title: Anatomical specificities of the degenerated cervical spine: a narrative review of clinical implications, with special focus on targeted spinal injections.
abstract: BACKGROUND
  Cervical radiculopathy is most often related to foraminal stenosis due to osteoarthritic changes of the uncovertebral joints anteriorly or zygapophyseal joints posteriorly, rather than disc herniation.
  
  
  OBJECTIVE
  To describe anatomical specificities of the degenerated cervical spine.
  
  
  METHODS
  A critical narrative review was conducted. Articles were non-systematically selected and based on authors' expertise, self-knowledge, and reflective practice.
  
  
  RESULTS
  Vertebral bodies of the lower cervical spine are characterized by 2 lateral prismatic bony protuberances, the uncinate processes, located on C3 to C7 superior vertebral endplates, that are involved in the stabilization of the cervical spine. Degenerative changes at the lower cervical spine can affect different anatomical structures: the intervertebral disc, uncovertebral joints, and facet joints. The incidence and severity of changes increase with age. Furthermore, uncovertebral osteoarthritis is characterized by the presence of transverse fissures in the annulus fibrosus.
  
  
  CONCLUSIONS
  These specific anatomical features of the cervical spine may have clinical implications, including more targeted spinal injections for managing disabling persistent or recurrent symptoms related to cervical spine degenerative changes such as cervical radicular pain.
authors.affiliation: Department of rehabilitation, service de rééducation et réadaptation de l'appareil locomoteur et des pathologies du rachis, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Descartes, PRES Sorbonne Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Laboratoire de pharmacologie, toxicologie et signalisation cellulaire, Inserm UMR-S 1124, UFR biomédicale des Saints-Pères, université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France. Electronic address: christelle.nguyen2@aphp.fr.
authors.forename: Christelle
authors.initials: C
authors.lastname: Nguyen
authors.affiliation: Department of rehabilitation, service de rééducation et réadaptation de l'appareil locomoteur et des pathologies du rachis, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Descartes, PRES Sorbonne Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
authors.forename: Katherine
authors.initials: K
authors.lastname: Sanchez
authors.affiliation: Department of rehabilitation, service de rééducation et réadaptation de l'appareil locomoteur et des pathologies du rachis, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Descartes, PRES Sorbonne Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Roren
authors.affiliation: Department of rehabilitation, service de rééducation et réadaptation de l'appareil locomoteur et des pathologies du rachis, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Descartes, PRES Sorbonne Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.
authors.forename: Clémence
authors.initials: C
authors.lastname: Palazzo
authors.affiliation: Department of rehabilitation, service de rééducation et réadaptation de l'appareil locomoteur et des pathologies du rachis, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Descartes, PRES Sorbonne Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
authors.forename: Laëtitia
authors.initials: L
authors.lastname: Falcou
authors.affiliation: Service de radiologie B, hôpital Cochin, université Paris Descartes, Assistance publique-Hôpitaux de Paris, PRES Sorbonne Paris Cité, Paris, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Drapé
authors.affiliation: Department of rehabilitation, service de rééducation et réadaptation de l'appareil locomoteur et des pathologies du rachis, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Descartes, PRES Sorbonne Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Laboratoire de pharmacologie, toxicologie et signalisation cellulaire, Inserm UMR-S 1124, UFR biomédicale des Saints-Pères, université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Rannou
authors.affiliation: Department of rehabilitation, service de rééducation et réadaptation de l'appareil locomoteur et des pathologies du rachis, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Descartes, PRES Sorbonne Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Poiraudeau
authors.affiliation: Department of rehabilitation, service de rééducation et réadaptation de l'appareil locomoteur et des pathologies du rachis, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Descartes, PRES Sorbonne Paris Cité, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm UMR-S 1153, institut fédératif de recherche sur le handicap, université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.
authors.forename: Marie-Martine
authors.initials: MM
authors.lastname: Lefèvre-Colau
mesh_terms: D002574:Cervical Vertebrae / Q000033:anatomy & histology / Q000473:pathology*; D006801:Humans; D007278:Injections, Spinal / Q000379:methods; D007403:Intervertebral Disc / Q000033:anatomy & histology / Q000473:pathology; D055959:Intervertebral Disc Degeneration / Q000188:drug therapy / Q000473:pathology*; D021801:Zygapophyseal Joint / Q000033:anatomy & histology / Q000473:pathology
keywords: Cervical spine; Degenerative disc disease; Spinal injections; Spondylosis; Uncarthrosis