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Cervical Spondylosis

By Michael Rubin, MDCM, Professor of Clinical Neurology, Weill Cornell Medical College; Attending Neurologist and Director, Neuromuscular Service and EMG Laboratory, New York Presbyterian Hospital-Cornell Medical Center

Cervical spondylosis is degeneration of the bones in the neck (vertebrae) and the disks between them, putting pressure on (compressing) the spinal cord in the neck.

  • Osteoarthritis is the most common cause of cervical spondylosis.

  • The first symptoms are often an unsteady, jerky walk and pain and loss of flexibility in the neck.

  • Magnetic resonance imaging or computed tomography can confirm the diagnosis.

  • Treatment includes a soft neck collar, nonsteroidal anti-inflammatory drugs, and sometimes surgery.

Cervical spondylosis usually affects middle-aged and older people. It is the most common cause of spinal cord dysfunction among people older than 55.

As people age, osteoarthritis becomes more common. It causes vertebrae in the neck to degenerate. When bone in the vertebrae attempts to repair itself, it overgrows, producing abnormal outgrowths of bone (spurs) and narrowing the spinal canal in the neck. (The spinal canal is the passageway that runs through the center of the spine and contains the spinal cord.) The disks between vertebrae also degenerate, decreasing the cushioning that otherwise protects the spinal cord. These changes may result in spinal cord compression, causing dysfunction. Because the tissue is damaged, it is more susceptible to injury. For example, minor neck trauma due to a fall or whiplash can severely damage the spinal cord.

Some people are born with a narrow spinal canal. In them, compression due to spondylosis may be more severe.

Often, the spinal nerve roots (the part of spinal nerves located next to the spinal cord—see Figure: How the Spine Is Organized) are also compressed.


Symptoms of cervical spondylosis may result from compression of the spinal cord, the spinal nerve roots, or both.

If the spinal cord is compressed, the first sign is usually

  • A change in walking

Leg movements may become jerky (spastic), and walking becomes unsteady. Sensation below the neck may be decreased. The neck may be painful and become less flexible. Reflexes in the legs typically become exaggerated, sometimes causing muscles to contract involuntarily (called spasms). Coughing, sneezing, and other movements of the neck may worsen symptoms. Sometimes the hands are affected more than the legs and feet.

If severe, compression may impair bladder and bowel function. If minor neck trauma severely damages the spinal cord, all four limbs may suddenly become paralyzed.

If spinal nerve roots are compressed, the neck is usually painful, and the pain often radiates to the head, shoulders, or arms. Muscles in one or both arms may become weak and waste away, making the arms weak.


  • Magnetic resonance imaging or computed tomography

Doctors suspect cervical spondylosis based on symptoms, especially in older people or in people who have osteoarthritis.

Magnetic resonance imaging (MRI) or computed tomography (CT) can confirm the diagnosis. MRI provides much more information because it shows the spinal cord and roots. CT does not. However, both procedures show where the spinal canal is narrowed, how compressed the spinal cord is, and which spinal nerve roots may be affected.


  • Nonsteroidal anti-inflammatory drugs

  • Sometimes surgery

  • For spasms, a muscle relaxant

Without treatment, symptoms of spinal cord dysfunction due to cervical spondylosis sometimes lessen or remain the same, but they may worsen.

Initially, especially if only nerve roots are compressed, a soft neck collar and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may provide relief. If they do not, surgery may be needed.

If the spinal cord is compressed, surgery is usually needed. An incision may be made through the front of the neck (anterior cervical fusion) or back of the neck (posterior laminectomy). Part of the affected vertebrae is removed to make more room for the spinal cord. Bone spurs, if present, are removed, and the spine may be stabilized by fusing the vertebrae together. As a rule, surgery does not reverse the existing nerve damage, but it prevents additional nerve damage. The earlier the surgery, the better the outcome.

Because the spine may be unstable after surgery, people may need to wear a rigid brace to hold the head still while healing occurs.

If muscle spasms occur, baclofen, a muscle relaxant, helps relieve them.