Discussion

This case reports a 25-year-old female college student with severe text neck-induced cervical osteoarthritis who experienced complete clinical symptom resolution, functional recovery, and notable radiographic restoration of cervical lordosis and intervertebral joint space following 10 months of conservative, multimodal chiropractic care.

Osteoarthritis serves as a general term for age-related deterioration that impacts the entire synovial joint, including the cartilage, subchondral bone, synovial tissue, and periarticular tissues [4,5]. With the exception of the atlantooccipital and atlantoaxial joints, facet joints (also known as zygapophyseal joints) are the only synovial joints in the spine. Facet joints participate in the same degenerative processes that contribute to the progression of osteoarthritis [6]. The intervertebral joints (disc joints) lack the synovial structures required to fulfill the criteria for osteoarthritis [7]. Osteoarthritis is generally accepted as a true disease, whereas degenerative disc disease is constantly viewed simply as an imaging description [8]. Accordingly, spondylosis (2022 ICD-10-CM Code M47) is primarily a term used to describe arthrosis or osteoarthritis of the spine and degeneration of the facet joints.

Cervical osteoarthritis or cervical spondylosis is no longer a condition that affects exclusively older adults; young adults are increasingly susceptible to early-onset degenerative joint disease due to chronic postural strain from modern digital device usage. Due to the growing popularity of media devices such as mobile devices and smartphones, the young population reporting chronic headache and neck pain and premature arthritis is increasing. Cervical degeneration and tissue wear are the most common causes of facet joint disorders in the spine. It is not unexpected that facet wear is attributed to prolonged neck flexion while looking down at a mobile screen. Continuous reinforcement of poor biomechanics, like excessive texting, is a constitutional factor facilitating cervical osteoarthritis. The bending of the neck forward will increase facet contact forces at adjacent segments [9], which contributes to the deterioration of the joints. Inflammation causes periarticular fibrosis and swelling of the joint capsules, resulting in stiffness and pain in the cervical spine [10]. Recognizing the association between radiographic findings and clinical complaints could offer useful insights for understanding the impact of the neck [6].

The capsule of the facet joints is richly innervated by mechanoreceptive and nociceptive afferents. Repeated stress of these afferents can trigger spinal sensitization through disrupted glutamatergic signaling, resulting in chronic pain and muscle weakness [11]. Unlike radiculopathy, facet arthropathy typically does not present with neurologic symptoms such as motor or sensory impairments or diminished reflexes. Pain originating from cervical facet joints of the lower neck often radiates to the shoulder girdle and interscapular region [6]. Degenerative changes in the facet joints may lead to neck stiffness, muscular spasms, and limitations in cervical mobility.

Currently, there are no specific treatments that can stop or reverse osteoarthritis or the degeneration of intervertebral discs. When conservative approaches do not succeed, interventional techniques such as facet joint injections, medial branch blocks, neurolysis, or surgical intervention are employed to alleviate pain [12]. In the scenario presented, the increased spacing of intervertebral and facet joints noted in the follow-up radiographs (Figure 2) may signify a favorable alteration associated with improved spinal function. Such advancements could stem from various effects of the manipulative procedures, including the correction of facet joint dysfunction [13], mobilization of restricted tissues, reinforcement of neck muscles, or relief of compressed tissues resulting from restricted mobility [14,15]. While cervical spinal adjustments are generally safe in appropriately screened patients, clinicians should exercise caution in those with conditions that may increase the risk of cervical artery dissection [16]. In this case, the patient denied any history of connective tissue disorders, and no adverse events were observed during treatment.

Our findings align with previously documented cases demonstrating that severe postural strain from mobile devices can induce early degenerative changes and loss of lordosis in young populations [17]. Similar to reports where correction of reversed cervical lordosis relieved chronic radicular and structural symptoms in young adults, our case illustrates that mechanical unloading of the cervical column via traction and adjustments can halt symptom progression and encourage functional recovery [18,19]. Furthermore, while conventional medical management of cervical osteoarthritis frequently relies on oral analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs), which provide temporary symptom suppression without correcting underlying sagittal malalignment, prior reports have demonstrated that conservative multimodal chiropractic care can effectively resolve refractory neck pain, headaches, and associated functional deficits [20].

However, several limitations inherent to this case report must be acknowledged. First, as a single-case study, the findings cannot be generalized to all young adults presenting with text neck or cervical osteoarthritis. Second, because a multimodal conservative care plan was utilized, combining thermal ultrasound, mechanical vibration, spinal manipulation, cervical traction, and ergonomic modifications, it is not possible to isolate the individual contribution or therapeutic efficacy of any single modality. Third, without a control group or long-term follow-up beyond 10 months, natural history, placebo effects, or long-term structural sustainability cannot be definitively established. Future prospective studies with larger sample sizes and long-term radiological monitoring are warranted to confirm these structural and functional outcomes.