Prevalence of Cervical Spondylosis and Its Associated Factors Among Symptomatic Adult Patients Attending Tertiary Hospital Ethiopia 2023

doi:10.21203/rs.3.rs-4206836/v1

Background: Cervical spondylosis (CS) is a comprehensive term that describes age-related chronic muscles or bones diseases, which results in neck pain, tingling in arms and possible myelopathic associated paralysis.

Objective: The Aim of this study is to assess the prevalence of CS and its associated factors among symptomatic adult patients.

Materials and Methods: The study was a retrospective hospital based conducted at Tikur Anbessa specialized hospital, between May to December 2022 on Cervical spondylosis (CS) patients. The source population was, all spondylosis patients. The study population was all CS patients having completed clinical and imaging data from January 2020 to January 2022. Patients with incomplete data, acute trauma to the neck, congenital, neoplastic, idiopathic, circulatory, and metabolic were excluded from study.

Result: During the study period, 2176 Spondylosis were diagnosed. Of these, medical records of 339 cases were taken. Among these, 189(55.8%) female and 150 (44.2%) were males. The mean age of patients was 54.9 years, with SD of 10.044. Among all spondylosis, the prevalence of cervical spondylosis was 97(28.6%) which is the second most common next to lumbar spondylosis 199(58.7%). 40(11.8%) were having both cervical and lumbar spondylosis and 3(0.9%) was having thoracic spondylosis. The female was higher than male with a (AOR = 2.959, CI= 1.445- 6.060, p=.003), and age group 40-59 years higher as compared to below 40 and above 60 years with a (AOR=2.011, CI=1.164 -6.240, p=.000). Current smokers were higher with a (AOR =2.02, CI=1.843-11.0242, p=.008) and current alcohol user also higher with a (AOR= 2.83, CI=1.520-10.974, p=0.000).

Conclusion: The prevalence of cervical spondylosis (CS) was high compared to the reported literatures on cervical spondylosis. The risk of CS increases with age in both sexes, and females were more affected by cervical spondylosis.

Cervical Spondylosis

Myelopathy

Neck pain

Prevalence

Radiculopathy

Cervical spondylosis(CS) is a term which describes age-related chronic disc degeneration, which affect the cervical vertebrae, the facet-joints and associated soft tissue supports (1).

It is a common cause of chronic neck pain. The C4-C7 most affected in middle aged people (2).

Numbness, weakness, and tingling in the neck and/or arms, pain in the neck and/or arms, and neck stiffness are the usual symptoms of cervical spondylosis. In addition sign/symptoms such as gait imbalance, loss of fine motor control in the hands, sensory and urine complaints are also present in cervical spondylosis(3).

The risk factors for cervical spondylosis includes sex, age, occupation, nature of work and place residence. Others are educational status, smoking, alcohol intake and previous macro and micro trauma in the neck region. Previous studies showed that, age was the main risk factor and risk increased with aging (4).

The degenerative changes such as osteophytes , disc-herniation , spinal canal stenosis, neural foraminal stenosis, ligament and facet-joint hypertrophy are also related to cervical spondylosis(5).

Prevalence of Musculo-skeletal disorder (MSD) in the neck and shoulder regions was higher among female 57.0% when compared to their male colleagues, 42.8% (6). The age groups 45-59 years were almost 4 times more likely to experience chronic-recurrent neck pain compared with the older or younger groups (7). Some studies identified physical based worked as an associated factors for CS(8,9).

Population based prevalence of cervical spondylosis was 13.7%(3). The lifetime and work related prevalence 48.5% and 55% respectively (3,10).

Cervical spondylosis is generally classified according to three clinical syndromes: axial neck/shoulder pain, cervical radiculopathy, and cervical myelopathy. Patients can have a combination of any of the three syndromes(11)

The prevalence of neck pain that interfered with daily activities was 49% (12). Cervical spondylotic radiculopathy is one of the frequent conditions related to dysfunction of cervical spinal nerve roots (11). Cervical spondylotic myelopathy known by spinal cord compression(13).

Many people with the problems are asymptomatic and the disorder is commonly discovered by imaging(14). 20%-60% degenerate over time without surgical intervention(8,15).

Operative management less frequently used. Non-operative management involves medications such as NSAD, antidepressants, and anticonvulsants and physiotherapy(8)

Previous studies in Ethiopia were exclusively on neck pain. There is no study dedicated on Cervical spondylosis in Ethiopia. Therefore, the aim of this study is to investigate the prevalence of cervical spondylosis and its associated factors and afford baseline data for future studies.

The study was conducted at Tikur Anbessa Specialized Hospital neurology and rheumatology clinic between 1 May, to 30 December 2022, in Addis Ababa, Ethiopia.

Retrospective cross-sectional study was implemented on data from 1, January 2020 to 1, January 2022.

Adult patients with diagnosis of cervical spondylosis were included in the study. Patients with incomplete data, history of acute trauma to the neck, congenital, neoplastic, idiopathic, circulatory, and metabolic were excluded from study.

