The syndromes of degenerative cervical disease

Senescence of the cervical spinal motion segment is manifest by changes in each anatomic component. The pathoanatomical change that predominates varies from one person to the next. Sufficient compromise of local neural structures will precipitate the onset of symptoms. The pattern of symptoms and any associated physical signs will vary according to which structures are stimulated or compressed. Radicular and myelopathic syndromes are produced by nerve root and spinal cord compression, respectively. These patterns can occur individually or in combination. Other less clearly understood patterns of local and referred symptoms may be mediated by the sinu-vertebral nerves or the medial branches of the posterior ramus. Techniques for the precise diagnosis of these syndromes are needed. Separating patterns of symptomatic degenerative cervical disease from other causes of neck, shoulder, and arm symptoms rests on an awareness of the broad spectrum of subjective complaints, a thorough physical examination, and confirmatory diagnostic studies. Clear delineation of the etiology will increase the likelihood of successful treatment.