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CERVICAL SPONDYLOSIS -CAUSES AND REMEDIAL MEASURES

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 Indo American Journal of Pharmaceutical Research, 2015 ISSN NO: 2231-6876

CERVICAL SPONDYLOSIS - CAUSES AND REMEDIAL MEASURES

P. Ravisankar*1, K. Manjusha1, V. Laya Sri1, K. Rajya Lakshmi1, B. Vijay Kumar1, P. Pragna2, K.
Avinash Kumar1, P. Srinivasa Babu1
1
Vignan Pharmacy College, Vadlamudi, Guntur (Dist.) - 522213, Andhra Pradesh State, India.
2
Malla Reddy Medical College for Women, Jeedimetla, Hyderabad-500055, Telangana State, India.

ARTICLE INFO ABSTRACT

Article history
Received 12/08/2015
Available online
31/08/2015
Keywords
Cervical Spondylitis,
Cervical Osteoarthritis,
Spinal Osteoarthritis,
Arthritis Of Neck,
Chronic Neck Pain.
Day by day the number of people with the ailment of cervical spondylosis otherwise known
as cervical osteoarthritis which is a disorder of abnormal wear and tear on the cartilage and
bones called cervical vertebrae of the neck has been increasing alarmingly. More or less, less
than 25 % of people below 40 years of age are facing Cervical Spondylosis [1] and about 60
% or above the age of 40 are affected by this disease. Although the role of genetics is yet to
be confirmed, people with above 50 years of age who experience the condition, are more
likely prone to normal or mild conditions of Cervical Spondylosis. At the age of 50, 50 % out
of them suffering from cervical spondylosis and at the age of 75, 70 % out of them are the
suffers with neck pain and stiffness. At the age of 60, most women and men are getting signs
and symptoms of cervical spondylosis. A close examination of X-ray findings evidently show
that 90 % of men older than 50 years and 90 % of women older than 60 years are getting
degenerative changes in the cervical spine which causes cervical spondolysis. It also
evidently shows that the condition is existing in more than 90 percent of the people over the
age of 65. Cervical spondylotic myelopathy is the most common cause of nontraumatic
spastic paraparesis and quadriparesis and as per reports that 23.6 % of patients suffering with
myelopathic symptoms. Around 1 in 10 people develop long-lasting chronic pain. Out of the
people suffering from neck pain nearly 75 % with radiculopathy and 50 % with myelopathy
get relief by way of therapy alone. For the remaining people suffering from radiculopathy and
or myelopathy 70 to 80 percent of patients get relief with surgery. Physical exercise,
meditation and yoga and less fat and vegetarian diet plays prominent role in decreasing the
cervical spondylosis and to keep up bones and joints in a healthy condition and can prevent
the advancement of neck and shoulder pain and the demineralization of bones.

Corresponding author
P. Ravisankar
Flat no. 501, Door no.4-1-16,
Sapthagiri Sesha Sai Sadan,
4/2, Lakshmipuram, Guntur-522007,
Andhra Pradesh, India.
banuman35@gmail.com
09000199106.
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Please cite this article in press as P. Ravisankar et al. Cervical Spondylosis - Causes And Remedial Measures. Indo American
Journal of Pharm Research.2015:5(08).

Copy right © 2015 This is an Open Access article distributed under the terms of the Indo American journal of Pharmaceutical
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INTRODUCTION
The medical word Spondylosis is derived from Ancient Greek word spondylos, "a vertebra", in plural "vertebrae - the
backbone". Spondylosis,” a term often used interchangeably with “spinal osteoarthritis” or “degenerative disc disease,” since
physicians used it in variety of situations so that it is difficult to define appropriately. Cervical spondylosis is often associated and
advances with the age, affecting equally both men and women but problems commences earlier in males with the gradual
advancement of age, owing to osteophytes or bone spurs, on vertebrals. Hard work, injury of the neck, genetic background and bad
diet habits with abnormal fat etc. are considered as the major grounds. Neck stiffness that gets worse over time, numbness or abnormal
sensations in the shoulders, arms, or legs, headache usually on the back side of the head are the major symptoms.
Cervical spondylosis [2] is a muscular condition or similarly as osteoarthritis of the spine. It often causes nerve root or spinal
compression pains. This can be triggered off by a traumatic experience such as a whiplash injury, old fractures, muscle tension, or by a
herniated disc or blood disease. Often, spondylosis specifically affects the facet joints in the spine.
Generally with age different degenerative changes in the cervical vertebrae can lead to a loss of intervertebral height with
narrowing of the central canal and intervertebral foramina. These changes are dehydrated disks, bone spurs, stiff ligaments, herniated
disks are extremely common, worsen with age, and are referred to by the common term cervical spondylosis which is shown in Fig 1.

Figure 1: Cervical spondylosis (anterolateral view).

