Q: I am suffering from spondylosis C4/C5 and occasional vertigo (mostly positional). I sleep straight like a stick and use two pillows. I do not turn on either side during my sleep. I get normal sleep. But, I have difficulty in getting up in the morning. The whole body especially the back becomes stiff. I manage to get up somehow with some effort but become normal after an hour of movement. I take Tenormin 25, which was prescribed for controlling tachycardia. I have heaviness of the head. My blood sugar level is under control. Sometimes, it gets elevated to 170 level (PP) and 110 (fasting). Blood pressure is normal though sometimes it is on the lower side (110/70). I have been taking Stemetil twice daily after food for almost three years now. Whenever I try to discontinue Stemetil, I get withdrawal symptoms like weakness and run down condition which leads to depression. I go for regular walks and am mentally active. I serve on the boards of some companies as a director and have no problem in participating in board discussions. How can I get rid of the difficulty in getting up in the morning? How to combat Stemetil withdrawal symptoms?

A:Our vertebral column (spine) is made up of bones called vertebrae, which have cartilage discs between them. These inter vertebral discs protect the vertebrae and make the spinal column flexible. A disc is made of connective tissue and has a stronger outer fibrous outer part and a softer jelly-like centre called the nucleus pulposus. The spinal cord (continuation of the brain below the skull), lies in the centre of the vertebral column. Nerves from the spinal cord come out from between the vertebrae to take and receive messages to various parts of the body. Your symptoms are very suggestive of cervical (neck) spondylosis. This is a chronic degenerative condition of the cervical spine that affects the vertebral bodies & inter vertebral disks of the neck and the nerve roots and/or spinal cord. Spondylosis progresses with age and often develops at multiple levels. This is usually an age-related change in which the disks and the surrounding ligaments lose their hydration and elasticity. Common clinical syndromes associated with cervical spondylosis include cervical pain (chronic pain in the lower part of head, neck or pain that radiates to back of the head, shoulder, scapula, or arm. The pain is often worse in certain positions and can interfere with sleep); giddiness, nausea, cervical radiculopathy (compression of the cervical nerve roots leads to radicular pain and/or weakness) and cervical myelopathy. Treatment is usually conservative and involves immobilisation of spine, traction of neck, neck exercises and application of heat to the area. Surgery is restricted to certain indications. Immobilisation of the cervical spine is the mainstay of conservative treatment as it limits the motion of the neck, thereby reducing nerve irritation. Soft cervical collars are recommended for daytime use only, but can only partly restrict the movements of neck. More rigid orthoses significantly immobilise the cervical spine. The use of moulded cervical pillow during sleep helps to better align the spine and provides symptomatic relief to some patients. Mechanical traction is useful as it promotes immobilisation and widens the foraminal openings. The use of isometric cervical exercises is helpful in maintaining the strength of the neck muscles. Neck and upper back stretching exercises, as well as light aerobic activities are also recommended. This should be done after consulting a physiotherapist. Passive treatment like application of heat to the tissues in the neck region, either by means of superficial devices (moist-heat packs) or mechanisms for deep-heat transfer (ultrasound, diathermy) provide symptomatic relief. Manual modalities like massage, mobilisation, manipulation etc. also help. This is done by a trained therapist who applies gentle pressure within or at the limits of normal motion with the aim of increasing the range of motion. Manual traction may be better tolerated than mechanical traction by some patients. The aim of surgery is to relieve pain and nerve compression and to stabilise the neck. It is reserved for a) progressive neurologic deficits; b) compression of the cervical nerve root, spinal cord, or both; c) intractable pain.