Spondylosis, Cervical and Lumbar
M Mahan and SW Chang, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
r 2014 Elsevier Inc. All rights reserved.
This article is a revision of the previous edition article by Eric W Nottmeier, Volker KH Sonntag, Christopher Ames, volume 4, pp 376–377, r 2003, Elsevier Inc.
Spondylosis is a term used to describe degenerative changes
that occur within the articular components of the spine.
These degenerative changes, occurring at both the macro- and
microscopic levels, may affect the ligaments, bone, inter-
vertebral disks, or any combination of these structures. Spon-
dylosis can cause a variety of spinal symptoms, including nerve
root compression, spinal cord compression, or joint pain.
When the ligaments are affected, they may become ossified
or hypertrophied, which enlarges their thickness and may lead
to compression within the spinal canal or neural foramina.
The posterior longitudinal ligament is located anteriorly in the
spinal canal on the posterior surfaces of the vertebral bodies
and intervertebral disks. Ossification of the posterior longi-
tudinal ligament is a well-described condition that can cause
cervical stenosis and anterior compression of the spinal cord.
The ligamentum flavum (yellow ligament) is located pos-
teriorly in the spinal canal and courses along the undersurface
of the laminae. Hypertrophy of the ligamentum flavum causes
narrowing posteriorly. The spinal canal may become com-
pressed in a trefoil shape, causing stenosis of the spinal canal,
neural foramina, or both.
Another characteristic of spondylosis is facet hypertrophy,
which is enlargement of the facet joints caused by repeated
strain on the spine. The facet joints are located posteriorly in
the spinal column and are important regulators of spinal
mobility. The facet joints hypertrophy in response to patho-
logical healing, similar to other synovial joint hypertrophy as
seen in osteoarthritis. Enlargement of the facet joints can cause
them to impinge on the spinal canal or neural foramina,
causing symptoms of myelopathy or radiculopathy, respect-
ively. Facet joints are innervated by pain receptors and
may become pain generators when undergoing degenerative
changes.
Osteophyte formation also occurs as a consequence of
intervertebral disk degeneration. Osteophytes are bony out-
growths that form as a result of subperiosteal bone formation
when a disk bulges and elevates the periosteum. The result is a
Encyclopedia of the Neurological Sciences, Volume 4 doi:10.1016/B978-0-12-385157-4.00787-9
bony ridge that can impinge on the spinal canal or neural
foramina. Osteophytes can also cause symptoms by com-
pressing nonneural structures. For example, anterior osteo-
phytes in the cervical spine can become large enough to
compress the esophagus, resulting in dysphagia.
The treatment of spondylosis depends on the symptom-
atology. Asymptomatic spondylitic changes are common
and require no treatment. When symptoms occur, they are
most often the result of neural compression. Compression of
the cervical or thoracic spinal canal can cause myelopathy,
whereas lumbar compression causes neurogenic claudication.
Neural foraminal stenosis causes radiculopathy, which may be
present at any segmental level of the spine.
Conservative therapy is the initial treatment for symptoms
of radiculopathy or lumbar stenosis and consists of antiin-
flammatory drugs, strengthening exercises, steroid injections,
or all the three. If a patient’s symptoms progress or are re-
fractory to conservative treatment, surgical decompression is
considered. Surgical decompression is the initial treatment for
myelopathy, bowel and bladder disturbances, or profound
and progressive motor weakness.
See also: Radiculopathy. Radiculopathy, Cervical. Radiculopathy,
Lumbosacral. Spinal Cord Diseases
Further Reading
Alexander JT (1996) Natural history and nonoperative management of cervical
spondylosis. In: Alexander JT (ed.) Principles of Spinal Surgery, pp. 547–558.
New York: McGraw-Hill.
Ball PA and Benzel EC (1996) Pathology of disk degeneration. In: Ball PA and
Benzel EC (eds.) Prinicples of Spinal Surgery, pp. 507–516. New York:
McGraw-Hill.
Chang SW, Kakarla UK, Maughan PH, et al. (2010) Four-level anterior cervical
discectomy and fusion with plate fixation: Radiographic and clinical results.
Neurosurgery 66: 639–646.
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