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Orthopaedic Diseases

Cervical Spondylitis


A very common disorder, normally seen in the elderly from the age of 55 onwards, cervical spondylitis today is increasingly frequent in the younger age group from 35 to 45 years of age. There are several reasons for this. Before coming to the pathophysiology, let us understand the developmental concepts.



Causes

This is basically a mechanical disorder.

  • Very stiff muscles in the cervical region can, over the years, cause a kinking of the cervical spine to the front.
  • Bad posture and lack of exercise to the cervical region are the key factors which are responsible in a majority of the patients.
  • Lying in bed with several pillows propping up the neck into an unnatural position can affect the alignment of the cervical column, causing a forward inclination.
  • Reclining on sofas with the spine hunched and the neck pushed forward is bad for cervical alignment.
  • Hunching over the computer for many hours, occupational hazards such as those of a writer, an illustrator or a painter, all cause the spine to be bent forward all the time.
  • Positioning the body to the same side during sleep, with the shoulder muscles and the neck compressed, also develops faulty alignment in the cervical spine. In due course the spine is bent, the front surface of the bones and disc are excessively pressurised and damage occurs.
  • The so-called executive chairs are ill-designed and push the neck out of alignment. No chair should reach over the head. The level should be up to the shoulder blades so that the chest can stretch over the edge keeping the body upright.

In India, railway porters carry heavy loads on their heads but they do not suffer from cervical pain (as one would expect) from the heavy load they carry every day. Only in the group of people who never exercise their bodies does this occur most frequently.



Pathology

Essentially, the pathology consists of:

  1. Narrowing of the cervical vertebrae with disc space reduction.
  2. Friction between two vertebral bodies created by this narrowing, with an osteophyte (bony spur) formation.
  3. Loss of normal concavity in the cervical region, i.e., loss of lordosis.
  4. Symptoms of vascular insufficiency.
  5. Numbness and tingling sensation in the hands or feet due to the compression of the cervical nerve roots.

The problems of vascular insufficiency consist of vertigo, giddiness, occasional tinnitus (a ringing sensation in the inner ear), a sense of unsteadiness, etc. In a severe case, there is transient loss of consciousness. The vertebro-basilar vessels are important arteries coursing along the cervical column to the back of the brain There are areas here that subserve balance and posture. If the blood flow is affected, the corresponding function is also affected. As the anatomical arrangement is intricate, any movement in the neck affects the flow of blood in the arteries. This syndrome is known as vertebro-basilar -insufficiency.



Symptoms

The most common symptom is pain in the neck, worsening with exertion and relieved, in the early stages, by rest. This pain often radiates down to the hand, with the fingers becoming numb due to compression of the nerves that innervate the upper extremity. The brachial plexus is affected. The trapezius area becomes tender and painful. A nodule can form in the muscle due to chronic pressure. The symptoms of cervical cord compression can sometimes be severe. The pain radiates down the right or left arm to the fingers, to the chest and shoulder blades depending on which side the nerve root is involved. It can become continuous, making movements painful and limited. If the cervical vertebrae become unstable, the danger of cord compression is imminent and, in some cases, fusion of the bones may be warranted. But this is rare.



Medical management

Medical science accepts cervical spondylitis as a normal degenerative aging change. Painkillers are prescribed. In order to prevent the symptoms of vascular insufficiency, anti-platelet drugs are given to maintain cerebral blood flow. This makes the platelets less sticky, the blood thinner and helps better flow. But this is illogical. The essential change is of a mechanical nature. If the cervical spine could be realigned and the intervertebral spaces widened, a normal state of blood flow would be restored. Physiotherapy can, at best, only offer marginal relief. sometimes the condition may even be aggravated. It is better avoided.

In situations where the patient suffers acute giddiness, it is useful to restrict the movement of the neck with a soft collar. Sudden neck movements cause the spur to impinge on the cervical nerves and blood vessels and reduce the blood to the brain. This creates a situation where the patient, sometimes becomes afraid of moving the neck. In the long run, of course, a collar is to be avoided as it stiffens the neck muscles and pushes the neck out of alignment. The problem is worsened as, for health, the muscles and bones have to be aligned and stretched rather than made stiff.

