Ross Hauser, MD

Cervical Spondylosis is an umbrella term used to describe degenerative changes in the cervical spine. It typically begins with repetitive actions “overuse injury,” that results in sprains (ligament damage) and rotational strains or compressive forces to the spine. This causes injury to the cervical facet joints which in turn can jeopardize the natural function of the the cervical ligaments and cause cervical facet joint pain. Further degeneration can lead to  abnormal motion in the cervical spine and cartilage breakdown.

Before you read on with this article, do you have questions about Cervical Spondylosis? Get help and information from our Caring Medical Staff.

Treatment for degenerative changes in the cervical spine

In our own published research, we documented that the use of conventional modalities for chronic neck pain remains debatable, most treatments have had limited success and despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures.(1)

In this research, our team led by Danielle Steilen-Matias, MMS, PA-C, noted that the capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Such pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions such as:

• disc herniation,
• cervical spondylosis,
• whiplash injury and whiplash associated disorder,
• post-concussion syndrome,
• vertebrobasilar insufficiency,
• and Barré-Liéou syndrome.

In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability.

Understanding Prolotherapy treatment is understanding that we are treating Cervical Spondylosis by treating cervical instability

In the our research study cited above we looked at how Cervical Spondylosis was described in the medical literature:

• Cervical Spondylosis has previously been described as occurring in three stages:
  • The dysfunctional stage: The dysfunctional phase is characterized by cervical capsular ligament injuries and subsequent cartilage degeneration and synovitis, ultimately leading to abnormal motion in the cervical spine. Over time, facet joint dysfunction intensifies as ligament weakness and laxity occurs. This stretching response can cause cervical instability, marking the unstable stage.
  • The unstable stage: During the degenerative progression occurring in the intervertebral discs, along with other parts of the cervical spine, ankylosis (stiffening of the joints) can also occur at the unstable cervical spine segment.
  • The stabilization stage: The stabilization phase occurs with the formation of marginal osteophytes (bone spurs) as the body tries to heal the spine. These bridging bony deposits can lead to a natural fusion of the affected vertebrae.

The degenerative cascade that causes Cervical Spondylosis, however, begins long before symptoms become evident.

• In its beginning stages, spondylosis develops silently and is asymptomatic. When symptoms of cervical spondylosis do develop, they are generally nonspecific and include neck pain and stiffness. Only rarely do neurologic symptoms develop (ie, radiculopathy or myelopathy), and most often they occur in people with congenitally narrowed spinal canals.
• Physical exam findings are often limited to restricted range of neck motion and poorly localized tenderness.
• Clinical symptoms commonly manifest when a new cervical ligament injury is superimposed on the underlying degeneration.
• In patients with spondylosis and underlying capsular ligament laxity, cervical radiculopathy is more likely to occur because the neural foramina may already be narrowed from facet joint hypertrophy and disc degeneration, enabling any new injury to more readily pinch on an exiting nerve root.

When the ligaments turn into bone to support the cervical spine – Doctors do not expect recovery with conventional treatments

Korean doctors writing in the medical publication the Asian spine journal give a good summary of the problem Ossification of the posterior longitudinal ligament.

Ossification of the posterior longitudinal ligament is a condition of abnormal calcification of the posterior longitudinal ligament. The most common location is at the cervical spine region. Compression of spinal cord caused by ossification of the posterior longitudinal ligament  may lead to neurologic symptoms and in the cases with severe neurologic deficit, surgical treatments are required.

However, the exact pathogenesis (origins) and natural history (progression) of  ossification of the posterior longitudinal ligament remain unclear, there is no standard treatment for patients with asymptomatic  ossification of the posterior longitudinal ligament, and there is disagreement about the best surgical approach for cervical fusion surgery.(2)

The same research team also gives us a good idea of the progression of treatments that lead to unsure surgery recommendation

As symptomatic treatments, pain medication, topical agents, anti-inflammatory drugs, antidepressants, anticonvulsants, non-steroidal anti-inflammatory drugs and opioid can be applied, and bed rest and assist devices, such as a brace, are recommended for local stabilization. However, once the symptoms of myelopathy, such as gait disturbance and disorders of fine motor movement in the hand develop, appropriate recovery is not expected with conservative treatments. The patient moves onto surgery.

