Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Director, Quality & Patient Safety (QPS) – Och Spine Hospital
Medical Director, Spine Unit – Och Spine Hospital
Co-Chief of Spinal Deformity Surgery • NewYork-Presbyterian / Columbia University
Och Spine Hospital • New York, NY
Cervical spondylosis is the medical term for age-related degenerative arthritis of the cervical spine. It is extraordinarily common — over 85% of people over 60 have radiographic evidence of cervical spondylosis, though many have no symptoms. When it does cause symptoms, they range from neck pain and stiffness to arm pain from nerve compression (radiculopathy) to spinal cord dysfunction (myelopathy). Understanding which symptoms require treatment is the key to appropriate management.
WHAT IS CERVICAL SPONDYLOSIS?
As the cervical discs age, they lose water content and height. The vertebral bodies respond by forming bony overgrowths (osteophytes). The facet joints degenerate and develop arthritic changes. The ligamentum flavum thickens. All of these changes reduce the space available for the spinal cord and nerve roots. The process is gradual, occurring over years to decades, which is why symptoms tend to develop insidiously rather than suddenly.
SYMPTOMS
- Neck pain and stiffness — the most common presentation; typically worse in the morning and with prolonged positions
- Headaches — particularly at the base of the skull from upper cervical degeneration
- Cervical radiculopathy — arm pain, numbness, or weakness from nerve root compression by bone spurs or foraminal narrowing
- Cervical myelopathy — spinal cord compression causing hand clumsiness, gait unsteadiness, balance problems, and in severe cases weakness of the arms and legs
- Lhermitte’s sign — an electric shock sensation radiating down the spine when the neck is flexed; a classic sign of cervical cord compression
DIAGNOSIS
X-rays show disc space narrowing, bone spurs, and facet arthritis. MRI is the primary study for evaluating cord and nerve root compression. CT provides better bony detail. Dynamic (flexion-extension) X-rays assess stability. Electrodiagnostic studies help differentiate radiculopathy from peripheral nerve conditions.
NON-SURGICAL TREATMENT
- Physical therapy — the most important non-surgical treatment; strengthening and stabilization exercises reduce symptoms in the majority of patients
- Anti-inflammatory medications
- Cervical epidural steroid injections — for radicular pain
- Activity modification and ergonomic optimization
WHEN IS SURGERY INDICATED?
- Cervical radiculopathy failing conservative treatment
- Cervical myelopathy — once moderate myelopathy is diagnosed, surgery is generally recommended without prolonged delay; the natural history of myelopathy is progressive deterioration and irreversible cord injury can occur with continued compression
- Instability causing progressive neurological symptoms
SURGICAL OPTIONS
The appropriate surgical approach depends on the specific levels involved, the pattern of compression, and the patient’s cervical alignment. Options include ACDF, cervical disc replacement, laminoplasty, and posterior laminectomy and fusion — selected individually based on each patient’s anatomy and pathology.
FREQUENTLY ASKED QUESTIONS
Does everyone with cervical spondylosis need treatment?
No. Most people have some degree of cervical spondylosis on imaging with no symptoms at all. Treatment is based on symptoms and neurological findings, not the presence of arthritis alone.
Is cervical spondylosis the same as arthritis?
Yes, it is essentially age-related degenerative arthritis of the neck, affecting the discs, joints, and ligaments of the cervical spine.
What is Lhermitte’s sign and should I be worried?
It’s an electric shock sensation down the spine with neck flexion, and it’s a recognized sign of spinal cord involvement. If you experience this, it’s worth a prompt evaluation.
Can physical therapy reverse cervical spondylosis?
Physical therapy cannot reverse the underlying degenerative changes, but it can meaningfully improve pain, posture, and function for many patients, particularly those without significant nerve or cord compression.
How do I know which surgery I might need?
This depends entirely on which levels are affected, the pattern of compression, and your cervical alignment, all of which are assessed through detailed imaging review.
WHY CHOOSE DR. SARDAR
Dr. Sardar treats the full spectrum of cervical spondylosis, from conservative management of symptomatic neck arthritis to complex multilevel decompression and reconstruction. He performs every cervical surgical approach and selects among them based on each patient’s specific anatomy and clinical picture.
This page is for educational purposes only and does not constitute individualized medical advice.
RELATED CONDITIONS & PROCEDURES
- Cervical Myelopathy Surgery — spinal cord compression from spondylosis; requires prompt surgical evaluation
- Cervical Radiculopathy — pinched nerve from spondylotic bone spurs or foraminal narrowing
- ACDF Surgery — the most common surgical treatment for spondylotic radiculopathy and myelopathy
- Cervical Laminoplasty — posterior decompression for multilevel spondylotic stenosis with preserved lordosis
To schedule a consultation, call 212-932-5187 or visit the contact page.