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Management of cervical spondylosis/cervical disc prolapse

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Conservative measures may be sufficient for the treatment of cervical spondylosis. These include:

  • non-steroidal anti-inflammatory drugs (if not contraindicated)
  • analgesia
  • a short course of a muscle relaxant such as diazepam may be of benefit if muscle spasm is present
  • during the initial phase, heavy lifting must be avoided
  • other possible interventions include:
    • a rigid neck collar. This can be beneficial, but only in the short term (no more than about a week). Even where myelopathy has occurred, around 50% of affected patients will improve with the use of a collar (1)
    • physiotherapy
  • even where it is obvious that a disc herniation has occurred, the principle of first treatment is the same as for a lumbar disc herniation, namely conservative
    • over 95% of patients with acute cervical discs causing radiculopathy will respond to 4–6 weeks of such therapy
    • the presence of minor or stable neurological deficit does not preclude medical treatment, or dictate surgery
    • affected patients must be reviewed regularly to assess neurological progress, or otherwise. If deterioration is seen, referral is required as surgery may be necessary
    • since spondylotic symptoms and signs are episodic, conservative measures are beneficial during periods of exacerbation

Operative procedures carry significant risks but surgical review is indicated if:

  • abnormal neurology, or persistent or progressive brachialgia with or without abnormal neurology
  • intermittent arm pain (brachialgia) rarely warrants surgery
  • more details concerning indications for surgical review are included in the linked item.

Surgical procedures include:

  • removal of osteophytes
  • laminectomy - usually, a wide decompression, e.g. from C3 to C7
  • foraminectomy - decompression of nerve root at one or more levels after drilling away overlying bone
  • all these procedures are usually combined with spinal fusion

Note:

  • surgery is good at reducing compressive nerve root symptoms and signs
    • symptomatic resolution can be expected in 75–90% of patients after cervical root decompression
  • surgery is also good at arresting myelopathic progression.
  • surgery is less good at reducing myelopathic symptoms and signs when these are chronic

Reference:

  1. ARC (January 2002). Rheumatic Disease In Practice.

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