Based on literature considering the prevalence of cervical spondylosis and its associated factors it was 13.76% and 72.2% respectively(3,16). Taking the highest percentage for analytical purpose and using single population proportion formula, with 95% confidence interval and 5% absolute precision, the sample size was calculated as 308.4. To adjust for incomplete information, using 10% contingency it became 339. Medical record numbers obtained from the health management information system (HMIS), then 339 computer-generated random numbers taken to collect data from I-care using Open Data Kit (ODK).

To ensure the quality of data, trained nurses were recruited to collect the data. The collected data were checked for completeness and consistency on each day of data collection by the principal investigator. Case sheets based on MRN were read, and the necessary details were seen. In case of unclear diagnosis neurologist was consulted.

Measurement

Cervical spondylosis: is a term that includes an extensive variety of advanced
deteriorating changes that disturb all the components of the cervical spine. To be termed
cervical spondylosis, it should contain at least one of the following clinical characteristics:
cervical radiculopathy, cervical myelopathy, and chronic neck or shoulder pain (32).
Spondylosis: may be applied non-specifically to any and all degenerative circumstances
affecting the discs, vertebral bodies, ligaments, and/or associated joints of the spine (41)

Data processing and Analysis

Data collection was done with Open Data Kit (ODK) version 1.25.2. After data collection, all completed forms were transported to Microsoft Excel for clearing and checking for completeness, and then exported to SPSS version 26 for analysis. Mean, median, and standard deviation were used to describe continuous and discrete data, and frequency and percentage were used to describe categorical data. Bivariate binary logistic regression analyses were used. Variables with p-values ≤ 0.2 were identified as candidate variables for multivariable analysis. The result of multivariate with p ≤ 0.05 were considered statistically significant. The level of significance of 5% and the adjusted odds ratio (AOR) with a 95% confidence interval (CI) were used to present the estimates of the strength of the association. Finally, the results were presented using text, tables, and charts.

Ethical consideration

Ethical clearance was obtained from the Department Research Ethics Review Committee (DRERC) on behalf of the College of Health Sciences at Addis Ababa University's Institutional Review Board (IRB). After getting permission from hospital administration, a cooperation letter was written for the concerned bodies of their respective departments following this research. Obtaining medical record number of selected sample were processed by assigned person. Confidentiality was maintained at all levels of the study; besides, only the MRN numbers of study participants were used without mentioning their names

Socio-demographic Characteristics

In the study period, 2176 degenerative spinal disease patients were diagnosed at the neurology and rheumatology clinic. Out of these, the medical records of 339 cases were taken randomly. Among the 339 cases, 189 (55.8%) were female and 150 (44.2%) were males. The mean age of degenerative spinal disease patients was 54.9 years, with an SD of ±10.044 and a median of 56 years. Separately, the mean age of females was 54.1 (95% CI for mean 52.66–55.53 years) and that of males was 56.03 (95% CI for mean 54.41–57.65 years). Most of the patients 193(56.9%) were between the age group of 40 to 59 followed by 122(36.0%) were greater than 60 years and 24 (7.1%) patients were less than 39 years. (Detail Table 1 below)

Table 1 Socio-demographic distribution of study participants attended at neurology and rheumatology, in TASH, 1 January,2020-1 January, 2022

Variables		Frequency	Percent
Sex	Female	189	55.8
Sex	Male	150	44.2
Age group	below 39	24	7.1
	between 40 and 59	193	56.9
	greater 60	122	36.0
Residence	City/Urban	109	32.2
	Semi- urban	157	46.3
	Rural	73	21.5
Educational Status	Degree and above	6	1.8
	College	38	11.2
	High school	37	10.9
	only write and read	30	8.8
	Illiterate	16	4.7
	Unknown	212	62.5
Occupation	Farmer	12	3.54
	Marchant	22	6.5
	Office work	51	15
	Labor	17	5
	Other	30	8.85
	Unknown	207	61.1
nature of work	Mental-based	72	21.2
	Physical-based	65	19.2
	Unknown	207	61.1

Prevalence of Cervical Spondylosis

The prevalence of cervical spondylosis was 97(28.6%) which is the second most common next to lumbar spondylosis 199(58.7%). The 40(11.8%) were having both cervical and lumbar spondylosis and 3(0.9%) were thoracic spondyloses. (Figure 1)

Clinical Characteristics of Patients with Cervical Spondylosis

Of the 137 patients diagnosed with cervical spondylosis, 135 (98.5%) had neck pain, with 75 (55.6%) being female. Regarding the duration, 96 (70%) had a duration greater than twelve months, 39 (28.8%) had a duration less than 12 months, and the least duration was three months (Figure 2)

Imaging Finding Results of Cervical Spondylosis Etiologic Factors (Table 2)

