From the Guidelines
The most effective treatment option for a 57-year-old female with degenerative disc disease and multilevel cervical spine stenosis is anterior cervical discectomy and fusion (ACDF), as it provides a durable and physiologically dynamic support system that protects neural structures and decreases mechanical pain. When considering treatment options, the following should be taken into account:
- Conservative management:
- Physical therapy focusing on neck strengthening and range of motion exercises
- NSAIDs (e.g., ibuprofen 400-800 mg three times daily) for pain relief
- Muscle relaxants (e.g., cyclobenzaprine 5-10 mg at bedtime) for muscle spasms
- Cervical traction to decompress nerve roots
- Interventional procedures:
- Epidural steroid injections (e.g., methylprednisolone 80 mg with lidocaine) for targeted pain relief
- Facet joint injections or medial branch blocks for facet-related pain
- Surgical options (if conservative measures fail):
- Anterior cervical discectomy and fusion (ACDF) for C3-C4, C4-C5, C5-C6, and C6-C7 levels
- Posterior cervical laminectomy and fusion if multiple levels are involved According to 1, an anterior approach is appropriate when confronting an infection confined to the disc space or vertebral body, and it poses less morbidity to the patient in terms of muscle manipulation and wound healing. The use of autologous bone, harvested from the iliac crest or the ribs, as graft material is probably the best option whenever possible, as it provides a durable and physiologically dynamic support system that both protects the neural structures and decreases mechanical pain 1. Treatment should start conservatively and progress to more invasive options if symptoms persist, with the goal of reducing pain, improving function, and preventing further neurological deterioration. Surgery is typically reserved for cases with persistent pain, progressive neurological deficits, or significant spinal cord compression.
From the Research
Treatment Options for Degenerative Disc Disease and Multilevel Cervical Spine Stenosis
- Conservative management strategies may be effective in treating degenerative disc disease and multilevel cervical spine stenosis, including medications, physical therapy, and exercise 2
- Physical therapy interventions such as posture training, dynamic shoulder/scapular strengthening, cervical stabilization, stretching, ultrasound, interferential current, and a progressive home exercise program may be beneficial in improving pain, function, and range of motion 3
- McKenzie exercises, which include posture correction, range of motion exercises, and lateral neck stretches, may be effective in reducing disability, pain, and improving range of motion in patients with chronic nonspecific neck pain 4
- Adding specific cervical and scapulothoracic stabilization exercises to a standard McKenzie protocol may lead to clinically meaningful reductions in neck pain compared to McKenzie therapy alone 4
- Manual therapy and exercise for postural stabilization may also be effective in treating patients with neck-tongue syndrome, a condition that may be related to compression or irritation of the C2 nerve root 5
- Conservative management of chronic traumatic cervical myelopathy may also be effective in improving pain, sleep, and function in patients with a traumatic mechanism of injury 6
Considerations for Treatment
- Treatment considerations should be tailored to the individual patient's needs and may include a combination of medications, physical therapy, and exercise 2
- Physical therapy interventions should be based on the patient's specific symptoms and functional limitations, and may include a range of exercises and modalities 3, 4, 5
- The effectiveness of conservative management strategies may vary depending on the individual patient and the severity of their condition, and may require ongoing monitoring and adjustment of treatment plans 6, 4