From the Guidelines
To stop progression of degenerative cervical spine changes, a multifaceted approach focusing on lifestyle modifications, physical therapy, and targeted medical interventions is recommended, as evidenced by recent guidelines 1.
Key Recommendations
- Maintain proper posture throughout the day to reduce stress on the cervical spine.
- Engage in regular low-impact exercises, such as swimming or walking, and consider specific neck-strengthening exercises prescribed by a physical therapist, typically 2-3 times weekly for 6-8 weeks.
- Utilize anti-inflammatory medications like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) under medical supervision to manage pain and inflammation.
- Prioritize weight management, as excess weight increases spinal stress.
- Make ergonomic adjustments to the workspace, including monitor height and chair support, to reduce daily strain.
- For persistent pain, consider epidural steroid injections containing medications like methylprednisolone or triamcinolone, as recommended by a doctor.
Rationale
The approach is based on the understanding that while some degree of degeneration occurs naturally with aging, lifestyle and therapeutic interventions can slow progression and manage symptoms. Recent studies, such as those published in the Journal of the American College of Radiology 1, emphasize the importance of conservative management for nontraumatic cervical neck pain or cervical radiculopathy, highlighting that most cases resolve spontaneously or with conservative treatment measures.
Considerations
- Imaging may not be required at the time of initial presentation in the absence of red flag symptoms, 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.
- Regular follow-up with a spine specialist is essential to monitor changes and adjust the treatment plan accordingly, ensuring that interventions are tailored to the individual's needs and response to treatment.
From the Research
Non-Operative Treatment
- Non-operative treatment plays an important role in treating degenerative cervical spine disorders, with medications, therapy, and interventional pain injections being used increasingly 2
- Physiotherapy is an effective initial option for patients with newly presented degenerative cervical spine disease, with improvements in pain score, neck range of movements, and activities of daily living (ADL) 3
- Activity modification, neck immobilization, isometric exercises, and medication can help manage intermittent neck pain in middle-aged and elderly patients with cervical spondylosis 4
Surgical Treatment
- Surgical treatment, including anterior and posterior decompression and fusion, can be effective for many cervical disorders, but may lead to significant problems such as adjacent level disease 2
- Laminotomy/foraminotomy and total disc arthroplasty may avoid some of these problems while providing similar clinical results 2
- Surgical intervention is indicated for patients presenting with severe or progressive neurologic deficits, with anterior cervical approaches generally preferred 4
Management of Cervical Disc Degeneration
- Cervical manipulation can be used to address acute, subacute, and chronic symptoms in patients with cervical disc degeneration, as recommended by clinical practice guidelines 5
- The mechanical consequences of underlying cervical pathology, including disc degeneration, should be considered when selecting manipulation techniques 5
- Degenerative compression of the cervical spinal cord without clinical signs of myelopathy is a controversial topic, with ongoing debate on terminology, epidemiology, natural course, diagnosis, predictive value, risks, and practical management 6