Table 2 imaging finding results of cervical spondylosis etiologic factors of patients with cervical spondylosis at neurology and rheumatology, in TASH, 1 January,2020-1 January, 2022

Imaging Finding Results of Cervical Spondylosis	Frequency	Percentage
Degenerative cervical diseases	107	78.1%
mass lesions	5	3.65%
tuberculous abscesses	2	1.5%
spondylolisthesis	2	1.5%
spondylodiscitis	1	0.73%
normal	20	14.6%

In this study, osteophytes, disc herniation, disc dehydration, spinal canal stenosis, neural foraminal stenosis, ligament thickening, facet joint hypertrophy, and repeated chronic neck injuries were identified as the causative factors for cervical spondylosis. (Table 3 below)

Table 3 Frequency and percentage distribution of imaging findings among cervical spondylosis patients at neurology and rheumatology, in TASH, 1 January,2020-1 January, 2022

Etiologic factor		Frequency	Percent
Osteophytes	Yes	84	61.3
Osteophytes	No	53	38.7
Disc herniation	Yes	48	35
Disc herniation	No	89	65
disc dehydration	Yes	35	25.5
disc dehydration	No	102	74.5
Spinal canal stenosis	Yes	67	48.9
Spinal canal stenosis	No	70	51.1
Neural-foraminal stenosis	Yes	91	66
Neural-foraminal stenosis	No	46	34
liagamentum thickening	Yes	43	31.4
liagamentum thickening	No	94	68.6
Facet joint hypertrophy	Yes	36	26.3
Facet joint hypertrophy	No	101	73.7
Chronic-repeated neck injury	Yes	31	22.6
Chronic-repeated neck injury	No	106	77.4
associated back pain	Yes	87	63.5
associated back pain	No	50	36.5

For various etiologic causes, there was a somewhat varied level of cervical vertebrae involvement. The C5-C6 region has the highest occurrence of bone spurs 32 (38%). There were 64.2% of females with osteophytes. Right, left, and bilateral neural foraminal stenosis was identified. Following bilateral, right unilateral involvement was prevalent. Depending on degree, spinal canal stenosis can be classified as mild, moderate, or severe. These included 8 (11.94%) severe, 35 (52.2%) moderate, and 24 (35.8%) mild spinal canal stenosis. The posterior longitudinal ligament and ligamentum flavum thickened and buckled in 43 (31.4%). It concurrently occurred with disc dehydration and osteophyte which involved multiple vertebral levels. Chronic-repeated neck injury was also one of compliant in the study which may occur accidentally/traumatic or during physical based work. It was seen by 31 (22.6%) of the people. Most people with cervical spondylosis had associated backpain which was simultaneously occur along with neck pain, shoulder pain and upper extremity pain (Table 4 below)

Table 4distribution of etiologic factors at specific cervical vertebrae among cervical spondylosis
patients at neurology and rheumatology, in TASH, 1 January,2020-1 January, 2022

Etiologic factors	Frequency%	Cervical vertebrae level
		C2-C3	C3-C4	C4-C5	C5-C6	C6-C7
Osteophyte	84(63.1%)	-	8(9.52%)	28 (33.3%)	32 (38%)	16 (19.0%)
Disc herniation	48(35%)	5(10.4%)	8(16.7%)	13(27%)	15(31.3%)	7(14.6%)
Spinal canal stenosis	67(48.9%	-	7 (10.4%)	34 (50.7%)	18 (26.9%)	8 (12%)
Disc-dehydration	35(25.5%)	-	-	6(17.1%)	15(42.9%)	14(40.0%)
Neural-foraminal stenosis	91(66%)	5(5.5%)	8(8.8%)	29(31.9%)	34(37.4%)	15(16.5%)
Facet joint hypertrophy	36(26.3%)	-	4(11.1%)	9(25%)	16(44.4%)	7(19.4%)

Other prevalent finding in spinal disc disorder was disc herniation. Disc herniation occurs as a bulge, protrusion, extrusion (the central nucleus moves), and sequestration (a fragmented disc). The direction of disc herniation was seen as anterior/forward, posterior/backward and posterio-lateral/side way. The posterio-lateral (side) way was identified as the common direction of disc herniation in the cervical region in this study (Figure 4)

Life style and behavior of cervical spondylosis patients.

In this study, smoking and alcohol intake were assessed. In the smoking and current alcohol intake histories of the patients with cervical spondylosis, 37 (27.0%) said yes to smoking and 57(41.6%) said yes to current alcohol use.

Table 5 percentage distribution of smoking and current alcohol usage among patients of cervical spondylosis at neurology and rheumatology clinic, in TASH, 1 January,2020-1 January, 2022(Table 5)

Life style	Frequency (%)
Life style		Female	Male	Total
Smoking	Yes	7(9.3%)	30(48.4%)	37(27.0%)
Smoking	No	68(90.6%)	32(51.6%)	100(73.0%)
Alcohol intake	Yes	21(28.0%)	36(58.1%)	57(41.6%)
Alcohol intake	No	54(72.0%)	26(41.9%)	80(58.4%)

Co-morbid Disorders of Patients with Cervical Spondylosis

Co-morbid disorders were common in spinal degenerative diseases. The most common was hypertension (Figure % below)

Medical and surgical managements of cervical spondylosis patients

Antidepressants (amitriptyline) were the first line of management (Figure 6 below).

