From the Research
Management of advanced multilevel degenerative cervical spine disease with reversal of lordosis typically begins with conservative approaches before considering surgical intervention, with a focus on improving quality of life and reducing morbidity and mortality. The most recent and highest quality study, 1, published in 2022, supports the use of anterior cervical corpectomy and fusion with stand-alone cages as a safe and effective surgical option for patients with multilevel degenerative cervical spine disease.
Conservative Management
Initial treatment includes:
- Physical therapy focusing on cervical strengthening and posture correction
- Pain management using NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily)
- Muscle relaxants such as cyclobenzaprine (5-10mg at bedtime) for associated muscle spasms
- Short-term use of oral steroids like a methylprednisolone dose pack or epidural steroid injections for moderate to severe pain
Surgical Intervention
If neurological symptoms are present or conservative management fails after 6-12 weeks, surgical intervention should be considered. Surgical options include:
- Anterior cervical discectomy and fusion (ACDF)
- Posterior cervical laminectomy with or without fusion
- Cervical disc arthroplasty in select cases The specific surgical approach depends on the patient's symptoms, location of pathology, and overall health status.
Key Considerations
- Early intervention is crucial when there are progressive neurological deficits or myelopathy to prevent irreversible spinal cord damage
- The goal of surgery is to decompress neural elements, restore cervical alignment, and stabilize the spine
- Studies such as 2 have shown that multilevel cervical arthroplasty can be an effective treatment option, with advantages over ACDF including motion preservation and decreased reoperations.
Quality of Life and Outcomes
The management plan should prioritize improving the patient's quality of life, reducing pain and disability, and minimizing the risk of complications and mortality. As noted in 3, physical therapy can be an effective treatment option for improving quality of life in patients with cervical spondylosis.