Cervical traction, where the skull is lifted up, has its value in a few cases. But, in due course, the weight of the skull makes it settle down on the cervical column and the symptoms recur. Though, obviously, the osteo-phytes cannot be removed, one can adjust and realign the spine so that compression of the vertebral arteries and cervical nerves does not occur.



Yogic management

All patients with cervical spondylitis have stiff neck and trapezius muscles and are unable to stretch the neck backward. This is an inherent problem and not a muscle spasm. As the anterior surfaces of the vertebrae are compressed causing pain, spinal extension (stretching the spine backward) relieves the problem, though the movement might initially cause vertebro-basilar insufficiency in some cases. Vertebro-basilar insufficiency is prevented because of the resultant elasticity of the cervical muscles and vertebral arteries.

It is essential to make flexible the trapezius, cervical and shoulder muscles. Patients with cervical spondylitis cannot stretch the dorsal spine. Once this can be accomplished, cervical spondylitis ceases to be a problem as extension movements reduce pressure on the cervical nerves. Again, by regularly practising back bends, this disorder can be averted.

In yoga, the intervertebral spaces are widened by pulling the trapezius and other muscles downwards. This is yogic traction. This lengthens the trapezius for it is along the line of gravity . Very little is achieved by conventional traction, where the muscles will telescope into each other again.

There are various asanas which prevent and give relief to this problem — sarvangasana, halasana and back bends are significant. Standing poses help align the cervical and dorsal vertebrae. Inverted poses like head stand and shoulder stand strengthen the cervical muscles and shoulder area. But the technique used in these cases is quite different from the normal.



In head stand the forehead, and not the centre of the skull, is placed on the ground. This lengthens the cervical column and helps weight bearing. Hence the concept that persons with cervical ailments should avoid head stand is incorrect. The correct method should be learnt, taking the ailment into account. As the condition improves, normal practice methods can be introduced. Thus elasticity of the cervical muscles is ensured. Shoulder stand is done with the help of the chair. This releases tight trapezius muscles and frees all the structures along the cervical spine. If the normal method of shoulder stand is practised by the patient, injury can occur to the cervical spine. A rolled blanket may help the neck if stiffness is excessive.

In halasana, the cervical column is elongated and given strength and alignment. The dorsal spine is strengthened and made supple. In back bends like urdhva dhanurasana and viparita dandasana, maximum freedom is given to the anterior surfaces of the cervical column and the dorsal spine. Nerve compression is released. For a patient with cervical spondylitis these poses are modified. A simple exercise is to suspend the neck on the rope, This helps even aged persons get relief. This single position provides relief from the symptom of vertebro-basilar insufficiency as the spine is made to fall into the anatomical line and blood courses normally into the back of the brain. Belts are used to make the shoulder and cervical muscles supple in a passive manner. This relieves nerve root compression in certain areas.

Elasticity of the backward movements of the hands is very important. This releases compression of the cervical nerves. The hands are made to hold bars with the palms facing downwards This opens out the sternum and dorsal spine. If the dorsal spine is well elasticised, the symptoms are controlled.

Twisting asanas are very useful to loosen the dorsal and cervical spine. In many, the rotators of the spine are very stiff and the neck is hardly able to perform normal everyday functions. These asanas help relieve stiffness and pain, and make the rotators of the neck soft and supple. In summary, the entire cervical column is made mechanically sound, so that movements are free and the symptoms are relieved.

The specific asanas recommended for the treatment of cervical spondylitis are bharadvajasana on the stool, the double rope back bend, cervical extension with the rope, shoulder stand with the chair stretching the trapezius muscle towards the chair, holding the window grills behind the body, trapezius traction and strapping the hands behind the back. The last relieves pain in the trapezius, cervical and mid-dorsal muscles, regardless of whether the pain is a referred pain or a localised one. Later, as recovery occurs, all asanas can be done. Back bends are very useful along with hand and elbow stand in younger patients. Click here for some of the useful asanas.



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