management of cervical spondylosis/cervical disc prolapse

Last reviewed 01/2018

Conservative measures may be sufficient for the treatment of cervical spondylosis, including:

• non-steroidal anti-inflammatory drugs if not contraindicated
• analgesia
• if muscle spasm then a short course of a muscle relaxant such as diazepam may be of benefit
• during the initial phase, heavy lifting must be avoided
• other possible interventions include:
  • a rigid neck collar can be beneficial - however 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
  • as spondylotic symptoms and signs are episodic, conservative measures are beneficial during periods of exacerbation

Operative procedures carry significant risks. 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.