Do not neglect cervical spondylosis—seek timely treatment.

Cervical spondylosis is a common and frequently occurring condition that poses a threat to physical health. It has an incidence rate of approximately 15% and can affect individuals of any age, though it is most prevalent among middle-aged and older adults (aged 40 and above). Broadly speaking, cervical spondylosis refers to the clinical symptoms and signs resulting from pathological changes in the cervical spine. In the international medical community, it is generally understood as a condition involving degenerative changes in the cervical intervertebral discs—and the subsequent degeneration of the vertebral joints—which lead to damage to the spinal cord, nerves, or blood vessels, manifesting in various symptoms and signs. Cervical spondylosis is the root cause of many other health issues; its degenerative progression is a long, slow process—it does not develop overnight. Therefore, early prevention, early detection, and timely treatment are essential for maintaining a healthy life.

 What Are the Symptoms of Cervical Spondylosis?

The symptoms of cervical spondylosis are complex and varied. The primary manifestation is pain in the neck and shoulders, which may radiate toward the back of the head (occipital region) and the upper limbs. Some patients may experience vertigo, falls, or abnormal sensations—such as heat or unusual sweating—on one side of the face. In severe cases, the function of the lower limbs can be impaired, potentially leading to paraplegia. Specific symptoms may include neck stiffness, rigidity, and pain; restricted neck movement; a heavy sensation in the shoulders and back; muscle hardening; weakness in the upper limbs; numbness in the fingers; reduced skin sensation in the limbs; or the involuntary dropping of objects held in the hand. Some patients may feel that their lower limbs are stiff and uncooperative, or conversely, weak and “soft,” as if they are walking on cotton. Others may experience headaches, dizziness, vision impairment, tinnitus, or nausea. In a small number of cases, patients may suffer from a loss of bladder or bowel control, sexual dysfunction, or even quadriplegia.

Naturally, not every patient with cervical spondylosis will exhibit all of these symptoms; typically, only a subset of them appears. Furthermore, for most patients, the symptoms are mild and the condition progresses over a long period. Therefore, there is no need to panic at the mention of cervical spondylosis, nor should one hastily assume that every minor discomfort is a sign of the condition. Due to the complex and diverse nature of the symptoms associated with cervical spondylosis—compounded by a lack of clear understanding—the condition is frequently confused with disorders in neurology, otolaryngology, or general internal medicine, often leading to delays in diagnosis and treatment. In recent years, as research has deepened, diagnostic capabilities have improved, and treatment methods have seen encouraging progress—most notably through the continuous refinement and advancement of surgical interventions. Currently, in addition to major hospitals, some secondary-level hospitals have also begun to explore the provision of surgical treatment for cervical spondylosis.

 Types of Cervical Spondylosis

Cervical spondylosis is classified in various ways; traditionally, it is categorized into the following six types:

(1) Cervical type (local type): Caused by degenerative changes in the cervical intervertebral discs, this type results in localized pain in the cervical region or referred pain in the occiput, neck, and shoulders, accompanied by restricted neck mobility.

(2) Nerve root type: Caused by degenerative changes in the cervical intervertebral discs that irritate or compress the spinal nerve roots, leading to sensory and motor dysfunction. This type is further divided into acute and chronic forms.

(3) Spinal cord type: Caused by degenerative changes in the cervical intervertebral discs that result in compression and ischemia of the spinal cord, leading to impaired spinal cord conduction. This is subdivided into central and peripheral types: the central type typically manifests first in the upper limbs and progresses downward to the lower limbs, while the peripheral type begins in the lower limbs and progresses upward to the upper limbs. Both subtypes can be further classified by severity into mild, moderate, and severe grades.

(4) Vertebral artery type: Caused by degenerative changes in the uncovertebral joints that irritate or compress the vertebral artery, resulting in vertebrobasilar insufficiency (inadequate blood supply).