Spondylolisthesis, spondylitis and spondylosis inspite of the three terms sounds identical, but in fact quite differ from each
other, and they require separate methods while execution of treatment. These words create certain confusion since they may often all
present in the same patient. As the words are based on the Greek root word “sphondylos” which means vertebra, and thus, each word
has to do with some dysfunction of the vertebra. The suffix “-oliothesis” means slipping or dislocation, and spondylolisthesis is the
slipping of one vertebra over another. The suffix “-osis” means that a disease state is present, and spondylosis is mainly describing
arthritic changes to the vertebrae. Finally, “-itis” means that inflammation is present, and spondylitis describes an inflammation that
badly affects the vertebrae. Cervical spondylitis [3-5] is typically a degenerative and not traumatic condition.
Alternate names for cervical spondylosis are cervical osteoarthritis, arthritis of neck, chronic neck pain of cervical
spondylosis, cervical osteoarthritis and degenerative osteoarthritis.
The common types of Spondylosis are 1. Cervical spondylosis 2. Lumbar spondylosis 3. Lumbosacral spondylosis 4. Multi level
spondylosis 5. Mild spondylosis 6. Severe spondylosis.
Cervical spondylosis is a general term for degeneration of the structures in the cervical/ neck region of the spine. In
spondylosis, rupture of a disk or overgrowth of the vertebrae or the ligaments that support the spine or a combination of these
conditions may compress the spinal cord or the nerves entering or exiting in the spinal cord, causing pain and other symptoms leads to
cervical spondylosis which is common among those of middle and old age people. Most of the cases are mild and respond positively
to self-treatment.
Spondylosis literally known as stiffening of the body due to blocks building in the bones of the spine (vertebrae). Spondylosis
refers to degenerative changes in the spine such as bone spurs and degenerating intervertebral discs. Spondylosis changes in the spine
are frequently referred to as osteoarthritis. The phrase "spondylosis of the lumbar spine" implies degenerative changes of the vertebral
joints and degenerating intervertebral discs in the low back. Spondylosis can occur in the cervical spine that is neck, thoracic spine in
the upper and mid back, or lumbar spine that is low back. Lumbar spondylosis and cervical spondylosis are the most general diseases.
Thoracic spondylosis frequently does not cause symptoms. Lumbosacral spondylosis is spondylosis which affects both the lumbar
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spine and the sacral spine that is below the lumbar spine, in the midline between the buttocks. Multilevel spondylosis indicates the
changes affecting multiple vertebrae in the spine. Examples of disc problems are shown in Fig 2.
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Figure 2. Different examples of disc problems.

Spondylosis is a common term that is often used to describe various types of spinal degeneration of anatomical elements in
the neck or back particularly due to old age which is a descriptive term. When the space between two adjoining vertebrae narrows, a
nerve root emerging from the spinal cord compressed called as radiculopathy [6] where in sensory and motor disturbances, such as
severe pain in the neck, shoulder, arm, back, and leg, accompanied by muscle weakness may occur. If direct pressure occurred on the
spinal cord especially in the cervical spine is known as myelopathy [7], accompanied by global weakness, gait dysfunction, loss of
balance, and loss of bowel and bladder control. The patient may shocks like paresthesia in hands and legs because of nerve
compression and lack of sufficient blood flow. If vertebrae of the neck is involved it is called cervical spondylosis where as lower
back spondylosis is defined as lumbar spondylosis.

Difference between spondylosis and spondylitis

Spondylosis includes cervical spondylosis among other categories. Spondylosis symptoms generally fall into two categories
namely localized symptoms and radiating symptoms. Localized symptoms of spondylosis occur at the site of the issue around a
herniated disc and they may include dull aching, limited movement or a feeling of instability. Radiating symptoms of spondylosis
affect remote areas of the body when nerves in the spine area affected by other issues like bulging discs and bone spurs. Symptoms
like pain, numbness, weakness and tingling sensations can affect the shoulders and arms in cervical spine degeneration, and they can
impact the buttocks, thighs, legs and feet in lumbar spine degeneration. Spondylitis implies ankylosing spondylitis which can affect
almost anyone and tends to affect men more than women. Spondylosis symptoms usually begin after age of 50. The onset of
spondylitis, on the other hand, typically happens between the ages of 20 and 40 and when it reaches advanced stage the bones of the
spine may actually fuse, making movement difficult and very painful.

