From the Guidelines
The best next step for this patient with neck pain and mild degenerative changes on cervical spine X-ray would be to start conservative management, as the X-ray findings show only mild degenerative changes without acute pathology, and most cervical pain responds well to conservative measures before more invasive interventions or advanced imaging are needed 1.
Key Components of Conservative Management
- Recommending over-the-counter pain medications such as acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) for pain relief.
- Prescribing physical therapy, focusing on cervical strengthening exercises, posture correction, and range of motion exercises, typically 2-3 sessions weekly for 4-6 weeks.
- Application of heat or cold packs for 15-20 minutes several times daily can provide symptomatic relief.
- Activity modification to avoid positions that exacerbate pain is important, along with ergonomic adjustments at work and home.
Consideration for Advanced Imaging
If symptoms persist beyond 4-6 weeks of conservative treatment or if neurological symptoms develop (numbness, weakness, radiating pain), then advanced imaging such as MRI would be warranted 1. This approach aligns with the recommendations from the American College of Radiology, which suggests that noncontrast MRI is usually appropriate for assessment of new or increasing radiculopathy due to improved nerve root definition.
Rationale
The rationale behind starting with conservative management is based on the understanding that spondylotic changes are commonly identified on radiographs and MRI in patients over 30 years of age and correlate poorly with the presence of neck pain 1. Moreover, most cases of acute cervical neck pain with radicular symptoms resolve spontaneously or with conservative treatment measures 1. Therefore, conservative management should be the initial approach, reserving advanced imaging for cases where symptoms persist or worsen, or when red flag symptoms are present.
From the Research
Next Steps for Patient with Neck Pain
- The patient's X-ray results show mild multilevel intervertebral disc spacing narrowing and degenerative endplate changes, which are common causes of neck pain 2, 3.
- The absence of vertebral compression fracture, spondylolisthesis, and significant facet joint disease suggests that the patient's neck pain may be related to degenerative disc disease 4, 5.
- Consideration of cross-sectional imaging, such as MRI, may be warranted to further evaluate the patient's condition and rule out other potential causes of neck pain 2, 6.
- The patient's treatment options may include conservative management, such as physical therapy and pain management, or surgical interventions, such as anterior cervical fusion or artificial disc replacement, depending on the severity of their condition and response to initial treatment 4, 2, 3.
- Regenerative biological therapies, including gene therapies, growth factors, and cellular-based injections, may also be considered as a potential treatment option for patients with chronic neck pain due to degenerative disc disease 3, 5.