What is the treatment for cervical spondylosis with muscle spasm and reversal of cervical lordosis on X-ray?

Treatment for Cervical Spondylosis with Muscle Spasm and Reversed Cervical Lordosis

For cervical spondylosis with muscle spasm indicated by reversal of cervical lordosis on X-ray, treatment should include short-term muscle relaxants (up to 2-3 weeks), physical therapy, and pain management, with surgery reserved for cases with severe or progressive neurological deficits. 1, 2

Understanding the Condition in Simple Terms

• Cervical spondylosis is age-related wear and tear of the spine that causes neck pain and stiffness 3
• Muscle spasm occurs when neck muscles tighten to protect the spine, often causing pain and limited movement 2
• Reversal of cervical lordosis means the normal forward curve in your neck has straightened or reversed, which can be seen on X-ray 3
• This condition can put pressure on nerves and spinal cord, causing pain, numbness, or weakness in arms and hands 1

Treatment Options

Conservative Management (First-Line Treatment)

• Medication for Muscle Spasm:

  • Muscle relaxants like cyclobenzaprine can help relieve muscle spasm for short periods (up to 2-3 weeks) 2
  • These medications work by reducing tonic somatic motor activity in the central nervous system 2
  • Note: Muscle relaxants should be used only for short periods as evidence for prolonged use is not available 2

• Physical Therapy:

  • Exercises to strengthen neck muscles and improve posture 1
  • Stretching techniques to reduce muscle tension and improve range of motion 4
  • Postural education to maintain proper neck alignment during daily activities 3

• Pain Management:

  • Anti-inflammatory medications to reduce pain and inflammation 1
  • Hot/cold therapy for temporary pain relief 1
  • Activity modification to avoid positions that worsen symptoms 1

When Conservative Treatment Fails

• If symptoms persist after 3 months of conservative treatment, further evaluation may be needed 1
• Patients with mild cervical spondylotic myelopathy (mJOA scale scores > 12) can be treated with either continued conservative therapy or surgical decompression for the first 3 years after diagnosis 1
• More severe myelopathy (mJOA scale score ≤ 12) should be considered for surgical intervention 1

Surgical Options (When Indicated)

• Anterior Approach:

  • Anterior cervical discectomy and fusion (ACDF) - effective for 1-2 level disease 1
  • Anterior corpectomy - recommended for 3-segment disease 1
  • Provides direct decompression of the spinal cord and nerve roots 1

• Posterior Approach:

  • Laminoplasty - preserves motion and reduces axial neck pain 1
  • Laminectomy with fusion - prevents post-laminectomy kyphosis 1
  • Better for multi-level disease (≥ 4 segments) 1

Important Considerations

• Relationship Between Lordosis and Symptoms:

  • Loss of cervical lordosis doesn't always indicate muscle spasm - studies show that 19% of patients with acute neck pain and 26% with chronic neck problems have straight cervical spines, but so do 42% of the normal population 5
  • The restoration of cervical lordosis may help alleviate symptoms in some patients 4
  • However, patients with small lordosis after surgery (<8°) can still have good clinical outcomes compared to those with larger cervical lordosis (>14°) 6

• Progression of Disease:

  • Cervical spondylosis often has a mixed progression with periods of stability 1
  • Long periods of severe stenosis can lead to potentially irreversible damage to the spinal cord 1
  • Horizontal displacement ≥0.3 on radiographs suggests cervical instability 7

• Complications to Watch For:

  • Post-surgical kyphosis occurs in approximately 10% of patients after laminoplasty 1
  • C5 nerve palsy can develop after surgery, especially when laminae are elevated to an angle > 60° 1
  • Pseudarthrosis (nonunion) can occur in approximately 10.9% of cases after corpectomy 8

When to Consider Referral to a Specialist

• Presence of progressive neurological deficits 1
• Failure to respond to conservative treatment after 3 months 1
• Signs of cervical myelopathy (difficulty with fine motor skills, gait disturbances) 1
• Evidence of significant spinal cord compression on imaging 1

Remember that while restoring cervical lordosis remains a goal of treatment, clinical improvement can still occur even with small lordosis after treatment. The most important factors are relieving nerve compression and stabilizing the spine to prevent further deterioration 6.