Correlation between clinical characteristics and imaging findings

The correlation between clinical characteristics and imaging findings was carried out using the Pearson correlation coefficient (r) to observe the relationship. Osteophyte complex, neural foraminal, spinal canal stenosis, and disc herniation had a positive correlation with cervical radiculopathy, cervical myelopathy, shoulder, and neck pain (r > 0.55).

Factors associated with occurrence of cervical spondylosis

Bivariate analysis

In this study sixteen explanatory variables were analyzed first by bivariable analysis. Based on the p-value (<0.2), nine variables were identified as candidate variables for the multivariable analysis (Table 6 below)

Table 6 Distribution of risk factors among patients with cervical spondylosis and results of bivariate analysis at neurology and rheumatology, in TASH, 1 January,2020-1 January, 2022

Variables		Frequency	COR	CI = 95	p-value
Gender	Female	75	2.12	1.4 -3.3	.001
Gender	Male	62	.429	-	-
Smoking	Yes	37	15.4	8.3- 150	.000
Smoking	No	100	.495	-	-
Alcohol intake	Yes	57	20.4	18.3-198.3	.000
Alcohol intake	No	80	.353	-	-
Age group	Below 39	14	.482	-	-
	Between40 &59	85	1.67	1.56-2.46	.102
	Above 60	38	.232	.201- 1.16	.236
Place of residence	City/Urban	67	3.31	1.78-6.16	.000
	Semi-urban	48	.679	.372-1.24	.206
	Rural	22	.521	-	-
Occupation	Farmer	14	1.4	0.5-3.5	0.29
	Marchant	23	2.8	1.4-5.5	0.3
	office work	51	3.5	1.5-7.1	0.3
	Labor	19	1.4	0.7-2.8	0.45
	Other	30	.89	-	-
Nature of work	Mental-based	72	1.7	1.1-2.5	0.33
Nature of work	Physical-based	65	0.56	-	-
Osteophyte	Yes	84	.990	.61- 1.61	.967
Osteophyte	No	53	.053	-	-
Disc herniation	Yes	48	1.06	.68- 1.64	.798
Disc herniation	No	89	.640	-	-
Dehydration of disk	Yes	35	1.41	.91-2.2	.23
Dehydration of disk	No	102	.545	-	-
Spinal canal stenosis	Yes	67	1.361	.86- 2.17	.192
Spinal canal stenosis	No	70	.539	-	-
Neural foraminal stenosis	Yes	91	1.17	0.25-5.39	.016
Neural foraminal stenosis	No	46	.540	-	-
Ligamentum thickening	Yes	43	.998	.61- 1.53	.887
Ligamentum thickening	No	94	.968	-	-
Facet joint hypertrophy	Yes	36	1.25	.80- 1.98	.333
Facet joint hypertrophy	No	101	.003	-	-
Associated back pain	Yes	87	7.31	4.23-12.7	.000
Associated back pain	No	50	.387	-	-
Repeated neck injury	Yes	31	18.8	8.2-42.97	.000
Repeated neck injury	No	106	.411	-	-

Multivariable analysis

As shown in the table below, of the nine variables included in the multivariable analysis, six of them remain significant at a p-value of ≤ 0.05(Table 7 below)

Table 7 Distribution of risk factors among patients with cervical spondylosis and results of multivariate analysis at Neurology and Rheumatology, in TASH, 1 January,2020-1 January, 2022

Variable		Frequency	AOR	CI=95%	P-Value
Sex	Female	75	2.96	1.45- 6.06	.003*
	Male	62
Age group	below 39	14	1	1.164 -6.24	.05*
	between 40 and 59	85	2.01
	sixty and above	38	.987
Current using alcohol	Yes	57	2.83	1.5-10.9	.00*
	No	80
Current smoking	Yes	37	2.02	1.8-11.02	.008*
	No	100
Associated back pain	Yes	87	2.85	1.2-6.97	.022*
	No	50
Place of residence	City/Urban	67	1.7	.13-.58	.001*
	Semi-urban	48	.27
	Rural	22	1

A hospital-based cross-sectional study on the prevalence of cervical spondylosis and related
risk factors was carried out at TASH. The study found the prevalence of cervical spondylosis
among all spinal degenerative diseases was 40.4%. The prevalence of this study is similar to a study in Bangladesh on male collies (loading and unloading) which was 39.8%, and comparable to the studies in Bathinda (Punjab), 47% and Korea among older adults, which was 47.8%(9,17,18)

But it was significantly higher than the population based study in China, 13.76%, and the studies in India, 17.2 % and the southwest region of Nigeria , 10.7% (3,8,19) and very different from study in Sweden which was 35 cases per 100,000 per year (20).

