Conservative measures may be sufficient for the treatment of cervical spondylosis. These include:
- non-steroidal anti-inflammatory drugs (if not contraindicated)
- analgesia
- a short course of a muscle relaxant such as diazepam may be of benefit if muscle spasm is present
- during the initial phase, heavy lifting must be avoided
- other possible interventions include:
- a rigid neck collar. This can be beneficial, but only in the short term (no more than about a week). Even where myelopathy has occurred, around 50% of affected patients will improve with the use of a collar (1)
- physiotherapy
- even where it is obvious that a disc herniation has occurred, the principle of first treatment is the same as for a lumbar disc herniation, namely conservative
- over 95% of patients with acute cervical discs causing radiculopathy will respond to 4–6 weeks of such therapy
- the presence of minor or stable neurological deficit does not preclude medical treatment, or dictate surgery
- affected patients must be reviewed regularly to assess neurological progress, or otherwise. If deterioration is seen, referral is required as surgery may be necessary
- since spondylotic symptoms and signs are episodic, conservative measures are beneficial during periods of exacerbation
Operative procedures carry significant risks but surgical review is indicated if:
- abnormal neurology, or persistent or progressive brachialgia with or without abnormal neurology
- intermittent arm pain (brachialgia) rarely warrants surgery
- more details concerning indications for surgical review are included in the linked item.
Surgical procedures include:
- removal of osteophytes
- laminectomy - usually, a wide decompression, e.g. from C3 to C7
- foraminectomy - decompression of nerve root at one or more levels after drilling away overlying bone
- all these procedures are usually combined with spinal fusion
Note:
- surgery is good at reducing compressive nerve root symptoms and signs
- symptomatic resolution can be expected in 75–90% of patients after cervical root decompression
- surgery is also good at arresting myelopathic progression.
- surgery is less good at reducing myelopathic symptoms and signs when these are chronic
Reference:
- ARC (January 2002). Rheumatic Disease In Practice.