From the Guidelines
For patients with marked spondylosis and facet arthropathy in the cervical neck, I strongly recommend initiating management with conservative treatments, as most cases resolve spontaneously or with such measures, according to the American College of Radiology Appropriateness Criteria 1.
Key Considerations
- The presence of red flag symptoms such as trauma, malignancy, prior neck surgery, spinal cord injury, systemic diseases, or neurological deficits necessitates immediate imaging and potentially more aggressive intervention 1.
- In the absence of red flag symptoms, imaging may not be required at the time of initial presentation, as 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.
Conservative Management
- Physical therapy focusing on neck strengthening exercises can help alleviate symptoms.
- Over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours as needed, not exceeding 4000mg daily) or NSAIDs such as ibuprofen (400-800mg three times daily with food) can be used for pain and inflammation.
- Applying heat for 15-20 minutes several times daily can help relax muscles.
- Using a cervical pillow for proper neck support during sleep is recommended.
- Maintaining good posture throughout the day, especially when using electronic devices, is crucial.
Monitoring and Further Intervention
- If pain is severe or persistent, prescription muscle relaxants like cyclobenzaprine (5-10mg at bedtime) or stronger pain medications may be considered.
- Symptoms such as weakness, numbness, or bladder/bowel changes indicate potential nerve compression and require immediate medical attention for possible more aggressive intervention, including surgical options if necessary.
From the Research
Marked Spondylosis and Facet Arthropathy in Cervical Neck
- Marked spondylosis and facet arthropathy in the cervical neck can be a significant source of chronic spinal pain, with facet joints being one of the proven causes of pain 2.
- The diagnosis of facet joint pain can be challenging, and the level of evidence for accurate diagnosis is IV, with a weak strength of recommendation for physical examination based on symptoms and signs 2.
- Imaging studies, such as fluoroscopic or computed tomography (CT) guidance, are recommended for facet joint interventions, with a level of evidence of I and strong strength of recommendation 2.
- Cervical facet joint nerve blocks and radiofrequency ablation are therapeutic options for managing chronic spinal pain, with a level of evidence of II and moderate strength of recommendation 2, 3.
- The presence of cervical facet joint ankylosis may indicate a higher disease burden and should be considered in the diagnosis and treatment of ankylosing spondylitis 4.
- Facet joint disorders, including degenerative disorders, septic arthritis, and systemic and metabolic disorders, can cause cervical facet joint pain syndromes, and treatment options include facet joint injection, decompression, and antibiotic therapy 5.
- Therapeutic facet joint injections with steroids can provide significant and sustained pain relief for patients with chronic spinal pain, particularly those with lumbar spondylosis and facet arthropathy 3.