AAOS Comprehensive Orthopaedic Review 4: Print + Ebook (AAOS - American Academy of Orthopaedic Surgeons)

Chapter 15 D egenerative C onditions of the C ervical S pine

PAUL J. PARK, MD THOMAS D. CHA, MD, MBA JEFFREY C. WANG, MD, FAAOS K. DANIEL RIEW, MD, FAAOS

I. EPIDEMIOLOGY AND PATHOANATOMY A. Degenerative cervical conditions are only slightly less common than low back pain. B. Radiographic evidence of cervical spondylosis is common in asymptomatic adults. C. Disease progression 1. The outer anulus fibrosus in a normal disk is mostly type I collagen; the inner nucleus pulposus is type II collagen. 2. With age, the ratio of keratan sulfate to chondroi tin sulfate increases and water content decreases, leading to a cascade of secondary degenerative events (spondylosis), starting with disk height loss and sometimes including disk herniation

or calcification. These changes can result in increased segment motion, compensatory osteo phytes, buckling of the ligamentum flavum, and facet arthrosis, all of which can cause neural impingement. 3. The clinical presentation of symptomatic cervi cal spondylosis may manifest as axial neck pain, radiculopathy, and/or myelopathy.

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II. AXIAL NECK PAIN A. Evaluation 1. History and physical examination

a. Symptoms are typically episodic, with acute pain generally improving over days to weeks. b. Symptoms are often exacerbated with range of motion (particularly extension). c. Physical examination should assess active flex ion, extension, lateral flexion, and rotation of the neck. d. A thorough neurologic examination with provocative tests should be performed to rule out radiculopathy or myelopathy. e. Red flags for an infectious or neoplastic eti ology include fever, unexplained weight loss, and nonmechanical pain. 2. Imaging studies a. Radiographs • Indications • History of trauma Dr. Cha or an immediate family member serves as a paid consultant to or is an employee of Bio2, GE Healthcare, K2M, and NuVasive and has received research or institutional support from K2M and NuVasive. Dr. Wang or an immediate family member has received royalties from Biomet, Novapproach, Seaspine, and Synthes; serves as an unpaid consultant to Precision OS; has stock or stock options held in Bone Biologics, Electrocore, Pearldiver, and Surgitech; and serves as a board member, owner, officer, or committee member of AO Foundation. Dr. Riew or an immediate family member has received royalties from Biomet; is a member of a speakers’ bureau or has made paid presen tations on behalf of Biomet, Medtronic, and NuVasive; serves as a paid consultant to or is an employee of NuVasive; serves as an unpaid con sultant to HAPPE Spine; has stock or stock options held in Amedica, AxioMed, Benvenue, Expanding Orthopedics, PSD, Paradigm Spine, Spinal Kinetics, Spineology, and Vertiflex; and serves as a board mem ber, owner, officer, or committee member of AOSpine and North American Spine Society. Neither Dr. Park nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this chapter. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023

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