Degenerative Cervical Spondylosis: Natural History, Pathogenesis, and Current Management Strategies

Degenerative cervical spondylosis is a common, mostly asymptomatic condition, occurring as a result of age-related degenerative changes in the cervical spine. Symptoms caused by cervical spondylosis can be categorized broadly into three clinical syndromes: axial neck pain, cervical radiculopathy, and cervical myelopathy; with patients commonly having a combination of these syndromes. This special issue contains eleven papers summarizing our present knowledge and understanding of the natural history, pathogenesis, and current management strategies for degenerative cervical spondylosis. In the paper entitled " The natural history and clinical syndromes of degenerative cervical spondylosis, " J. C. Kelly et al. outline the three clinical syndromes of axial neck pain, cervical radiculopathy, and cervical myelopathy. Radio-graphic evidence of spondylotic changes is frequently found in many asymptomatic adults. The majority of symptomatic patients present between the ages of 40 and 60, with men more commonly affected than women at a ratio of 3 : 2. Disc degeneration and bulging, osteophyte and spur formation, ligamentous hypertrophy, vertebral subluxation, decreased disc height, and facet joint arthropathy may all contribute to narrowing of the spinal canal and interver-tebral foramina. Radiculopathy is a result of intervertebral foramina narrowing. Narrowing of the spinal canal results in spinal cord compression, ultimately resulting in cervical myelopathy. The course of disease development and the ultimate prognosis for patients with cervical spondylosis is highly variable and extremely difficult to predict. In the paper entitled " The natural history and clinical presentation of cervical spondylotic myelopathy, " C. K. Yarbrough et al. describe cervical spondylotic myelopathy as an impaired function of the spinal cord caused by degenerative changes of the cervical spine resulting in spinal cord compression. While many patients with mild signs of cervical spondylotic myelopathy will stabilize or improve over time with conservative management, the clinical course of a specific individual patient cannot be predicted. Asymp-tomatic patients with cervical stenosis and abnormalities on electrophysiologic studies may be at higher risk for developing myelopathy. L. A. Ferrara identifies aging as the major risk factor contributing to the onset of cervical spondylosis in the paper " The biomechanics of cervical spondylosis. " Several acute and chronic symptoms can occur that start with neck pain and may progress into cervical radiculopathy. Eventually, the degenerative cascade causes desiccation of the intervertebral disc resulting in height loss of the cervical spine. This causes ventral angulation and eventual loss of lordosis, with compression of the neural and vascular structures. …