The research cited above comes from 2011, in a new study from August 2017, doctors at the Fujian Medical University in China published research in the medical journal Medicine that evaluated the effectiveness of various surgical interventions for the management of cervical spondylosis due to the ossification of the posterior longitudinal ligament.(3)

What is interesting in this study is that the doctors found success in treating patients surgically in a manner similar to concepts of Prolotherapy. Let’s look at this fascinating comparison in bullet points:

• The Chinese doctors found that cervical fusion for cervical spondylosis due to the ossification of the posterior longitudinal ligament worked better if it was performed early in the patient’s diagnosis.
  • Clearly we find comprehensive Prolotherapy works better when treatment occurs earlier in the diagnosis rather than later.
• The researchers found that patients in more significant pain improved the most. Patients with less significant pain did not improve that much.
  • We also find that in many patients with significant pain, even the smallest relief is greatly magnified. In patients with less pain, there is obviously less significant pain improvement. For instance a patient with a 2 out of 10 pain who jumps to 0 – has moved 2 levels. A patient with level 9 pain that improves to level 5 pain has jumped 4 levels. The pain relief is then much more significant. HOWEVER, our argument is why go through the high risk of cervical fusion for relief of lower level pain. See below.
• The researchers found that addressing the problem of neck pain by creating stability were the posterior longitudinal ligament had become stiff and painful significantly helped patients.
  • We find that Prolotherapy addresses the problem of neck pain by creating stability were the posterior longitudinal ligament had become stiff and painful significantly helped patients in a non-surgical way.

Let’s finish up this comparison with conclusion notes from surgeons:

• There can be limited (successful) surgical outcomes after laminoplasty (the creation of more space for the nerves by removal of bone) with risk of kyphotic cervical alignment (the cervical spine curves forward after failed cervical surgery),  the spinal canal occupation, (bone growth filling in the cervical spinal canals causing cervical stenosis) reossification, (calcium and bone buildup return to the soft tissue to assist in cervical neck stability). And hypermobility of the cervical spine (Cervical instability)
• Laminoplasty has been advocated because of its preservation of neck range of motion compared with laminectomy with fusion. However, ossification of the posterior longitudinal ligament is different from other etiological factors of myelopathy with respect to neck range of motion that may incite further progression of ossification of the posterior longitudinal ligament.
  • (This is extraordinary. Laminoplasty is prefered because the neck maintains its natural range of motion. However, this may lead to bone and calcium formation in the posterior longitudinal ligament. The range of motion after laminoplasty is unstable. Successful surgery did not correct the problem.)

Cervical Spondylosis is very treatable with Prolotherapy, see our main page Prolotherapy for Neck Pain and Cervical Instability for more information.

In our clinical and research observations, we have documented that Prolotherapy can offer answers for sufferers of cervical instability, as it treats the problem at its source. Prolotherapy to the various structures of the neck eliminates the instability and the sympathetic symptoms without many of the short-term and long-term risks of cervical fusion. We concluded that in many cases of chronic neck pain, the cause may be underlying joint instability and capsular ligament laxity. Furthermore, we contend that the use of comprehensive Prolotherapy appears to be an effective treatment for chronic neck pain and cervical instability, especially when due to ligament laxity. The technique is safe and relatively non-invasive as well as efficacious in relieving chronic neck pain and its associated symptoms.

Medical research validating the use of Comprehensive Prolotherapy, from simple dextrose injections to stem cell prolotherapy injections is not new. There is 55 years of research supporting the use of Prolotherapy for problems of the neck and head.(4)

Do you have questions about Cervical Spondylosis? Get help and information from our Caring Medical Staff

1. Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. Open Orthop J. 2014 Oct 1;8:326-45. doi: 10.2174/1874325001408010326. eCollection 2014. [Google Scholar]
2. Choi BW, Song KJ, Chang H. Ossification of the posterior longitudinal ligament: a review of literature. Asian spine journal. 2011 Dec 1;5(4):267-76.  [Google Scholar]
3. Wu D, Liu CZ, Yang H, Li H, Chen N. Surgical interventions for cervical spondylosis due to ossification of posterior longitudinal ligament: A meta-analysis. Medicine. 2017 Aug 1;96(33):e7590. [Pubmed] [Google Scholar]
4. HACKETT GS, Huang TC, RAFTERY A. Prolotherapy for headache. Headache: The Journal of Head and Face Pain. 1962 Apr 1;2(1):20-8. [Google Scholar]

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