Cervical spondylosis
Cervical spondylosis is an age-related degeneration ('wear and tear') of the bones (vertebrae) and discs in the neck. To an
extent, all develop some degeneration in the vertebrae and discs as become older. It tends to start sometime after the age of about 30.
Cervical spondylosis is another name for osteoarthritis that exists in the joints of the vertebrae of the neck. This means that it
is a degenerative disease where surfaces of the bones have lost their cartilage lining in the cervical vertebrae. The seven
cervical vertebrae constitute the top portion of the spine which is the long and flexible column of bones that supports the skeleton and
protects the spinal cord. Flat, circular pads of cartilage known as intervertebral disks serve as cushions between the vertebrae and
allow for smooth movement. In spondylosis, rupture of a disk, or overgrowth of the vertebrae or the ligaments that support the spine,
or a combination of these may cause to compress the spinal cord or the nerves passing through it create pain apart from symptoms
pertaining to spondylosis. This disease is common among those of middle aged and older people but many cases are mild and respond
well to self-treatment of spondylosis. If there is inflammation of the joint associated with this degeneration, it is termed as
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spondylitis where as spondylitis describes general dysfunction of the vertebrae. This is usually caused by the wear and tear due
to old age, is often related to osteoarthritis, and is more commonly seen in the neck and may occur in any region of the spine.
One feature of the degeneration is that the edges of the vertebrae often develop small, rough areas of bone called osteophytes.
More over many years, passed by, the discs become thinner. This degeneration is a normal ageing process which can be likened to
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having 'wrinkles in the spine'. In many people, the degeneration does not cause any symptoms.
Neglecting the pain could lead to a slipped disc, which is a far more painful condition. "One of the first warning signs of
cervical spondylosis is pain in the neck and shoulders, which may lead to excruciating pain shooting down the arms if it is unchecked,

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it could hamper abilities of body's coordination and make it hard to perform simple, day-to-day activities such as buttoning a shirt or
brushing hair or teeth."
The most common symptom of spondylolisthesis is lower back pain. It can cause pain and radiate to the arms or legs,
stiffness in the muscles surrounding outer of place of vertebra is also common, and may experience neurological symptoms, such as
numbness and weakness, in extreme aggravated conditions. However, certain sports, such as football, gymnastics, and weight lifting,
are more prone to cause this particular condition because these activities require repeated hyperextension of the spine. Occasionally
headaches may also occur, which usually start at the back of the head, just above the neck, and pass over the top to the forehead.

Cervical spondylosis causes and risk factors

Cervical spondylosis [8] often develops as a result of changes in the neck joints as age advances at about age of 40, as a result
of which spinal disks can become dry and commences to shrink reducing the cushion between them duly developing cracks as well as
bones spurs additional growth in bones of the neck region and the ligaments connecting the bones turns to stiff. At this stage shrinked
disks and bone spurs can put more pressure on the spinal cord and nerve roots, resulting joint pains and difficult to move the neck.
Bones and ligaments get thicker, intruding on the space of the spinal canal. Another cause may be a old injury to the neck and poor
posture. This can affect not the arms, but also the legs.

Other factors affecting cervical spondylosis

By holding neck position uncomfortably for lengthy periods or repeating the same neck movements. People who are very
active at work or in sports and certain long term activities, such as carrying axial loads, professional dancing and gymnastics and
participation of martial arts for many years are more prone to get cervical spondylosis. By attaining the age of 60, majority of persons
face signs of cervical spondylosis as seen on x-ray observations. Being overweight and not exercising properly quicken this disease.
Over load activities that requires heavy lifting or a lot of bending and twisting, put extra strain on the neck. One more cause is long
ago spine surgery, ruptured or slipped disk, severe arthritis and petty fractures to the spine due to osteoporosis.

Symptoms
A symptom [9] is something the patient himself feels and reports, while a sign is an unknown thing that other people or the
health provider detect. To cite an example pains are symptoms while rashes are signs. Most people with cervical spondylosis don’t
poses symptoms and if occur, they may be from mild to severe and may develop either progressive regularly or erupt suddenly. One
common symptom is pain around the shoulder blade, along the arm and in the fingers. The pain may improve on standing, sitting,
sneezing, coughing, or backward tilting of the neck. Another common symptom is muscle weakness which make it difficult task to
raise the arms or keep hold of the objects strongly. A stiff neck and pain that becomes worse. Headache that mostly originate in the
back of the head. Tingling or numbness that mainly affects shoulders and arms, although it can also occur in the legs. Symptoms that
include loss of control and loss of bladder or bowel control, abnormal reflexes. Inability to fully turn the head or bend the neck,
sometimes interfering with driving. Grinding noise or sensation when the neck is turned. Symptoms are severe in the morning and
again at the end of the day.
Symptoms of cervical spondylosis with myelopathy include tingling, numbness, weakness in the arms, hands, legs, or feet.
Lack of coordination and difficulty while walking and muscle spasms leading to sudden pain. The most common symptom of cervical
spondylosis is cervical radiculopathy [10, 11], which causes pain shooting down into one or both arms. The patient may feel the pain
over the shoulder blade or it may spread to the upper arm, forearm, or fingers and it may get violent after standing or sitting, at night,
when you sneeze, cough, or laugh and when bending the neck backwards or walk more than a few yards apart from weakness in
certain muscles.

Neck stiffness –
This is more common after a long period of inactivity which includes sleep also.

Other problems –
Coordination difficulties. Arms and legs may become feeble and lack of dexterity.

Affect of brain –
If blood vessels are pressed the blood supply to the brain may be affected slightly which in turn occurs dizziness, and even
blackouts. Dysphagia [12,13] is a sign of difficulty to swallow when the bones press against the oesophagus which is a rare symptom.

