Degenerative change
Very common
What it means
A general term for age-related wear in the discs and joints.
Significance
On its own, usually none. It is close to universal past middle age.
Cervical spondylosis: the wear and tear report on your neck
Spondylosis is the medical word for age-related change in the discs and joints of the neck. It appears on the scans of most people past middle age, including people who feel completely fine. It is better understood as something that happens to necks over time than as a disease you have caught.
What you need to know in 30 seconds
Spondylosis is age-related change, not an injury or an illness. Nearly everyone develops some of it eventually.
It shows up on scans of people with no symptoms. Disc bulging was present in 87.6 per cent of 1,211 symptom-free volunteers.
Most people with spondylosis on a report will never need treatment for it.
It matters when the changes start pressing on something: a nerve root, or the spinal cord.
The severity on a scan and the severity of your symptoms often do not match. Treatment follows symptoms, not pictures.
Staying active and strong is the single most useful thing most people with spondylosis can do.
Normal ageing
Spondylosis describes change that accumulates in every neck over time, not a disease process.
87.6%
Of symptom-free volunteers had disc bulging on MRI, and it became more common with age.
Mostly silent
The majority of people with these findings have no symptoms attributable to them.
Symptoms lead
What is treated is how you are affected, not how alarming the wording on the report sounds.
WHAT IT IS
Discs thin, joints wear, and bone responds
Over decades the discs lose water and height, the small joints at the back take more load, and the body lays down extra bone at the margins. That combination is what spondylosis means.
1
Healthy disc at its full height, cushioning the level
2
Worn disc, thinner and less able to absorb load
3
Bony spur formed at the margin as the body responds
01
The words sound worse than the situation
Degeneration, deterioration and degenerative disease are all standard radiology terms for ordinary ageing. They describe an appearance, not a prognosis. Most people reading these words about their own neck are considerably more alarmed than the findings warrant.
02
It becomes relevant when space runs out
Spondylosis matters when the accumulated change narrows the space around a nerve, causing radiculopathy, or around the spinal cord, causing myelopathy. Until that point it is usually a finding rather than a problem.
03
Scan severity and symptom severity diverge
People with dramatic-looking scans often have little trouble, and people with modest findings can be in real pain. That is why nobody should be offered an operation on the strength of a report alone, without an examination that matches it.
DECODING YOUR REPORT
What those phrases actually mean
These are the terms that appear most often on a cervical spine report, and what each one is describing.
Osteophyte
Very common
What it means
A bony spur formed at a joint or disc margin as the body responds to load.
Significance
Matters only if it is narrowing the space a nerve or the cord needs.
Disc desiccation
Very common
What it means
The disc has lost water content, so it appears darker on MRI and is often thinner.
Significance
A normal ageing appearance. It does not predict pain by itself.
Foraminal narrowing
Common
What it means
The small opening a nerve root exits through has become tighter.
Significance
Relevant if your symptoms follow that specific nerve. Otherwise often incidental.
If a report has worried you, that is a reasonable thing to bring to a consultation and have explained properly. A large part of a first appointment is often simply going through the imaging and separating the findings that explain your symptoms from the ones that are just your age.
WHEN TO GET IT LOOKED AT
The symptoms that make spondylosis worth assessing
Spondylosis on a report needs no action by itself. These developments do.
1
Pain travelling into an arm
Pain, tingling or numbness following a path down the arm suggests a nerve root has become involved.
2
Clumsy hands or poor balance
Fumbling buttons and keys, or feeling less steady walking, suggests the spinal cord may be affected.
3
Weakness rather than just pain
A muscle that is measurably weaker, particularly if it is getting worse, warrants assessment sooner.
4
Neck pain that is not improving
Pain that has not responded to several months of good non-surgical care is worth reviewing properly.
Seek urgent care
Sudden or rapidly worsening weakness, new clumsiness and unsteadiness in both hands, or any change in bladder or bowel control needs emergency assessment rather than a routine appointment. Call 000 or go to your nearest emergency department. GPs with an urgent concern can phone the rooms directly on (07) 3870 3708.
WHY IT HAPPENS
Mostly time, with a few things that speed it up
01
Age
The dominant factor by a wide margin. Discs lose water and height from early adulthood onward, and the joints adapt to the changing load.
02
Genetics
How quickly discs degenerate runs in families to a meaningful degree. Some people simply show change earlier than others at the same age.
03
Smoking
Smoking is associated with faster disc degeneration, and it also reduces the success rate of spinal fusion if surgery is ever needed.
