Uncocervicarthrose : dégénérescence discale cervicale et uncarthrose

Abstract

The vertebral bodies of the lower cervical spine are characterized by two lateral prismatic bony protuberances (uncinate processes, UP) located on the superior vertebral endplates from C3 to C7. The UP are involved in the stabilization of the cervical spine by limiting inclination and lateral posterior translation and guiding flexion/extension. Several types of anatomic degenerative changes can be found at the lower cervical spine (spondylolysis): degeneration in the intervertebral disc (IVD), uncovertebral and facets joints arthrosis. The incidence and severity of these cervical degenerative lesions increase with advancing age even in asymptomatic individuals. Moreover, the evolution is naturally positive in most cases. Degenerative lesions of the anterior and lower cervical spine (uncocervicarthrosis) include degeneration in the IVD and uncovertebral arthrosis. The degenerative disc lesions are associated with aging and can contribute to disc-space narrowing, osteophytes and cervical spine stenosis. The uncovertebral arthrosis could be related to transverse clefts in the annulus fibrosus and present the clinical and radiological characteristics of joint degeneration. The cervical radiculopathy (CR) is most commonly linked to foraminal encroachment of the spinal nerve due to degenerative changes of the uncovertebral joints (anteriorly) and zygapophyseal joints (posteriorly) than to the herniated disc. At the chronic and disabling phase, the degenerative disorders of the cervical spine is mainly supported by injections and exercises. Among the injections, only epidural injections of corticosteroid plus local anesthetic have demonstrated their effectiveness on CR and chronic neck pain. In case of disabling CR related to degeneration of the UP causing a conflict between the osteophytes and the neurological root in the foramen, a treatment with intradiscal corticosteroid injections can be proposed if standard treatments fail. A systematic Cochrane review shows the effectiveness on pain and function of specific cervical and scapular stretching and strengthening exercises. Neuromuscular exercises based on eye-neck coordination/proprioception are also recommended.