The discrepancy seen between the above result and the current study was probably due to
study design and sample size, as the study in China was a population-based study and that
in Nigeria and India used a smaller sample size.

In this study, the most affected age group was 40–60 years, which was 57%. This was in line with the study done in the same setting in the radiology department on people with neck pain that undergo cervical spine MRI evaluation and the studies done in Ireland, China, Nepal, and Nigeria on patients with neck pain (3,5,15,21–23). The second highest was seen in those aged above 60 years. The reason for the higher incidence in these age groups was due to involvement in high-effort activities in the 4^th and 5th decades and degenerative process due to age. When the aging and degenerative processes combined, it become pathological.

Sex was related to cervical spondylosis. In this study, there was a difference between males and females. This study showed that female was more vulnerable to cervical spondylosis with (AOR = 2.959, CI= 1.445- 6.060, P= .003). The reason may be that women hold the same position for several hours. One study in China found menopause as an associated factor for cervical spondylosis (OR = 1.772, 95% CI: 1.159–2.710)(3). Estrogens can maintain the collagens that protect the intervertebral disc. Lou et al. found a relationship between menopause and the degeneration of the intervertebral disc(24). This finding is almost similar to the most of world literatures

In this study regarding the place of residence, living in a city or urban area had no association with cervical spondylosis, and living in a semi-urban had protective factors for cervical spondylosis with (AOR = .27, CI= .129-.576, p=.001).

In nature of work, office work/ mental based work had positive relation with cervical spondylosis. This was the same with the study in China and different from the study in Bangladesh on male coolies(3,9).

The difference was the study in Bangladesh was exclusively done on male coolies. Smoking and current alcohol use also had positive associations with cervical spondylosis, with (AOR =2.016, CI=1.843-11.0242, p=.008), and (AOR =2.83, CI=1.520-10.974, p=0.000), respectively. One of the experimental studies identified that, smoking increased the production and release of inflammatory cytokines, determining decomposition of chondrocyte activity and as a result, disc degeneration occur(24).

Factors such as sex, age, body mass index, different influences like smoking and drinking habit, exercise, occupational aspects like working-hours, head down position, over-head actions and low job satisfaction are considered as associated factors of shoulder and/ neck musculoskeletal pain among school teachers in different epidemiological studies(16).

Many other studies also identified smoking and alcohol intake as a risk factor for CS. The neck pain was the common complaint in patient with cervical spondylosis. The complaint was high with people in their 4th, 5th, and 6th decades. The most common types of NP were chronic neck pain with arm pain (about 70%), followed by chronic neck pain without arm pain (about 13.9%), and acute neck pain with arm pain and acute neck pain without arm pain were less common in this study.

This study also showed 98.5% were diagnosed with NP in people with cervical spondylosis. It was higher than the study in Northwest Ethiopia (Gondar Town), which was 72.2% (22).

It was also higher than the study in Norwegian on cervical spondylosis and neck pain, which was 34%, and the study in Denmark (University of Southern Denmark), which showed the lifetime prevalence of NP ranged from 14% to 71%, with elderly women being more affected(12,25).

This study was also different from the population-based study in the USA, 13.3%, and the studies in North Carolina, 22.2% and Sweden, 66%(26–28).

The other problem was shoulder/axial joint pain along with chronic NP in people with cervical spondylosis. According to this study, the problem occurred in 74.5% of those diagnosed with cervical spondylosis it is comparable to study in China which was 66.7%, but, higher than the studies in Botswana, 52.5% and Sweden 30.7% (6,27,29).

This study was higher than other studies as it tried to assess symptomatic individuals. The difference in studies may be due to the difference in study variables and study design and some of the studies were population-based studies.

The most significant symptoms in people with cervical spondylosis were cervical radiculopathy. Radiculopathy (nerve root compression) due to cervical spondylosis occurred more frequently at the C5-C7 levels, with C3-C4 affected in a small percent. Neurological characteristics follow the anatomical distribution of the nerve root in the upper limb with sensory symptoms like shooting pains and numbness, but weakness was less common in this study. In some patients, a diminished reflex was reported at a specific level, like the biceps at C5-C6 and the triceps at C7. This study reported that cervical radiculopathy was seen in 85.4% of those who had cervical spondylosis.

It was higher than the study in Sicilian municipality which reported the existence of cervical radiculopathy was 33% and study in Minnesota which was 31%(30,31)

This was higher than all other similar studies because it focused primarily on spinal degenerative diseases. But on the other hand, a meta-analysis study of the African population reported that patients in developing countries are often diagnosed very late in the course of their illness, when irreversible changes and progressive neurological deterioration have already occurred. This may be due to the lack of diagnostic facilities and inadequate suspicion on the part of the caregivers. (32).