04
Load and past injury
Heavy repetitive loading, sustained awkward positions and previous neck injury can all bring changes forward.
HOW IT IS ASSESSED
Working out which findings matter
01
History and examination
What you can and cannot do, where symptoms travel, reflexes and strength. This establishes whether any structure is actually being compressed.
02
X-ray and MRI
X-rays show alignment and bone spurs; MRI shows the discs, nerves and cord. Together they show the anatomy, not the diagnosis.
03
Matching the two
The decisive step. A finding is only relevant when it corresponds to the level and the pattern your examination points to.
WHAT TO EXPECT
For most people, this stays in the background
Spondylosis progresses slowly and unevenly, and progression on imaging does not reliably mean worsening symptoms.
Most never
Most people who have cervical spondylosis noted on a scan will never need treatment directed at it. Neck stiffness and occasional flare-ups are common and manageable. The small proportion who do need more are the ones in whom the changes go on to compress a nerve root or the spinal cord, and those situations announce themselves through symptoms rather than through the report.
MANAGEMENT
What actually helps
FOUNDATION
Movement and strength
Keeping the neck and shoulder girdle moving and strong is the most useful long-term measure. Inactivity tends to make a stiff neck stiffer.
FOR FLARES
Physiotherapy and medication
Flare-ups usually respond to targeted physiotherapy, simple analgesia or anti-inflammatories, and a short period of modified activity.
SOMETIMES
Targeted injections
Where a specific joint or nerve is the source, an injection can settle it and help confirm where the pain is coming from.
RARELY
Surgery
Reserved for spondylosis that is compressing a nerve or the spinal cord, not for the appearance of wear on a scan.
Surgery is not a treatment for spondylosis itself. It is a treatment for what spondylosis is doing to a nerve or the cord in a particular person, at a particular level. Non-surgical treatment and whether surgery is warranted are covered separately.
Most people who have this on a scan will never need treatment for it
Age-related change in the discs and joints of the neck is extremely common on imaging, and often has nothing to do with the symptoms that prompted the scan. What the report says matters far less than what your neck and arms are actually doing.
COMMON QUESTIONS
The things people ask most
Is cervical spondylosis serious?
Usually not. It is age-related change that most people develop and most never need treatment for. It becomes serious only if it compresses a nerve root or the spinal cord, which produces specific symptoms rather than just an alarming report.
Is it the same as arthritis of the neck?
Broadly yes. Neck arthritis, degenerative disc disease and cervical spondylosis are overlapping terms for the same age-related wear in the discs and joints of the cervical spine.
Will it keep getting worse?
The changes generally progress slowly with age, but symptoms do not track that neatly. Many people find their neck settles into a manageable pattern, and worsening pictures on imaging do not reliably mean worsening pain.
Can it be reversed?
The structural changes cannot be undone. What can change substantially is how much trouble they cause you, through strength, movement, load management and treating specific pain sources when they appear.
Should I stop exercising?
No. Staying active is one of the most useful things you can do. Modify what clearly aggravates it rather than stopping altogether, and get guidance if you are unsure what is safe.
Do I need surgery for spondylosis?
Almost certainly not for the spondylosis itself. Surgery is considered when the changes are compressing a nerve or the spinal cord and causing symptoms that warrant it, which is a small minority of people.
RELATED CONDITIONS
What spondylosis can lead to
Cervical radiculopathy
Arm pain, tingling or weakness from a pinched nerve root, often caused by the bony narrowing spondylosis produces.
Read about radiculopathy ›Cervical myelopathy
Pressure on the spinal cord itself. The most important consequence of advanced spondylosis, and the one worth acting on early.
Read about myelopathy ›Cervical spinal stenosis
Narrowing of the canal that houses the spinal cord, frequently the result of accumulated spondylotic change.
Read about stenosis ›About this information
This page is general information about the cervical spine. It is not a substitute for an individual assessment and it cannot tell you what is happening in your own neck. Where figures are given, they come from the published research listed below and describe groups of people rather than individuals. Please discuss your own circumstances with your GP or a specialist. More about Dr Tollesson.
References
Abnormal Findings on Magnetic Resonance Images of the Cervical Spines in 1211 Asymptomatic Subjects. Spine, 2015, for the prevalence of degenerative findings in people without symptoms and their increase with age.
Wear on a scan is not a sentence. What matters is how your neck actually behaves.
A consultation will tell you which findings are relevant to you, what is likely to help, and whether anything needs doing now. A GP or specialist referral is needed for a Medicare rebate.