andphysiotherapy fails, and the condition is severe, where the nerves are affected, surgery may be required.. Decompression of the nerve is done to relieve the nerve which is compressed by the bones and the disc.

MEDICAL TREATMENT




• Physiotherapy

The goal of physiotherapy treatment is to relieve pain, and enhance movements of the neck.

• Shortwave Diathermy - A disc or heating pad is placed over the back of the neck. The warmth obtained from the shortwave diathermy current relaxes the muscle and the pain is relieved.

Cervical Traction - Traction is a mechanical device, which supports the head and chin. It is used to relieve the nerve compression by a bone.




• Posture correction - Simple postural exercises can be taught to correct the faulty position of the neck.

Motivation is given to maintain the erect posture:

Collars - Two types of collars can be prescribed:

Soft Collar - Soft collar is used during night times to prevent awkward position of the neck during sleep.

Firm Collar - Firm collar steadies the neck and relieve pain, especially during traveling or work. It is removed when the pain subsides.




Relaxation

Relaxation is essential part of treatment. Tension in neck and shoulder muscle, pain, anxiety are all relieved by relaxation.

Relaxation can be done in two ways:

Physical Relaxation.

Mental Relaxation.




• Physical Relaxation:

The whole body is relaxed by free suitable and comfortable positions, so that the muscles are freed from tension and the pain is relieved. For eg., position of relaxation - when you are lying flat on your back.

One pillow under the head

One cushion for the shoulder and

One under knees.

The pillow should be firm and thin

This position will allow relaxation for your body while lying down.

Relaxation while sitting. The head, neck and shoulder are supported by high backed chair, with a small pillow at lower back.

Feet supported on stool or low bench

Arm, resting on arm of chair or pillow



• Ergonomics

Ergonomics concentrates on the architectural design of furnitures like desk, chairs, tables etc. The design of the furniture should be such that it should support the body structure without causing any undue strain to the muscles of the back and neck .

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• Do's and Dont's

If you are prone to cervical spondylosis, Avoid bad roads, if travelling by two or four wheelers

Do not sit for prolonged period of time in stressful postures

Do use firm collars while traveling

Do not lift heavy weights on head or back

Do not turn from your body but turn your body moving your feet first

Do turn to one side while getting up from lying down

Do the exercises prescribed regularly

Do use firm mattress, thin pillow or butterfly shaped pillow

Do not lie flat on your stomach.




• Yogasanas for cervical spondylitis:• Here are some of the most useful Yoga asanas for

cervical spondylitis. Before practicing these Yogasanas you should seek guidance of your health provider and should only practice under guidance of an Yoga expert.

• Sarpasana• Dhanurasana• Shalabhasan• Dandasana• Bhujangasan• Tadasana• Makarasan• Neck excercises ( forward bending and backward

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Cervical spondilytis slide share

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