(5) Sympathetic type: Caused by degenerative changes in the cervical intervertebral discs that irritate or compress the sympathetic nerve fibers in the neck, triggering a range of reflex-mediated symptoms.

(6) Other types: Includes conditions such as the esophageal-compression type. ## Why Does Cervical Spondylosis Occur?

1. Age-related factors: Much like a machine, the human body experiences increasing wear and tear as it ages. The cervical spine undergoes various degenerative changes, with the degeneration of intervertebral discs serving as the fundamental and most critical basis for the development of cervical spondylosis. Additionally, the degeneration of facet joints and various ligaments also plays a significant role.

2. Chronic strain: This refers to damage caused by excessive activity beyond normal limits. Examples include poor sleeping habits, such as using a pillow of an improper height or positioning it incorrectly; individuals who frequently wake up with a “stiff neck” (acute cervical strain) are at a higher risk. Furthermore, improper working postures—especially among those who spend long periods with their heads bowed—are associated with a very high incidence of cervical spondylosis. Certain inappropriate physical exercises, such as performing handstands or somersaults without proper technique, can also increase the risk.

3. Trauma: In the presence of pre-existing cervical degeneration or instability, trauma to the head or neck can easily trigger the onset or recurrence of cervical spondylosis. Patients may experience a sudden onset of symptoms following even minor trauma, often with significant severity. If the trauma results in fractures or dislocations, treatment becomes considerably more complex.

4. Inflammation of the throat or neck: Acute or chronic inflammation in the throat or neck region can lead to inflammatory edema in the surrounding tissues, which may easily trigger symptoms of cervical spondylosis or exacerbate an existing condition.

5. Developmental spinal stenosis: Individuals with spinal stenosis are more susceptible to developing cervical spondylosis, and their prognosis is generally less favorable.

6. Congenital malformations of the cervical spine: Various congenital abnormalities—such as the fusion of vertebrae or basilar invagination (an indentation of the base of the skull)—can predispose an individual to cervical spondylosis.

7. Metabolic factors: Disruptions in the body’s metabolism—particularly imbalances in calcium and phosphorus metabolism or hormonal regulation—can often contribute to the development of cervical spondylosis. 8. Psychological Factors: Clinical practice has shown that a negative emotional state often exacerbates cervical spondylosis. Conversely, when the condition worsens or flares up, patients frequently experience a further decline in their emotional state—becoming easily agitated or prone to temper outbursts—which, in turn, causes the symptoms of the condition to intensify.

 Treatment of Cervical Spondylosis

Conservative Treatment

Treatment methods for cervical spondylosis are categorized into non-surgical (conservative) and surgical approaches. Non-surgical treatment involves a comprehensive, integrative approach combining Traditional Chinese Medicine (TCM) and Western medicine. Depending on the specific circumstances, one or several of these methods may be employed concurrently. They are outlined as follows:

Manual Therapy (Massage and Manipulation)

This is a primary method used in Traditional Chinese Medicine for treating cervical spondylosis and is considered quite effective. It works by alleviating tension and spasms in the neck and shoulder muscles, restoring mobility to the cervical spine, and releasing adhesions around nerve roots and soft tissues, thereby relieving symptoms.

Cervical Traction

This is a widely used and highly effective treatment for cervical spondylosis. It is suitable for various types of the condition and is particularly effective in the early stages.

Physical Therapy

Physical therapy plays a multifaceted role in the treatment of cervical spondylosis. During the acute phase, modalities such as iontophoresis, ultrasound, ultraviolet therapy, or diadynamic currents may be used. Once pain subsides, treatments such as ultrasound, iodine iontophoresis, electrical stimulation, or other forms of heat therapy may be applied.

Medication

Medications serve as an adjunctive, symptomatic treatment for this condition. Options include analgesics, sedatives, vitamins (such as B1 and B12), vasodilators, and traditional Chinese herbal medicines, all of which can help alleviate symptoms.

