Diseases and Conditions » Cervical Spondylitis

Cervical Spondylosis is a condition of degeneration of the inter-vertebral disks, which advances with advancing age and which, in course of time, also involves the adjacent vertebrae and the para-vertebral structures.The elasticity of the inter-vertebral disks is lost and it predisposes the disks to injury and tear. It also leads to inflammatory changes which in turn brings about calcification (deposition of calcium) leading to extra bone formations called osteophytes in the adjoining structures.

Spondylosis is a specific form of arthritis, which attacks vertebrae and connecting bone, and ligament structures. The spines of majority of people above the age of 50 have certain degree of osteo arthritic changes. But they seldom cause acute symptoms. Certain precipitating factors like trauma, incorrect posture of the body, pressure while sleeping and excessive intake of sour food usually precipitate spondylitis attacks. In ayurveda this condition is known as Griva Sandhigata Vata.

What are the commonly encountered problems relating to the cervical spondylosis?

Pain in the back of neck, shoulder and arms,hands, back of the scalp, numbness in the hands,lack of sensation in certain areas of the hands, difficulty and restriction in the movement of the neck,Head ache localized at the back of the head & giddiness on jerky neck movements,stiffness of the neck and even paraplegia occur due to spondylitis condition. The movement of the spine generally aggravates the pain of the neck. It is often associated with loss of memory and sleeplessness.

What are these caused due to?

• Pain in the neck region can be caused by a variety of reasons. Different centres in and around the cervical vertebrae are sensitive to pain and problems connected with any of these regions can cause pain. The Periosteum ( The outer layer of the cervical vertebrae ), The anterior and posterior ligaments ( the ligaments which run along the vertebrae and stabilize them ), The facet joints ( the joint formed between the sideward protrusions of the vertebrae ) The para-vertebral muscles are all pain sensitive and any lesions to the above structures are capable of producing pain.
• Pain, numbness and lack of sensation in the other areas are produced by problems effecting the nerves that emerge from the cervical region. By far, the most common cause of neck pain is the spasm of the para-vertebral muscles of the neck.
• The main causes of these problems are 1) Spondylosis, 2) Herniated inter-vertebral disks, 3) Fibro-myalgia and myo-fascial pain syndromes. Though the three refer to three different entities, they are interrelated and often super-imposed.

What is Herniated inter-vertebral disk?

The inter-vertebral disks are made-up of two concentric layers, the inner gel like Annulus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus looses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as Dehydration of the disk. The disk then is highly vulnerable to tears and as these occur, the inner annulus pulposus protrudes through the fibrous layer, producing a bulge in the inter-vertebral disk. This condition is named as herniated disk. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems.

What is fibromyalgia and myo-fascial pain syndrome?

These are conditions characterized by pain in the muscles following severe spasm associated with morning stiffness, disturbed sleep, a feeling of swelling and have clear trigger points. These points are tender and when palpated produce the typical pain.

Symptoms of Cervical Spondylosis

• neck pain (may radiate to the arms or shoulder)
• loss of sensation or abnormal sensations of the shoulders, arms, or legs
• weakness of the arms or legs
• neck stiffness that progressively become worse
• loss of balance
• headaches, particularly in the back of the head ,Muscle spasms
• loss of control of the bladder or bowels (if spinal cord is compressed)
• You may feel or hear grinding or popping in the neck when you move.
• permanent disability (occasional)
• General tiredness and anxiety - can be present.

Cervical spondylosis vs Ankylosing spondylosis

Even though ankylosing spondylitis and cervical spondylitis sound similar, they are different. Spondylitis is a term relating to "wear and tear" and is more common with the people of older age .Ankylosing spondylosis relates to an inflammatory condition in which new bone is produced and then leads to fusion. The vigorous exercise therapy suggested for people with ankylosing spondylosis might be harmful to those suffering from spondylitis.

Does Cervical Spondylosis affect other organs

Consequences

Increasing neck pain is a key indication of cervical spondylosis. It may be the only symptom in many cases. Examination shows that ability to flex the head to the side and to rotate the head becomes limited.Weakness or sensation losses indicate damage to specific nerve roots or to the spinal cord.

The condition gradually progresses with age and the patients develop diminition in the range of movement in all directions apart from Myelopathy (Degeneration of the myelin sheath of the nerves) leading to weakness, atrophy, difficulty in using the small muscles of the hands and sensory loss in the extremities. Herniated cervical disk:- Herniation of the cervical disk produces problems according to the site of herniation and if the bulge is central it can lead to compression of the spinal cord leading to de-myalination and to myelopathy charecterised by a feeling of chillness, loss of bladder and bowel control and generalized lack of strength of the muscles in the region below the site of lesion.. If lateral, it may compress the emerging spinal nerve roots and produce symptoms like pain, numbness, loss of sensation and reduction in reflexes in the areas innervated. Fibromyalgia:- This condition only produces the immediate symptoms and does not lead to other long-term complications. It only predisposes the patient to injury.

Complications involved in Cervical spondylosis are

• chronicneck pain
• progressive loss of muscle function or feeling
• inability to retain feces (fecal incontinence) or urine (urinary incontinence)
• Loss of bladder and bowel control in extremely severe cases, if the spinal cord is affected, there will be loss of balance and also loss of bladder and bowel control.
• Muscle weakness the muscles responsible for maintaining the neck in erect position can become weak.
• Sensory loss the bone of the neck applies pressure over the nerves passing through them and can causes loss of sensation in the arm or fingers.

What are the current approaches to treatment of these conditions in modern medicine?

Fibromyalgia: - Treatment is often difficult and frustrating. In some patients’ mild analgesic drugs, heat and massage yield temporary relief. In patients with trigger points, massage or local injection with local anesthetics may give relief. For some patients combination of the above with treatment of associated psychological disorders is necessary for long-term relief.

