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Neurological consequences of cervical and lumbar spondylosis
1. Big picture
Spondylosis means degenerative disease of the spine: disc degeneration, osteophytes, facet joint arthrosis, ligament thickening, and narrowing of intervertebral foramina or the spinal canal.
For the neurology exam, the key is not the X-ray finding itself, but what neurological structure is compressed:
| Structure affected | Clinical consequence |
|---|---|
| Nerve root | Radiculopathy: dermatomal pain, sensory loss, reduced reflex, myotomal weakness |
| Cervical spinal cord | Cervical myelopathy: upper motor neuron signs, spastic gait, tetraparesis/paraparesis |
| Lumbar spinal canal / cauda roots | Neurogenic claudication, cauda equina syndrome |
| Cervical muscles / upper cervical nerves | Cervicogenic or spondylotic headache |
| Vertebral/vascular structures rarely | Dizziness-like complaints, but do not overdiagnose this |
The examiner usually wants you to distinguish:
cervical radiculopathy vs cervical myelopathy, and lumbar radiculopathy vs lumbar spinal stenosis vs cauda equina syndrome.
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