From the Guidelines
The management of cervical spondylosis should initially focus on conservative approaches, including physical therapy and pain management with nonsteroidal anti-inflammatory drugs (NSAIDs), before considering surgical interventions, as most cases resolve spontaneously or with conservative treatment measures 1.
Initial Assessment and Conservative Management
The initial assessment of cervical spondylosis involves evaluating for the presence of "red flags" such as trauma, malignancy, or systemic diseases, which may necessitate immediate imaging or further investigation 1. However, in the absence of these red flags, imaging may not be required at the time of initial presentation. Conservative management typically includes physical therapy to improve range of motion, reduce pain, and strengthen the neck muscles.
Pain Management
Pain management is a crucial component of conservative treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are often recommended for their anti-inflammatory and analgesic properties. Muscle relaxants may be used for short periods to alleviate muscle spasms. In cases of more severe pain, a short course of oral corticosteroids can be considered to reduce inflammation.
Interventional Options
If conservative measures fail to provide adequate relief after 6-8 weeks, interventional options such as epidural steroid injections or facet joint injections may be considered. These procedures aim to reduce inflammation and relieve pain by targeting specific areas of the cervical spine.
Surgical Intervention
Surgery is typically reserved for patients with progressive neurological deficits, severe pain unresponsive to conservative treatment, or spinal cord compression. Procedures such as anterior cervical discectomy and fusion (ACDF) or cervical artificial disc replacement are common surgical options. These surgeries aim to decompress neural structures, stabilize the spine, and alleviate symptoms.
Key Considerations
It's essential to note that spondylotic changes are common in individuals over 30 years of age and do not always correlate with the presence of neck pain 1. Therefore, the decision to proceed with imaging or more invasive treatments should be based on a comprehensive clinical evaluation, including the presence of red flags, the severity of symptoms, and the failure of conservative management. Conservative approaches should be prioritized, given that most cases of acute cervical neck pain with radicular symptoms resolve spontaneously or with conservative treatment measures 1.
From the Research
Medical Management
- Medical management is often the initial management of cervical spondylitic syndromes, including radiculopathy, myelopathy, and neck pain 2
- This includes pharmacological and rehabilitation treatment, such as the use of anti-inflammatory drugs, muscle relaxants, analgesics, antidepressants, anticonvulsants, steroids, facet joint ablation, and physical therapy 2
Rehabilitation Therapy
- Rehabilitation therapy is an essential component of conservative treatment for cervical spondylosis 3
- New physical therapy techniques, such as Sling Exercises Training (SET), fascia manipulation, muscle energy technique (MET), and proprioceptive neuromuscular facilitation (PNF), can aid in the rehabilitation of cervical spondylosis 3
- The effectiveness of treatment largely hinges on the patient's ability to improve their dysfunction 3
Treatment Approaches
- Treatment options for cervical spondylosis include surgical and conservative approaches, with conservative treatment often being the preferred choice 3
- Prospective studies comparing the efficacy of surgical versus medical management are lacking 2
- A rationale for the medical management of acute neck pain, chronic neck pain, radiculopathy, and myelopathy is presented in the literature 2