When to Seek Medical assistance from a doctor

If continuous neck pain does not respond to self-treatment, if pain is not healed with the prescribed medications and other
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conservative treatments and unable to start or stop urinating or numbness in the groin area indicate serious nerve dysfunction which
insists immediate need to consult a doctor. If weight loss or fever more than 1010 F is coupled with back or neck pain. Because the
diagnosis of spondylosis is made with images of X-ray, CT scan, or MRI scan, most of the people have already consult their doctor
with this diagnosis more than once. Therefore the valid reasons for re-evaluation by the health-care professional include the following.
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Diagnosis
The doctor will generally begin by asking the patients about symptoms of medical history following physical examination
mainly focusing on the neck, back and shoulders, bending tests and the strength of hands and arms, loss of sensation and walking test.
Predictive cervical compression test is performed by laterally bending the patient’s head and placing downward pressure on it. A
positive sign denotes that neck or shoulder pain exists on the side to which the head is laterally bent.
Lhermitte sign indicates feeling of electrical shock with neck flexion. Reduced range of motion of the neck is the most
frequent objective finding on physical examination [14-17]. MRI and CT scans are helpful for pain diagnosis but generally are not
certain and must be considered together with physical examinations and history.
Lumbar back pain is the result of spondylosis, but most common outcome is muscle strain. Apart from the above tests other
tests need to be done include imaging examinations [18,19] such as X - rays, computed tomography (CT), and magnetic resonance
imaging (MRI). In the MRI scans large magnets, radio waves, and a computer to exhibit the optimum clear images of the body are the
best helping aids to decide the specific type of disease.
This tests vividly show the bone spurs on vertebral bodies in the spine, thickening of facet joints (the joints that connect the
vertebrae to each other), and narrowing of the intervertebral disc spaces including the degree of disc herniation, the facet joints, the
nerves, as well as the ligaments in the spine and able to visualize the spine in greater detail and can diagnose correctly narrowing of
the spinal canal (spinal stenosis) if present. The main objective found in physical examination is to reduce the range of motion of the
neck.

Surgery
There is no treatment to end the process of gradual growth spondylosis, because it is a degenerative process. But the back
pain and neck pain which caused by spondylosis can be checked with proper treatment. Hence the treatment of spondylosis [20-26] is
akin to the treatment of back pain and neck pain. At present numerous types of treatments in practice such as medications, own-care,
performing exercises and physical therapy, adjunctive therapies like chiropractics and acupuncture, duly reducing with injections, and
surgery as far as possible. Spondylosis is a chronic condition which requires unending absolute care even though it is not progressive
in several cases. Any type of spinal cord compression could result in permanent functional disability.
The goal of surgery is to wipe out the source of pressure on the spinal cord as well as nerves. The surgery may also include
adding stabilization in the form of implants or through fusion of the vertebrae but it can be preferred only when there is a severe loss
of function of neck organs mainly loss of feeling and loss of function in the arms, legs, feet, or fingers. In advanced cases to relieve
pressure on the spinal nerves, surgery can be preferred. Surgery is necessary to remove overgrowth of bones in the vertebrae to avert
severe stiff joint movement. Exercise or physical therapy can render help a great deal in this context. Surgery is suggested for cervical
radiculopathy in patients who suffered from serious pain or weakness if no relief is found with conservative therapy. For cervical
spondylosis with myelopathy (CSM) [27] doctors option is to suggest operation therapy over conservative therapy for moderate-to-
severe myelopathy[28-33].
The surgeon can approach the cervical spine from the front (anterior) or the back (posterior). Approaching from the front
might be used to remove the discs and spurs that are causing pressure. The disc may be replaced with an implant. A more extensive
surgery may be necessary for the removal of both discs and parts of the vertebra which are to be replaced with a bone graft or implant.
Numerous surgical procedures have been evolved to cure the signs and symptoms crept in with spondylosis. The vertebral
column can be operated by the surgeon from the front, side, or rear positions. Osteophytes and sometimes parts of intervertebral discs
are generally removed through surgery to relieve pressure on the adjacent nerve roots or the spinal cord. Surgery is rarely necessary to
the patients with acute back pain, unless progressive neurologic problems develop as most patients improve dramatically after
treatment with medications and physical therapy with in brief period soon after back pain starts.
The operation is executed through a small, minimally invasive, incision by using appropriate suitable microscope
where in structures are lucidly magnified for clear view and enable to operate without any flaw to avoid tissue damage.
Surgery is sometimes performed for acute sciatica, if nerve problems such as weakness and numbness are severe and worsens rather
than improve, causing neurological problems.
Spinal decompression surgery procedures are performed to relieve pressure on the nerves in the back due to spinal stenosis,
herniated intervertebral discs, or foraminal stenosis to narrow openings between the facet joints due to bone spurs. Fusion of the
vertebrae is sometimes combined with one or more of these procedures in order to stabilize the spine. Various common techniques for
decompression are briefly explained below.1. Laminectomy is a procedure to take away the bony arches of the spinal canal (lamina)
subsequently increasing the size of the spinal canal and decreasing pressure on the spinal cord. 2. Discectomy is a procedure to
remove a portion of an intervertebral disc that is exerting pressure on a nerve root or the spinal canal. 3. Foraminotomy is a procedure
to open out (enlarge) the openings for the nerve roots to exit the spinal canal.4. Osteophyte removal is a procedure to get rid of the
bone spurs from an area where they are causing pinched nerves. 5. Corpectomy is a procedure to take off a vertebral body and discs.
In a laminectomy surgery the rear parts of the vertebrae in the neck, the lamina and spinous processes are removed. In this type of
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surgery the vertebra is cut to free along one side. Both procedures relieve pressure on the spinal cord or nerves. Surgery is normally
followed by suitable rehabilitation programs. In addition to treatment options, there is need to follow appropriate changes in the
lifestyle to enable, to live with relief even if arthritis exists.
Disc replacement is a relatively new operation where the degenerated and comp ressed disc is removed duly
replacing by an artificial disk which consists more elasticity and allow better movement. Even then, surgery for patients with
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chronic low back pain is controversial, since certain examinations prove improvement in pain and disability, but majority studies do

