The discs between cervical vertebrae degenerate due to wear and tear. There is loss of disc height and formation of reactive bone called osteophytes. This results in neck pain, which may be referred down to shoulders and between the scapulae. X-rays are diagnostic of this condition. Cervical spondylosis is treated with physiotherapy and analgesics. Ergonomics at work place and regular exercises is important in prevention of this condition. Cervical fusion may be needed in patients who do not respond to conservative treatment.

Cervical disc prolapse

The nucleus pulposus of cervical disc may prolapse through tear in fibres of peripheral annular fibrosus. The prolapsed material may compress either of nerve root or spinal cord. If the nerve root is compressed the condition is called cervical radiculopathy. In cervical radiculopathy pain radiated down along affected nerve root into hand. Patients may also complain of tingling, numbness or weakness in hands.

Cervical Myelopathy

n older patients with multiple level disc degeneration the spinal cord may get compressed. This condition is called cervical myelopathy. This may also occur due to ossification of posterior longitudinal ligament.In cervical myelopathy, the earliest symptoms are clumsiness while walking. There is spasticity in lower limbs and it may result in loss of bladder and bowel control.

MRI scanning is investigation of choice in both the above conditions (Fig. 1). Cervical radiculopathy can be treated non-operatively with traction, (Fig.2) exercises and analgesics. If non-operative treatment fails surgery is indicated in these conditions. Surgical options include anterior cervical discectomy and fusion (Fig.3) or cervical disc replacement. Cervical myelopathy usually needs surgical intervention. The spinal cord is either decompressed from the front by removing the compressing disc or vertebrae and stabilising with bone graft and plates or from the back by doing laminectomy (fig. 4) or laminoplasty.