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The treatment of the cervical spondylosis depends upon the severity of the signs and symptoms and stage of the disease. Most of the cases responds to the non surgical methods such as medicines and physical therapy. Only few cases where other treatment fails or nerve compression gets worsen are considered for surgery.
There are three types of treatment options available for the cervical spondylosis:-
I. Non surgical treatment
II. Spinal injections
This is one of the primary treatment options available. It is an important method as it can slow down the process of further wear and tear on the spine, especially at an early stage. The goal of the physical therapy is to relieve symptoms, strengthen weakened muscles and to correct the altered biomechanics, relieving pain and other symptoms and preventing further wear and tear.
It usually consists of some exercises and stretches which a person can learn under supervision and perform regularly at home. It may also involve certain therapies such as traction or posture therapy to manage the narrowing of the spaces and to relieve impingement on the nerves or correct the posture of the spine. Typically 2 to 3 sessions/week of physical therapy is advised which may be continued for 6 to 8 weeks. However, the duration of the sessions can vary according to the condition of the neck.
The physiotherapist may also use some heating techniques to relieve symptoms of pain and spasm during the acute phase. They may apply heat to the superficial tissue of the neck by using moist heat packs or to the deeper tissue by using machines like ultrasound or diathermy. The deep heating techniques are generally avoided in cases of nerve compression.
Medicines are usually the first line treatment given to relive symptoms such as pain and spasm. There are number of medicines that can be used according to the need:
• Paracetamol: it is a pain killer that is easily available over the counter which can be used to relive mild pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): these are the first line of medicines given to treat neck pain. They reduce pain and inflammation and includes medicines such as ibuprofen, naproxen and others. NSAIDs may lead to some side effects especially on organs like kidneys, liver or stomach lining especially if taken for a long time.
• Corticosteroids: sometimes oral prednisone may be given for a few days to relieve pain.
• Muscle relaxants: many a times especially in acute pain with spasm, muscle relaxants are given to relieve spasm and pain. The spasm tends to aggravate pain which in turn results into increase muscle spasm which acts as a vicious cycle. Muscle relaxants such as cyclobenzaprine or carisoprodol often with pain killers.
• Neuropathic pain relief: these medicines are generally given to people complaining of severe radiating pain to arm or shoulder. Medicines such as gabapentin is recommended to relieve such pain. Pregabalin is another medicine that can be used.
These are given to provide support and immobilization to the neck. Two types of collars used are soft and hard collars. The hard collars are generally used immediately after cervical injury or cervical fractures to immobilize the spine.
While soft collars are generally preferred in cervical spondylosis as they provide close to normal range of motion. A study suggested reduced pain with the use of cervical collar in 76% people. It is believed that soft collars provide placebo effect to relieve symptoms. However, long term use of collar is not established.
Moreover, it is feared that long term immobilization may result into atrophy of muscle due to non use which may get prone to further injury.
It is generally advised to wear soft collar as long as possible during the day considering one’s personal comfort. With improvement of the symptoms collar is advisable to be worn only during strenuous activities with eventual discontinuation.
People with moderate to severe pain which are not relieved with oral medicines may be given injections into the spine to relieve their symptoms.
Typically the injection contains two medicines:
• Steroid: which helps to reduce inflammation
• Anesthetic medicine: given to block pain
Spinal injections are of two types depending on the site of injection:
• Facet joint injection: in this method the medicine is injected into the degenerated facet joints which leads to the symptoms of cervical spondylosis. The facets joints are present in back of the cervical spine which plays role in the movement of the spine. The person is made to lie on his stomach facing toward the floor after which the doctor injects a small quantity of medicine into the joint under the guidance of X-rays.
• Cervical epidural injection: here the medicine is injected into epidural space (space present between protective layer of the spinal cord called dura and the bones). This is the space contains fat, small blood vessels and nerve roots. This procedure is typically done in cases of cervical spondylosis with pain radiating to arm or shoulder due to compression of the nerve (radiculopathy).
Most of the cases of cervical spondylosis are treated with non surgical methods. Surgery of the spine is a complex procedure with long post op recovery period. Doctor would discuss the expected results and risks before opting for surgery. The persons general health, age and presence of any underlying health condition would also be considered before selecting for surgery.
Surgery is typically recommended in following cases of cervical spondylosis:
• Cases where symptoms of nerve compression such as weakness or numbness in the limbs worsens even after treatment.
• Cases where there is significant compression of the spinal cord causing issues with walking and balance.
• Severe cases where non surgical methods fail to provide relief. This excludes people where pain is due to other medical problems.
The type of surgery opted depends upon the type and location of the problem in the cervical spine which classifies surgeries into two broad category:
Anterior approach surgery: surgery done from front part of the neck. This includes
Anterior diskectomy and fusion: removal of IV disk and fixation of vertebral bodies
Anterior corpectomy and fusion: removal of vertebral body and fixation
Posterior approach surgery: surgery done from front part of the neck
Laminectomy: removal of posterior part of the vertebrae to make free space for the spinal cord.
Laminoplasty: partial removal of the posterior part of the vertebrato give some space for the spinal
The goal of cervical surgery is to remove compression from the nerves and the spinal cord by removing the following
• Herniated disk
• Bony overgrowth- spurs
• Vertebral body
• Hypertrophied soft tissue
Studies have shown good short term relief from symptoms in properly selected patients. However, long term follow up to 2 years have not shown any significant superiority over non surgical methods.
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