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not show improvement when compared with nonsurgical treatment like physical and pain therapy management. Close observations
evidently prove that numerous patients still persist chronic back pain after successful surgery.

Treatment
Reduction of pain and restoration of normal function are the main objectives of treatment [34 -37]. To reduce the
pain of inflammation, anti-inflammatory drugs (non-steroidal anti-inflammatory drugs ) are prescribed for brief spells which
should never be taken without medical consultations. Treatment is usually conservative in nature. Patient education on lifestyle
modifications and (NSAIDs) and physical therapy is brought forward to manage spondylosis symptoms apart from substitute therapies
such as massage, chiropractic, trigger-point therapy. Yoga and acupuncture therapy may be suggested.

Available conservative cervical spondylosis treatments are

 Absolute rest is direly needed.
 To get relief from pain due to inflammation, non-steroidal anti-inflammatory drugs (NSAIDs) or other non-narcotic products,
Chiropractic therapy can be used to manage episodes of acute pain.
 Wearing a cervical collar aid to support at the neck for limiting movement of the neck. Some other varieties of physical therapies
namely, the application of heat and cold therapy, traction, and execution of apt exercises need to be followed.
 Mild cases of cervical spondylosis may resolve on their own due to short period of rest and immobilization of the neck by
wearing brace aid to the neck may help in recovery.
 Traction therapy may be required if pain persists which can be taken up and continued at home if congenial in respect of
outpatients.
 Over-the-counter analgesic medicines can be used for minor pain and with regard to severe cases prescribed painkillers, muscle
relaxants or tranquilizers ensuring relief may be used.
 Non-steroidal anti-inflammatory drugs (NSAIDS) can also be utilised to relieve inflammation and pain. Injecting drugs
(corticosteroids and a local anaesthetic) into the joints of the spine or the area surrounding the spine.
 It is often put forth certain argument that the cause of spondylosis is simply old age, and that posture modification treatment is
often practiced. Understanding anatomy of the body particularly the neck is the key factor for conservative management of
spondylosis.

Spondylosis Medications
No medication is available to reverse the degenerative process of spondylosis successfully. Treatment of pain for spondylosis
commonly includes anti-inflammatory medications, pain medicines like analgesics and muscle relaxants [38]. Nonsteroidal anti-
inflammatory medications (NSAIDs) namely Ibuprofen (Advil, Motrin) and Naproxen (Aleve) which are available over the counter
are very effective to relieve back and neck pain due to spondylosis. Muscle relaxants like Cyclobenzaprine (Flexeril) and Tizanidine
(Zanaflex) [39] can relieve the muscle spasm connected with spondylosis. Analgesics (pain medications), such as
Acetaminophen (Tylenol) and Tramadol (Ultram) can be used to get relief from pain and in case of extremely acute pain a narcotic
medication such as Norco, Vicodin or others are suggested for a short period. Fish oil is known to be anti-inflammatory agent and
studies show that it may reduce back and neck pain symptoms. Certain anti-depressants are helpful in treating chronic back pain.
Medications like tricyclic anti-depressants, including Amitriptyline (Elavil) and Doxepin (Sinequan) and Duloxetine (Cymbalta) have
been used in small doses, to relieve chronic back pain, neck pain, and other pains. Some people find topical medications, which are
massaged directly onto the location of the pain, helpful in relieving pain from spondylosis namely aspercreme and capsaicin cream are
anti-inflammatory and act as helping aids to reduce inflammation.

Injections for spondylosis

Steroids may be injected into the facet joints which connect the vertebrae, trigger points in the soft tissue, or directly into the
intervertebral disc spaces to manage acute radicular pain which radiates into a limb. Steroids (cortisone) as an epidural injection can
be injected into the epidural space which is the space surrounding the spinal cord.
Other injection procedures for back and neck pain such as intradiscal injections (cortisone injection directly into an
intervertebral disc), trigger point injections of steroid, anaesthetic, or both, facet joint steroid injection, steroid injection into the
sacroiliac joints and also steroid injection into the piriformis muscle for piriformis syndrome; Radiofrequency denervation (destruction
of painful nerves using a radiofrequency current) are also in practice at present.

