From the Research
Treatment for cervical spondylosis should prioritize conservative approaches, including physical therapy, pain management with NSAIDs, and lifestyle modifications, with surgical options considered only if conservative treatments fail after 6-12 weeks or if neurological deficits progress, as supported by the most recent and highest quality study 1.
Overview of Treatment Options
Treatment options for cervical spondylosis include both conservative and surgical approaches. Conservative treatments are typically tried first and include:
- Physical therapy focusing on neck strengthening exercises, posture correction, and range of motion exercises
- Pain management often involves medications such as NSAIDs (ibuprofen 400-800mg three times daily or naproxen 500mg twice daily), muscle relaxants (cyclobenzaprine 5-10mg three times daily), and in some cases, short-term opioids for severe pain
- Cervical traction may provide temporary relief by creating space between vertebrae
- For persistent pain, steroid injections (epidural or facet joint) can reduce inflammation, though their effects are temporary
- Lifestyle modifications like ergonomic adjustments at work, proper pillow support during sleep, and avoiding activities that worsen symptoms are essential
Surgical Options
If conservative treatments fail after 6-12 weeks or if neurological deficits progress, surgical options may be considered, including:
- Anterior cervical discectomy and fusion (ACDF)
- Cervical disc replacement
- Posterior cervical laminectomy Surgery aims to decompress the spinal cord and nerve roots while stabilizing the spine. The choice of treatment depends on symptom severity, presence of neurological deficits, and the patient's overall health status.
Evidence Supporting Conservative Treatment
A systematic review 1 found that surgical treatment is more effective than conservative treatment in lowering neck and arm pain, as well as improving the Neck Disability Index (NDI) score, especially in the short term. However, conservative treatment, including medical exercise therapy, mechanical cervical tractions, transcutaneous electrical nerve stimulation, pain management education, and cervical collar, once or twice a week for 3 months, is beneficial in the long term and avoids the risks of surgery.
Considerations for Treatment
The decision to proceed with surgical treatment should be based on the severity of symptoms, the presence of neurological deficits, and the patient's overall health status. Patients with severe or unbearable pain may benefit from surgical treatment as soon as possible, while those with mild symptoms may be managed conservatively 1. Additionally, segmental instability and cervical spinal stenosis are adverse factors for the prognosis of conservative treatment, and patients with these conditions may require closer monitoring and earlier consideration of surgical intervention 2.