What is the diagnosis for a patient with neck pain and mild degenerative changes at the C5-6 level, as indicated by a cervical spine radiograph (x-ray) showing disc space narrowing and maintained vertebral height?

From the Guidelines

The patient's cervical spine X-ray shows mild degenerative changes at the C5-6 level, and conservative management is typically recommended for such cases, including over-the-counter pain relievers and physical therapy, as most cases of acute cervical neck pain with radicular symptoms resolve spontaneously or with conservative treatment measures 1. The cervical spine maintains normal alignment with a preserved lordotic curve, and there is no evidence of fractures, abnormal soft tissue swelling, or concerning lesions. This represents early degenerative disc disease at the C5-6 level, which is a common age-related finding. Some key points to consider in the management of this patient include:

• The presence of degenerative changes should be interpreted with caution, as spondylotic changes on radiographs and MRI are common in patients over 30 years of age and have been shown to correlate poorly with the presence of neck pain 1.
• Imaging may not be required at the time of initial presentation in the absence of red flag symptoms, as most cases of acute cervical neck pain with radicular symptoms resolve spontaneously or with conservative treatment measures 1.
• Conservative management options include:
  • Over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours as needed) or NSAIDs such as ibuprofen (400-600mg every 6-8 hours with food).
  • Physical therapy focusing on neck strengthening and stretching exercises to help improve symptoms.
  • Heat or ice application for 15-20 minutes several times daily to provide relief.
  • Maintaining good posture, using proper ergonomics, and avoiding prolonged positions that strain the neck as important preventive measures. If pain persists or worsens, follow-up with the healthcare provider for additional treatment options is recommended 1.

From the Research

Cervical Spine Findings

• The patient's cervical spine shows vertebral height maintained throughout, with no fractures or acute osseous abnormalities 2.
• The alignment reveals a normal lordotic curve with no abnormal prevertebral soft tissue swelling.
• There is disc space narrowing with mild degenerative changes at the C 5-6 level, which is consistent with cervical disc degeneration (CDD) being a progressive, age-related occurrence frequently associated with neck pain and radiculopathy 3.
• Other disc space heights are maintained, and the C 1-C 2 level is intact, with no lytic or blastic lesions.

Degenerative Changes

• The patient's mild degenerative changes and degenerative disc disease at the C 5-6 level are consistent with the findings of degenerative disk disease being a strong etiologic risk factor of chronic low back pain (LBP) 4.
• A multidisciplinary approach to treatment is often warranted, including patient education, medication, and cognitive behavioral therapies.
• Surgical intervention with a rehabilitation regime is sometimes advocated, and biologic therapies show promise, but clinical trials are needed before advocating their use in humans.

Treatment and Management

• The optimal timing of physical therapy intervention post-surgery remains unresolved, but early rehabilitation strategies for intervertebral disc disease could enhance results in terms of pain and disability without an enhanced risk of complications 5.
• Conservative treatment has been effective for mild and moderate idiopathic conditions, but severe cases and systemic conditions were often excluded from studies 6.
• Some pharmacological treatments, manual therapy, and electrotherapy have shown benefits for handling degenerative conditions, although the most effective combination of techniques is unknown.