The cervical myelopathy showed clumsiness of the hand, gait disturbance, sensory ataxia and bladder dysfunction. Wasting and fasciculation of biceps and triceps were also identified. Extremity weakness alone and/or with loss of bladder control, quadriparesis, and sensory disturbances were the problems seen. The cervical myelopathy was 5.6% in this study which was comparable with study Taiwan 4.04% (95% CI 3.98–4.11) but, significantly lower than study in Northern Nigeria which ranges from 20% to 60% in spondylosis cases (15,33).

According to this study extremity weakness was leading problem about 35% and one case of cervical myelopathy identified as grade 5 nurick scale.

In this study, the imaging examination revealed the most prominent characteristic features of cervical spondylosis, which included bone spurs, disc dehydration, disc bulge, spinal canal stenosis, neural foraminal stenosis, and herniation of the disc at C3-C4, C4-C5, C5- C6, and C6-C7. The C5-C6 level was concerned with a common single level in the spondylosis process. The next frequency was C4-C5. This had similar characteristics to study in China (13). Overall, multiple levels of involvement were seen in the cervical vertebrae involved.

In addition, the MRI findings of the spine identified the presence of posterior longitudinal ligament and ligamentum flavum (LF) thickening and facet joint hypertrophy. Cervical spondylosis as well as ossification of the posterior longitudinal ligament (OPLL), signify two of the utmost shared roots of cervical spinal cord dysfunction globally. In difference to age-related spondylosis, OPLL is an anomalous outcome record dominant in the Asian population, considered by pathological ectopic bone development in the posterior longitudinal ligament. OPLL has been revealed to lead to myelopathy in approximately 17% of those affected (34).

Pathologic change in hypertrophy of the ligamentum flavum and thickening of bone may result in additional reduction of the spinal cord space (32).

This study found that facet joint hypertrophy and ligamentum thickening were present in 32.4% and 27% of participants in the sixth and seventh decades, respectively.

In this study, the osteophyte complex was 61.3 % in the cervical spine. This study was comparable with a study at the same setting in the TASH radiology department on people with chronic neck pain, which was 68.8% (5)The study had more findings than the study done in Tokyo, Japan; the difference may have been caused by the Tokyo study's small sample size (35).

Another prevalent investigation in spondylosis was neural foraminal stenosis. In bivariable analysis, neural foraminal stenosis had an association with clinical characteristics of cervical spondylosis (COR= 1.17, 955%CI: 0.25-5.39). Additionally, radicular pain was reported by those who had neural foraminal stenosis. Recent studies with computer assisted and intravenously contrast-enhanced myelography and with gradient-echo MRI have shown that neural foraminal stenosis caused by uncal osteophytes are much more common than disc herniation as the cause of cervical radiculopathy (30). In this study, 66% of the cervical spine had neural foraminal stenosis. It was lower than the 73.1% from the previous study at TASH and the 77% from the Danish study (5,25).

The spinal cord is compressed by severe spinal canal stenosis, which results in compressive
myelopathy. Other study also identified severe cases of cervical spinal canal stenosis can also cause paraplegia, with more than 70% of the cases, the reflexes are hyperactive at a variable distance below the level of cervical spinal canal stenosis; clonus or Babinski’s reflex may also be present (32). According to this study, the cervical spine's spinal canal stenosis was found to be 48.9%. It was once lower than in the prior TASH research (5).

Another common problem was disc herniation, which affected more women in their fourth and fifth decades. Disc protrusion, disc-bulge, sequestration, and disc extrusion all occurred in disc herniation. This study's disc-herniation rate of 35% was greater than the previous TASH radiology department study's 11.5% and comparable to Borno State Nigeria, which was 37%(8,37(5,15)).
Joint hypertrophy and a narrowing of the disc gaps are connected to flavum thickening. Since the majority of degenerative conditions coexist, ligament thickness and osteophyte complex are also intimately connected. Chronic repeated neck injury was identified 31(22.6%) in this study.

In bivariable analysis chronic repeated neck injury has showed an association with cervical spondylosis with (COR=18.8, 95% CI: 8.2-42.97, P=.00). The associated backpain also had an association with cervical spondylosis with (AOR= 2.85, CI: 1.2-6.97, P= 0.022).

In spine degenerative disease, the co-morbidities were frequent. The co-morbid conditions that were most frequently present were hypertension, DM, rheumatoid arthritis, spinal TB, and others. Another study conducted in the People's Republic of China found that comorbidities of cardiovascular disease, cerebral infarction, hyperlipidemia, and diabetes were also present (29). Antidepressant, anti-convulsants, corticosteroids, and non-steroidal anti-inflammatory drugs were the most frequently prescribed drugs. These drugs were prescribed either singly or in combination. In addition to the prescribed medication, physiotherapy was also ordered. Surgical management was less frequently used and was typically conservative. The therapy of cervical spondylosis in Africa was primarily conservative in another review research (32). Laminoplasty, Laminotomy, and Laminectomy were the most frequently performed surgical procedures.

