From the Guidelines
Treatment for multiple spondyloarthrosis in the neck should begin with NSAIDs as the initial pharmacological management, as recommended by the Pan American League of Associations for Rheumatology 1. The goal of treatment is to control symptoms, improve quality of life, and prevent disease progression. Key aspects of treatment include:
- NSAIDs, such as ibuprofen or naproxen, to reduce pain and inflammation
- Physical therapy, focusing on neck strengthening exercises, posture improvement, and range-of-motion activities, to improve function and reduce pain
- Patient education on the importance of regular exercise and stopping smoking to manage the condition
- Consideration of biologic agents, such as tumor necrosis factor-alpha (TNF-alpha) inhibitors, in patients with persistently high disease activity despite conventional treatments 1. It is essential to individualize treatment according to the patient's specific needs, symptoms, and disease characteristics, as outlined in the 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis 1. Regular monitoring of disease activity, including patient-reported outcomes, clinical findings, laboratory tests, and imaging, is crucial to adjust treatment strategies and ensure optimal management of the condition 1.
From the Research
Treatment for Multiple Spinous Process Fractures in the Neck
- The treatment for multiple spinous process fractures in the neck, also known as clay-shoveler's fracture, can be conservative, with the use of a cervical collar 2.
- Isolated transverse process fractures, which are similar to spinous process fractures, can be managed with unrestricted movement, bracing, and orthotics, with no evidence of permanent neurologic deficit or spinal instability 3.
- A study on isolated transverse process fractures of the subaxial cervical spine found that unrestricted movement resulted in satisfying functional, anatomic, and neurologic outcomes without associated adverse events 4.
- However, the effectiveness of cervical immobilization protocols, including the use of cervical collars, remains unclear due to the lack of standardized protocols and high-quality studies 5.
- The initial assessment and management of cervical spine injuries should follow the Advanced Trauma Life Support (ATLS) protocols, with adequate protection of the cervical spine through triple immobilization to prevent further neurological injuries 6.
Considerations for Treatment
- The unique anatomy and flexibility of the cervical spine predispose it to a risk of injury, and trauma to the cervical spine can range from minor muscular strains to life-threatening fracture-dislocations associated with spinal cord lesions 6.
- Clinical decision rules, such as the Canadian C-Spine Rule, can be used to risk-stratify patients needing radiography, and the level of cervical spine instability is important in guiding definitive management 6.
- The presence of cervical spine injury may not always be overt, and further imaging may be necessary to confirm the diagnosis 6.
- Multiple isolated spinous process fractures may be a warning sign of more severe spinal injuries 2.