Herniated cervical disk: - Though the management of herniated disk is controversial, the first step is bed rest. For those not responding to rest, surgical removal of the bulging disk followed by fusion of the vertebrae is the only option in modern medicine.

Cervical spondylosis: - Conservative management comprises of bed rest, cervical traction and use of cervical soft collar. If patients develop progressive neurological deficit, surgical removal of the disk with spinal fusion is the only option in conventional medicine.

What are the long terms consequences of the above therapeutic approaches? There is no known medical treatment in modern medicine and the long term success of the conventional therapy is highly limited. Surgery offers moderate relief but is associated with the risks of a major surgery involving delicate structures and vital parts. Apart from the same, it leads to restricted mobility.

Do other systems of medicine offer better modes of treatment?

Yes. Ayurveda offers a unique concept in the management of problems of the cervical region. It offers comprehensive solutions to the problem in all stages.

How does Ayurveda interpret these conditions?

Ayurveda understands the functioning of the body as comprising of three basic functions, Movement, Change and growth & stability, which are referred to as the three doshas Vata, Pitta & Kapha. These functions in a state of equilibrium lead to health and in-equilibrium to diseases. The disturbance to any one of these ultimately leads to problems related to all the three functions. Treatment in Ayurveda is aimed at restoring the equilibrium through correction of the underlying functional in-equilibrium. Treatment comprises of three approaches, Elimination (Sodhanam) of the accumulated toxic products of digestion, metabolism and the disease process, Pacification (Samanam) and correction of the entities responsible for altered functioning and Rasayanam (Rejuvenation) of the bodily tissue to regain and maintain natural strength and vitality. Vata, the principle of movement is the predominant function with the skeleto-muscular system and the nervous system. Problems relating to these systems are predominantly caused by vitiated Vata. The vitiation of vata is caused by two mechanisms. One of them is obstruction to vata due to malfunctioning of kapha and pitta. The other one is increase of vata independently as in the case of the degenerative problems.

The therapeutic approach to the two types of vitiation is different. If Vata’s functions are deranged due to Kapha and Pitta, as in the case of inflammation, correcting them through elimination and pacification is the method to be adopted. For diseases due to Vata alone (the degenerative disorders), the concept is to use medications which arrest the degenerative processes. While fibromyalgia is a condition where Vata is deranged due to Pitta and Kapha, the other two problems are due to Vata alone. The treatment of cervical spondylosis and herniated disk comprises of use of medications to arrest the degenerative process.

Natural Herbal treatment for Cervical Spondylosis

In Cervical Spondylosis,Any external massage is not of much use. Violent massage with deep pressure is very harmful for the spondylitis patient. Only gentle massage over the muscles of the neck and shoulder joints should be applied and for this purpose Mahanarayan taila is best suited. This gentle massage can be given 2-3 times a day .In winter season; this medicated oil should be gently warmed before application.Guggulu, gum resin extracted from the plant is the best medicine for the treatment of cervical spondylosis. Ayurvedic physicians for the treatment of this condition popularly use a compound preparation named as simhanada guggulu. It is given in a dose of 2-4 tablets, 4 times a day. Usually hot water or hot milk id given to the patient after the administration of this medicines. This medicine has slightly laxative effects. For the patient to recover from cervical ailments, it is necessary that this bowel should move clearly and regularly. This medicine is very much helpful for this purpose. For patients having clear motions, this medicine should be given in a dose of 2 tablets and constipated patients the dose should be 4 tablets. If the constipation is not relieved even by taking 4 tablets the dose can be further increased to 6 tablets.At night some medicines should be given to the patients, which will act as a purgative. Triphala powder is the best medicine for spondylitis.

One teaspoonful of triphala should be given to the patient, mixed with a cup of warm milk and one spoon of sugar. In the motions become regular by the intake of simbanada guggulu, then triphala powder should be given only twice a week otherwise it can be given every day.Hot fomentation on the vertebrae of the neck is very useful for cervical pains.In a big handkerchief about 500gms of salt should be kept over a frying pan till it becomes tolerably hot. Then this should be applied over the neck. Care should be taken to see that it should not be too hot. In that case, it may cause burns. Sometimes patients suffering from cervical Spondylosis develop some anesthetic patches in the back, neck, shoulders and arms because of the pressure from nervous systems .The patient is therefore not able to feel the quantum of heat applied during fomentation. It should therefore be the responsibility of the attendant to examine the heat of the bolus before applying it on the affected parts.

This fomentation should be continued about ½ an hour every day.After fomentation the affected part should not be exposed to cold wind. In winter season therefore immediately after fomentation, the affected part should be covered with some wool engarment. In other seasons also the affected part should be kept covered with some cotton garments after fomentation. It is very convenient to take the fomentation before bedtime. After the fomentation the patient should go to sleep so that he does not run the risk of exposure.DietSour things particularly curd, are strictly prohibited. Fried things, pulses and various preparations of pulses are also contra- indicated in this condition. Bitter vegetables like bitter variety of drumstick, neem flowers and bitter gourd are very useful. Wheat is better than rice for the patient.He should however, avoid taking refined wheat which is known as maida (flour) and suji (semolina). To some extent they are constipated and do not help the patient in the recovery.

LifestyleExposure to cold,cold bath and any violent exercise of the neck muscles, including pressure, are very bad for the patients of Cervical spondulosis. Under the impression that this pain is being caused by some defects in the muscles, people undertake different types of neck exercises .While reading and writing, one should maintain a comfortable posture. Morning walk gives some relief to the patient, but if it is cold outside the patient should always use a woolen scarf around his neck while going out of the house.