Compared to data from published literatures on cervical spondylosis, the prevalence of cervical spondylosis in this study was comparatively high. In, Korea, Bathinda (Punjab), India(population), China, Nigeria, and Sweden the prevalence was: (47.8, 47,17.2,13.8,10.7 and 0.035 %) respectively. The development of cervical spondylosis is influenced by numerous factors. Age, sex, behavioral factors, and associated conditions were the most significant. Females were more affected. The most affected age groups were the fourth, fifth, and sixth. The study indicated that chronic co-morbidity was widespread among patients with this medical condition.

Ethical issue

Human Ethics and Consent to Participate declarations

Ethical clearance was obtained from, Neurology and Rheumatology departments after I presented my proposal to the departments. The departments allowed me to collect data from Health Management Information System (HMIS)

As my research was retrospective study first, I have collected patients MRN with medical diagnosis of Cervical Spondylosis from nursing Log book. Confidentiality was maintained at all levels of the study; besides, only the MRN numbers of study participants were used without mentioning their names.

The Neurology and Rheumatology departments held a meeting and approved my data collection (see the following paper)

Declaration of Interest

I want to declare that there are no competing financial interests or personal relationships that may appear to my study.

Conflict of interests

There is no conflict of interest

Funding

No funding

Kelly JC, Groarke PJ, Butler JS, Poynton AR, O’Byrne JM. The Natural History and Clinical Syndromes of Degenerative Cervical Spondylosis. Adv Orthop. 2012;2012:1–5.
Pharmacology CERVICAL SPONDYLOSIS : A Rising Trend Worldwide Assistant professor & HOD Pharmacology , Vardhman Institute of Medical Sciences ,. 2017;2249.
Lv Y, Tian W, Chen D, Liu Y, Wang L, Duan F. The prevalence and associated factors of symptomatic cervical Spondylosis in Chinese adults: A community-based cross-sectional study. BMC Musculoskelet Disord. 2018 Sep 11;19(1).
Zindrick MR. The pathophysiology of disc degeneration. 2008;90(10):1261–70.
Endale Balcha T, Bekele Getaneh F, Mekonnen Woldeyohannes A. Cervical Spine Magnetic Resonance Imaging… A Retrospective Analysis on Cervical Spine Magnetic Resonance Imaging Findings in Patients with Neck Pain in a Tertiary Hospital, Addis Ababa, Ethiopia A Retrospective Analysis on Cervical Spine Magnetic Resonanc. Ethiop J Heal Sci [Internet]. 2021;31(5):1025. Available from: http://dx.doi.org/10.4314/ejhs.v31i5.
Erick PN, Smith DR. The Prevalence and Risk Factors for Musculoskeletal Disorders among School Occupational Medicine & Health Affairs The Prevalence and Risk Factors for Musculoskeletal Disorders among School Teachers in Botswana. 2016;(January 2014).
Carroll LJ, Hogg-Johnson S, van der Velde G, Haldeman S, Holm LW, Carragee EJ, et al. Course and Prognostic Factors for Neck Pain in the General Population Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders S75. Vol. 33, Number 4S.
Oguntona S. Cervical spondylosis in South West Nigerian farmers and female traders. Ann Afr Med. 2014;13(2):61–4.
Mahbub MH, Mahbub MH, Laskar MS, Seikh FA, Altaf MH, Inoue M, et al. Journal of Occupational Health Prevalence of Cervical Spondylosis and Musculoskeletal Symptoms among Coolies in a City of Bangladesh. Vol. 48, J Occup Health. 2006.
Klussmann A, Gebhardt H, Liebers F, Rieger MA. Musculoskeletal symptoms of the upper extremities and the neck: A cross-sectional study on prevalence and symptom-predicting factors at visual display terminal (VDT) workstations. BMC Musculoskelet Disord. 2008;9.
Davies BM, Mowforth OD, Smith EK, Kotter MRN. Degenerative cervical myelopathy. BMJ. 2018;360.
Côté P, Van Der Velde G, Cassidy JD, Carroll LJ, Hogg-Johnson S, Holm LW, et al. The Burden and Determinants of Neck Pain in Workers Task Force on Neck Pain and Its Associated Disorders [Internet]. Vol. 33, SPINE. 2000. Available from: http://www.cdc.gov/EpiInfo/
Wang C, Tian F, Zhou Y, He W, Cai Z. The incidence of cervical spondylosis decreases with aging in the elderly, and increases with aging in the young and adult population: A hospital-based clinical analysis. Clin Interv Aging. 2016 Jan 12;11:47–53.