Exercises, physical therapy, and additional therapies

While there is no cure for cervical spondylosis, it is possible to use various treatment options, as detailed below to reduce the
pain caused by this condition. Exercise increases blood flow to the muscles, which supplies healing nutrients like oxygen which
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protects the function of the spine and related muscles and improves the release of endorphins which is a substance produced in the
brain causing reduction of pain. People consists of degenerative disc disease ought to do moderate exercises not less than 30 minutes
daily including low impact strength gaining activities like mild activity exercises such as walking, biking, and swimming.
Physical therapy may be effective for restoring a range of motion, flexibility, and strength. Decompressive therapies namely
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manual mobilization, mechanical traction may also help to eliminate pain yet physical therapy and chiropractic cannot cure the
degeneration of spine and disks. Regular exercising on a regular basis, mainly walking and yoga, have proved to be beneficial for
chronic back pain.

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Acupuncture for back pain involves inserting very thin needles at various depths into specified affected areas in the body.
The needle placement is designed to balance the chi (or qi) which is thought to flow on meridians throughout the body. Studies of
acupuncture for back and neck pain have mixed results.

Spondylosis exercises
Spondylosis treatment usually commences with a conservative steps since an individual with spondylosis is basically
experiencing the aches and pains due to old age factor.
Better relief from spondylosis symptoms through massage, yoga, herbal treatments, acupuncture and other prescribed holistic
procedures. Low-impact exercises such as walking, swimming, aerobics and light weight training can be effective physical treatments
to be followed in consultation with a physical therapist to get relief from spondylosis. These exercises strengthen the small muscles
combined with the spine to provide better structural support to the vertebrae to improve flexibility of the spine particularly in the
cervical and lumbar regions and to improve cardiovascular health to ensure proper blood flow throughout the spine. Spondylosis
exercises can be an effective conservative method of treatment for degenerative spine problems but excessive exercise or the wrong
performance can become the neck or back pain more violent. This is an effective measure to manage the symptoms of stiffness and
nerve compression associated with degenerative spine conditions. If conservative treatments such as exercise, pain
medication, physical therapy, or behavior changes yield no relief form spondylosis pain, after lapse of prolonged period, steps to
be taken for other suitable surgical treatment. By practicing good posture of body, a patient can maintain proper alignment of the spine
and ensure even distribution of the body’s weight properly, which reduce pressure on the spinal parts and can delay the need for
spondylosis treatment. In the event of conservative or alternative treatments fail to mitigate symptoms after several months, surgical
spondylosis treatment may become an option worth to be considered.

Alternative spondylosis treatments [40]

Acupuncture:
This practice involves the insertion of very thin needles into various strategic points on the body which reduces stress and
enhances the body’s natural healing process leads to symptom relief.

Restorative gentle form of yoga:

It is designed specifically to reduce stress and rehabilitate injuries by performing a series of simple prescribed yoga poses, a
patient can achieve relaxation and symptom relief.

Chiropractic adjustment:
It can be done to misaligned spinal vertebrae which exerts pressure on sensitive neural tissues helps to reduce inflammation
and improve joint function.

Conservative spondylosis treatments:

Conservative course of treatment include a combination of narcotic pain medication. Non-steroidal anti-inflammatory drugs
(NSAIDs), Thermotherapy, cryotherapy, posture modification, physical therapy, lifestyle modification. Losing weight, limiting or
eliminating alcohol and tobacco use etc. In most cases, the discomfort that results from spinal degeneration can be managed with
conservative spondylosis treatments. The goal of conservative spondylosis treatment is to achieve symptom relief non-surgically
through one or more of the following methods.

Limited rest:
In severe cases, a patient may benefit from a brief period of rest, but any inactivity or rest should be limited to a maximum of
one to three days since lengthy period of bed rest can enhance risk of the patient resulting to develop deep vein thrombosis which is a
form of blood clots in the legs. Simple physical activity is a must since it enable the movement of fluids around the spine.

Physical therapy:
The main goal of physical therapy as a spondylosis treatment is to increase the flexibility and endurance of the core muscles
that support the spine, particularly those surrounding the area of degeneration. Molded cervical pillows can better align the spine
during sleep and provide symptomatic relief for some patients. Immobilization curtails motion of the neck, thereby reducing nerve
irritation. Soft cervical collars are recommended for use especially in day time.

Mechanical traction:
It is a widely used technique. This form of treatment may be useful because it promotes immobilization of the cervical region
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and widens the foraminal openings.

The use of cervical exercises has been advocated in patients with cervical spondylosis which are beneficial to maintain the
strength of the neck muscles. Neck and upper back stretching exercises, as well as light aerobic activities, also are helpful.

Manual therapy:
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In this technique massage, mobilization, and manipulation, may provide further relief for patients with cervical spondylosis.
Manual traction may be better than mechanical traction in some patients.

