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Pathoanatomy of Cervical Spondylosis



- Pathoanatomy:
    - osteophytosis occurs as result of breakdown in the out annular fibers of annulus fibrosis;
            - disk material stretching & displacing these fibers, causing stress at ligamentous attachments leading to formation of osteophytes;
            - osteophytes collects initially extend horizontally;
            - later on osteophytes extend vertically from edges of vertebra, sometimes bridging disk space;
    - involves the disc, two facet joints & two false uncovertebral joints (Lushka);
    - cervical cord becomes impinged when diameter of canal (normally about 17 mm) is reduced to less than 13 mm;
    - hyperextension:
           - cord increases in diameter and it & roots are pinched between discs and adjacent spondylitic bars anteriorly, and hypertrophic 
                  facets and infolded ligamentum flavum posteriorly;
    - hyperflexion:
           - cord narrows and the neural structures are  tethered anteriorly across discs or spondylitic bars;
    - radiculopathy:
           - spondylotic changes in the foramina primarily from chondro-osseous spurs of the joints of Luschka may restrict motion and may 
                  lead to nerve root compression;
    - soft disc herniation:
           - is usually posterolateral, between posterior edge of uncinate process & lateral edge of posterior longitudinal ligament, resulting in 
                  acute radiculopathy;
    - myelopathy:
           - central herniation;
           - spondylotic bars with a congenitally narrow canal;

- Apophyseal Joints:
    - show early irregularity and blurring of the joint surfaces;
    - joint space narrowing and eventual spurring and sclerosis;
    - lateral view & oblique view:
           - allows evaluation of facet joints;
           - determine if osteophytes of apophyseal joints project medially into foramina canal;
    - specifically, osteophytes arising from the ventral portion of superior articular process may cause symptomatic foraminal narrowing;
    - rarely osteophytes may also project anteriorly and impinge upon vertebral artery, resulting in arterial insufficiency;
    - loss of disk height leads to reduced neuroforaminal volume, rendering root more susceptible to compression;

- Joints of Luschka:
    - joints give rise to bony spurs or ridges -osteophytes- as can main fascet joints & edges of vertebral bodies adjacent to intervertebral disc;
           - this is symphysis type of articulation between vertebral bodies;
           - exiting nerve root on each side travels between these joints, & can be compressed by osteophytes extending into intervertebral 
                 foramen from any or all three of sources mentioned