Warm Compresses

Warm compresses improve blood circulation, relieve muscle spasms, and reduce swelling, thereby easing symptoms. They also help stabilize the affected vertebrae following manual therapy. This can be done using hot towels or hot water bottles; ideally, it should be performed using a traditional Chinese herbal decoction for steaming or washing the affected area. Warm compresses should not be used during the acute phase when pain is severe. Surgical Treatment

There are various surgical approaches for cervical spondylosis. One method involves an incision in the front of the neck (anterior approach); the esophagus and trachea are retracted to the side, exposing the cervical vertebral bodies, allowing for the removal of portions of the vertebrae and intervertebral discs. Contraindications for this approach include severe osteoporosis, significant segmental instability, trauma, tumors, and infections. Another method involves an incision in the back of the neck (posterior approach), where the skin and subcutaneous tissue are incised to reach the vertebral laminae; these are then either opened or partially resected to achieve decompression. The choice of surgical approach is primarily based on the patient’s specific condition, with the goal of effectively relieving pressure on the spinal cord, nerve roots, vertebral arteries, or esophagus.

Artificial cervical disc replacement involves implanting a mobile device into the intervertebral space to replace the original disc. This preserves motion at the affected segment and helps reduce the risk of secondary degeneration in adjacent segments. Indications for this procedure include cervical myelopathy, cervical radiculopathy, or cervical disc herniation requiring anterior decompression, provided there is no significant degeneration of the intervertebral space or segmental instability. Contraindications are similar to those for other anterior procedures: severe osteoporosis, significant segmental instability, trauma, tumors, and infections.

Percutaneous cervical discectomy (aspiration/excision) is performed under X-ray guidance using specialized instruments to remove cervical disc material; as it does not require an open incision, it minimizes trauma to the body. Similarly, under X-ray guidance, a specific substance—collagenase—can be injected into a diseased cervical disc to dissolve the herniated material, thereby relieving pressure and achieving a therapeutic effect. Both of these techniques are currently being further explored and gradually implemented in China.

 Which Cases of Cervical Spondylosis Require Surgery?

Treatment for cervical spondylosis is broadly categorized into non-surgical and surgical approaches. When it comes to surgical intervention, it should be approached with the utmost seriousness. The neck possesses a complex anatomical structure and serves vital physiological functions: it supports the cranium; it houses the blood vessels that supply the brain; it contains the initial segments of the digestive and respiratory tracts; and the spinal cord within the cervical vertebrae acts as a critical gateway for neural communication between the brain and the rest of the body—all sensory input from below the head must pass through the cervical spinal cord to reach the brain, and all motor commands from the brain to the body must likewise traverse this same pathway. Consequently, non-surgical treatment is the preferred approach for cervical spondylosis to ensure patient safety. However, when non-surgical interventions prove ineffective, surgical treatment must be considered.

In cases of myelopathic cervical spondylosis—where the cervical spinal cord is compressed by osteophytes (bone spurs), the ligamentum flavum, or herniated intervertebral discs—non-surgical treatment may be appropriate if symptoms are mild, provided the patient is closely monitored. If, however, the patient develops paralysis below the neck, experiences varying degrees of sensory or motor impairment, or if symptoms of spinal cord compression worsen progressively or suddenly, surgical intervention is required immediately. Delaying surgery can lead to the degeneration of compressed nerves, making recovery difficult.

For vertebral artery-type cervical spondylosis, characterized by recurrent episodes of cervicogenic vertigo or sudden falls (“drop attacks”), surgery may be considered if the site and severity of the vertebral artery compression have been confirmed via angiography and long-term non-surgical treatment has failed. In rare instances of radiculopathic (nerve root-type) cervical spondylosis where non-surgical treatment is ineffective and the compressed nerve can be precisely localized, surgery may be performed on a case-by-case basis. Surgical outcomes for sympathetic-type cervical spondylosis are generally less favorable; therefore, surgery should be approached with great caution.

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