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Heat therapy:
This easily available no cost treatment which can be treated at home, not only provide comfort and facilitates relaxation, but
also help to reduce back pain and the blood vessels in the muscles surrounding the spine will become dilated, and increase the flow of
oxygen and nutrients which enables healing of damaged tissue.

Cold therapy:
In this technique treatment can be taken up by using a variety of tools, like reusable cold packs, instant disposable ice packs,
a plastic baggie filled with ice and wrapped in a towel, a frozen towel or sponge for effective relief of pain by applying to painful areas
several times a day up to 20 minutes for each time.

Medications:
Over-the-counter prescription medications, such as non-steroidal anti-inflammatory drugs like Ibuprofen and Naproxen, and
pain relievers like Acetaminophen, can reduce inflammation and discomfort around degenerated area of the spine.

Therapeutic exercises:
Physical activity aid the patient to maintain a healthy weight, which reduces stress on the spinal cord causing pain relief apart
from strengthen the core muscles that support the spine.

Lifestyle modifications:
Good health habits and discarding smoking and drinking habits paves way to enhance spinal health conditions.

Epidural steroid injections:

If severe symptoms do not respond adequately to conservative treatments of spondylosis, a physician takes up a series of
epidural steroid injections to get relief from pain and inflammation.

Recreational therapy:
It renders assistance to the patient to maintain physical strength, social skills, motivation and increase individual self-
confidence, provide community integration and independence duly adjusting to the disability to face and curtails existing behavioral ill
habits which adversely affects spinal cord and discs degeneration act. Life style modifications may involve an evaluation of work
place ergonomics, postural training, neck-school therapy, stress management and vocational assistance.

Cervical retraction exercise:

The patient is instructed to move the head backward slowly over the spine as far as possible with the head and eyes remaining
even level.

Cervical extension exercise:

The patient is instructed to retract the cervical spine, lift the chin up, and extend the cervical spine to the end range. The
patient then is instructed to perform 2 to 3 small right to left oscillations of the head. The patient then will return the head to the
midline position, tuck the chin, and take back to the retracted position.

Deep neck flexor exercise:

The patient is instructed to slowly nod the head and flatten the curve of the neck without pushing the head back to ensure
minimal activation of sternocle idomastoid muscle during the deep neck flexor contraction.

Scapular Strengthening Exercises:

These are good aids to relieve from neck, back pain and inflammation due to spondylosis. Thermal therapy shows
symptomatic relief only and ultrasound appears more invasive treatments such as epidurals may be of benefit in a selected group of
patients.

Adverse effects due to unusual work activity:

Cervical spondylosis is often found among people who carry heavy loads on their head or shoulders. Another major ground
attributes to heavy work that keeps abnormal pressure on the neck area, such as lifting heavy loads, performance of gymnastics certain
yogic asanas which negatively affect the neck components. Other important factor is executing work that needs to work in one side
bending position for lengthy periods without movement to second side. Also all such activities like improper sleeping positions, use
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of very soft sleeping mattresses and pillow, watching the TV seated at an odd position which puts pressure on the neck, sleeping in
sitting position while travelling for long distances and working with the phones for long time, forward bending and rotation of the
neck, prolonged extension of the neck, prolonged sitting for long time or standing, and selecting improper chair to sit and forced the
neck to bend putting pressure over the neck attract cervical spondylosis.
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Self-care at home for spondylosis [41]:

Physical therapy may be effective for restoring range of motion, flexibility, and core strengthening. Decompressive therapies
such as manual mobilization, mechanical traction may also help alleviate pain. Some people view that strong compliance with postural
modification is necessary to realize maximum benefit from decompression, adjustments, and flexibility rehabilitation.
Home treatment is important owing to pain caused by spondylosis because pain may frequently improve or resolve after
several days. Experts have found that bed rest prolongs the time to recovery. Therefore, it is suggested to continue normal or near
normal activities. However, nothing to be done anything that could exacerbate the problem, such as heavy lifting. Some people find
heat or ice to be helpful for back and neck pain caused by spondylosis. Sleeping with a pillow between their legs may be helpful for
low back pain. Special pillows to offer additional cervical spine support have been developed for neck pain can be used observing the
relief.

PREVENTION
Excessive mental, emotional and physical stress may land in worst stage of symptoms of cervical Spondylosis. Stress causes
headache and worsens neck pain and stiffness. The onset of cervical spondylosis can be slowed down by doing the following
 Specific exercises to the effected joints to ensure that transmissi on of weight them to be more balanced.
 Ensuring that the joints in the neck are not subjected to repetitive and continuous strain and stress but with frequent
breaks.
 There are some medicines which will make the cartilage lining stronger but such medicines render no help in advanced
disease when there is no cartilage exists to strengthen it.
 Intake of a balanced diet, in terms of the calorific and protein intake, and one which provides anti -oxidants (vitamins and
minerals) in sufficient quantity always good to keep the spine straight while sitting or standing and reduce tension by
practicing pranayam as well as meditation.
 It is always prohibitable to do forward bending exercise and jogging, running, jerking vigorously, carrying heavy bags and lifting
heavy weights. Soft chair, bed should be avoided. Don’t take pain killers too much for a prolonged period which causes stomach
ulcers.
The following easy yoga asanas and simple exercises can play a vital role in managing and treating of cervical spondylosis
and neck pain. Because there are certain yoga poses and postures that can help strengthen the back muscles, which in turn increase
their flexibility. Most of the cervical spondylosis yoga exercises increase traction naturally, which reduces the compression in the
nerve root. Some of the most common poses that can be included in yoga for cervical spondylosis in routine are:
Surya Namaskar (Sun Salutation): Matsyasana (Fish Pose): Bhujangasana (Cobra Pose): Makarasana (Crocodile Pose) Bal-
Shayanasana (Infant’s Pose): Ardha Naukasana (Half Boat Pose): Ardha Salbhaasana: (Half Locust Pose): Shanshank-Bhujangasana
(Striking Cobra Pose): Kohni Chalana (Elbow Rotations).