Xiong W, Li F, Guan H. Tetraplegia after thyroidectomy in a patient with cervical spondylosis : A case report and literature review. Med (United States). 2015 Feb 2;94(6).
Olarinoye-Akorede S, Ibinaiye P, Akano A, Hamidu A, Kajogbola G. Magnetic Resonance Imaging Findings in Cervical Spondylosis and Cervical Spondylotic Myelopathy in Zaria, Northern Nigeria. Sub-Saharan African J Med. 2015;2(2):74.
Temesgen MH, Belay GJ, Gelaw AY, Janakiraman B, Animut Y. Burden of shoulder and/neck pain among school teachers in Ethiopia. BMC Musculoskelet Disord. 2019 Jan 10;20(1).
Moon MS, Yoon MG, Park BK, Park MS. Age-related incidence of cervical spondylosis in residents of Jeju Island. Asian Spine J. 2016;10(5):857–68.
Budhiraja G, Guram D, Singh H. Incidence of Cervical Spondylosis as Cause of Vertigo in a Tertiary Care Hospital in Malwa region of Punjab. 2020;(April 2019):2019–21.
Raghvi A, Roselin V, Rajasekaran S. Prevalence of Cervical Spondylosis among Cases with Vertigo in a Tertiary Care Center. 2023;
Jackson JA, Liv P, Sayed-noor AS, Punnett L, Wahlstr J. Risk factors for surgically treated cervical spondylosis in male construction workers : a 20-year prospective study. 2023;23:136–45.
Singh S, Kumar D, Kumar S. Risk factors in cervical spondylosis. J Clin Orthop Trauma. 2014 Dec 1;5(4):221–6.
Kolenkiewicz M, Włodarczyk A, Wojtkiewicz J. Diagnosis and Incidence of Spondylosis and Cervical Disc Disorders in the University Clinical Hospital in Olsztyn, in Years 2011-2015. Biomed Res Int. 2018;2018.
Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Aug 22;386(9995):743–800.
de Oliveira Vilaça C, Orsini M, Leite MAA, de Freitas MRG, Davidovich E, Fiorelli R, et al. Cervical spondylotic myelopathy: What the neurologist should know. Vol. 8, Neurology International. Page Press Publications; 2016. p. 69–73.
Jensen RK, Jensen TS, Grøn S, Frafjord E, Bundgaard U, Damsgaard AL, et al. Prevalence of MRI findings in the cervical spine in patients with persistent neck pain based on quantification of narrative MRI reports. Chiropr Man Ther. 2019 Mar 6;27(1).
Goode AP, Freburger J, Carey T. Prevalence, practice patterns, and evidence for chronic neck pain. Arthritis Care Res (Hoboken). 2010;62(11):1594–601.
Brattberg G, Thorslund M, W&man A. The prevalence of pain in a general population. The results of a postal survey in a county of Sweden. Vol. 37, Pain. 1989.
George P L, Bhaveshkumar A, Nauman C, Herbert H E. Cervical Spondylotic Myelopathy: An Updated Review. Neurosurg Cases Rev. 2021 Jan 23;4(1).
Peng B, DePalma MJ. Cervical disc degeneration and neck pain. J Pain Res. 2018;11:2853–7.
Radhakrishnan K, Litchy WJ, Fallon WMO, Kurland LT. Epidemiology of cervical radiculopathy A population-based study from Rochester , Minnesota , 1976 through 1990. 1994;325–35.
Salemi G, Savettieri G, Meneghini F, Di Benedetto ME, Ragonese P, Morgante L, et al. Prevalence of cervical spondylotic radiculopathy: A door-to-door survey in a Sicilian municipality. Acta Neurol Scand. 1996;93(2–3):184–8.
Belachew DA, Schaller BJ, Guta Z. Cervical spondylosis: a literature review with attention to the African population. 2007.
Wu JC, Ko CC, Yen YS, Huang WC, Chen YC, Liu L, et al. Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: A national cohort study. Neurosurg Focus. 2013 Jul;35(1):1–5.
Wilson JR, Patel AA, Brodt ED, Dettori JR, Brodke DS, Fehlings MG. Genetics and Heritability of Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament. Spine (Phila Pa 1976) [Internet]. 2013 Oct;38:S123–46. Available from: http://journals.lww.com/00007632-201310151-00012
Shiga H, Matsumoto M, Fujimura Y, Suzuki N, Nishi Y, Nakamura M, et al. MRI of cervical intervertebral discs in asymptomatic subjects. Vol. 80, J Bone Joint Surg [Br]. 1998.

No competing interests reported.

Prevalence of Cervical Spondylosis and Its Associated Factors Among Symptomatic Adult Patients Attending Tertiary Hospital Ethiopia 2023

Status:

Version 1

Abstract

Figures

Introduction

MATERIALS AND METHODS

RESULT

Prevalence of Cervical Spondylosis

Clinical Characteristics of Patients with Cervical Spondylosis

Co-morbid Disorders of Patients with Cervical Spondylosis

Medical and surgical managements of cervical spondylosis patients

Correlation between clinical characteristics and imaging findings

Factors associated with occurrence of cervical spondylosis

Multivariable analysis

Discussion

CONCLUSION

Declarations

REFERENCE

Additional Declarations

Status:

Version 1