Spondylosis with Generalized Degenerative Disk, Uncovertebral, and Facet Pain

Cervical spondylosis (CS) is a broad term referring to a common aging phenomenon due to degenerative osteoarthritis of the cervical spine. The majority of patients with CS are asymptomatic even with advanced changes seen on radiographs. Aging and trauma are the main risk factors for developing spondylosis, and no associations have been established with other conditions such as lifestyle, height, obesity, physical activity, smoking, and alcohol use. Pain derived from CS is usually responsive to activity modification including isometric exercises, cervical stabilization, and conservative management with medications. More severe neurologic symptoms are not typical and are seen more commonly in patients with congenital cervical spinal stenosis. Pain due to CS typically arises from cervical facet and uncovertebral joint hypertrophy, as well as disk space collapse. Patients typically complain of neck, occiput, or posterior shoulder pain. Lateral radiography is the initial diagnostic imaging of choice, and MRI can be useful for defining intra-articular effusions and defining abnormalities in the nerve roots and spinal cord. Physical therapy, oral analgesics, and facet injections are first-line treatments. Surgery is reserved for the rare patient with associated neurologic deficits.