Dietary tips to get relief from cervical spondylosis:

In addition to physical exercise, meditation and yoga diet plays a prominent role in diminishing the problems of cervical
spondylosis. It is suggested that four small meals at appointed timings in a day which contains salad of steamed vegetables, raw
vegetables, sprouts and the nuts, dry fruits in addition to vitamin D, vitamin C, phosphorus, calcium and proteins. Taking lemon juice
mixed with little salt at least 2-3 times a day provide immune to the body organs. Daily consumption of 2 cloves of garlic in the
morning decreases the problem of cervical spondylosis.

Fruits and vegetables:

Fruits and vegetables containing vitamins C and A fight against free radicals responsible for inflammation and help to reduce
painful swelling around the neck.
Fish, some kinds of nuts such as almonds, pista and oil seeds are rich sources of omega 3 fatty acids and vitamin E acting
against inflammation. Apple, garlic, ginger and turmeric are also anti-inflammatory. Avoid red meat and coffee as it increase acid load
in the body. Including fruit juice and vegetarian soup in the routine diet is necessary. Monounsaturated fatty acid diet helps to reduce
inflammation. Adding more bitter vegetables like bitter gourd and drum stick in the routine food is ideal.
Meat is a rich source of sulphur which can change the pH of blood. Meat has more amount of acid load due to the rich
sulphur content which increases the acidity of the blood leading to the demineralization of bones.
As age advances the digestion of milk becomes more difficult due to decreased gastric acid and enzyme content. The
maldigestion of milk not only gives gastrointestinal discomfort but also gives an increased acid burden to the body which leads to joint
pains and aggravation of arthritis. Therefore prefer vegetarian sources of calcium like almonds, pulses, sesame flex seed and
sunflower seeds, soya beans and its products and leafy vegetables containing calcium and other minerals and vitamins.
Fried foods, spicy, oily foods, excessive meats and refined foods like sweets, confectionery, bread and other refined wheat
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products are the main incriminating factors in joint diseases. This kind of food leads to excess acid load in the blood so that the
kidneys are unable to cope up with the constipation which also initiates the formation of toxins in the gut, which get absorbed into the
blood and increase its acidity. This too, contributes along with other factors in the development of cervical spondylosis and bone
demineralisation.
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A vegetarian diet, which is rich in fibre in the uncooked form, contains a lot of vitamins and minerals proves very beneficial
as it prevents constipation, removes toxic matter from the gastrointestinal tract, thereby preventing increased acidity of the blood. The
increased amounts of minerals and vitamins in vegetarian foods including leafy curries contribute richly to the smooth functioning of
bone metabolism. Excessive sour foods whether vegetarian or non-vegetarian are detrimental to bone, cartilage and joints.

CONCLUSION
The number of people with the complaints of neck and shoulder pain termed as cervical spondylosis has been mounting
significantly day by day. Now a days over tired work culture coupled with hectic schedule of continuous programmes enforced
excessive sitting hours in a particular posture at various offices and business fields badly affected mentally, physically, emotionally
and socially which leads to develop mild or severe neck, shoulder and cervical problems. In cervical spondylosis there may be
abnormal growths or "spurs" on the bones of the spine (vertebrae). In advanced cases, the spinal cord becomes involved which can
affect not just the arms, but the legs as well. Analysis of the available data shows that rich vegetarian diet prevent the progression of
neck and shoulder pain and the demineralization of bones due to its high fibre, vitamins and minerals and low acid content which
minimize cervical spondylosis problem. Avoiding smoking, maintaining a healthy weight through good nutrition and exercise, staying
well hydrated, and reducing alcohol consumption all can contribute to get back good health and quick healing of this disease.
Conservative treatments are also highly potent and effective and can be successfully managed and reduce these problems. One of the
most important factor for maintaining healthy functioning of the neck is to accustom to a good healthy lifestyle that do not disturb
natural bodily mechanics and its rhythms. The patients suffering from chronic cervical spondylosis approaching doctors for a
permanent solution, has become a vain effort as there is no permanent solution. In final, when enquired in to numerous patients
personally by the author they confirmatively informed that, they got good relief to some extent from homeopathy medications.

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