Cervical spondylosis

Also called Neck arthritis, Neck pain, Degenerative disc disease

Age-related wear in the neck, present on scans in almost everybody over 60. The findings are normal; what matters is whether the spinal cord is being squeezed.

What it is

Wear-and-tear change in the discs and joints of the neck. By 60, the great majority of people have it on imaging, most with no symptoms at all.

That statistic is the whole point. A scan report listing degeneration, disc bulges and osteophytes describes an ordinary neck, and being shown it without that context frightens people into moving less, which makes the pain worse. See back pain, where the same problem plays out.

Most neck pain settles with movement, reassurance and time.

The exception is when the wear narrows the space around the spinal cord or a nerve root. Nerve root compression causes arm pain and is usually manageable. Cord compression, called cervical myelopathy, is different: it is progressive, it damages the cord permanently, and surgery works best when it is done early. It is regularly missed for a year or more because the symptoms are attributed to ageing.

Signs you might notice

Neck pain and stiffness, often worse in the morning and with certain positions. Headaches from the base of the skull.

Nerve root compression: pain, pins and needles or weakness travelling down one arm in a defined band.

**Cervical myelopathy**, the one to recognise: hands becoming clumsy, dropping things, difficulty with buttons, coins or handwriting; an unsteady, wide-based walk; heaviness in the legs; numbness in both hands; and later, bladder changes. It is usually painless, which is why it is missed.

Urgent assessment for any of the myelopathy signs, and same-day for new bladder or bowel problems with limb weakness.

Also urgent: neck pain with fever, unexplained weight loss, a history of cancer, or after significant trauma.

How it can affect day-to-day life

The clumsy-hands and unsteady-walk combination in an older person is routinely put down to age, arthritis or essential tremor. Naming myelopathy and asking for it to be excluded is often what gets the scan.

For ordinary neck pain, the treatment is the opposite of the instinct: keep moving, keep working, keep the head turning. Collars are almost never helpful and weaken the neck.

Desk set-up, phone habits and pillow height are worth changing, and are cheaper than anything else on offer.

Fear of the scan report is a genuine clinical problem here. Ask for the findings to be explained in the context of what is normal for the person's age.

Supporting someone well

Keep the neck moving. Gentle range-of-movement exercise several times a day beats rest.

Ask for physiotherapy; in most of the UK you can self-refer.

Ask for the scan report to be interpreted, not just handed over.

Learn the myelopathy signs and act on them: dropping things, buttons, unsteady walking. Ask for an urgent spinal opinion, not a physiotherapy referral.

Avoid a soft collar unless it has been specifically prescribed.

Sort out the desk, the screen height and the pillow.

For persistent arm pain, ask about nerve root compression and imaging rather than repeated painkillers.

Where to get help

A GP practice, or self-referral to physiotherapy for uncomplicated neck pain.

Urgent GP or spinal referral for clumsy hands, unsteady walking or numbness in both hands.

Arthritis UK have good self-management material for neck pain.