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Treatments and drugs
By Mayo Clinic staff
Without treatment, the signs and symptoms of cervical spondylosis usually decrease or stabilize. Occasionally, they may worsen. The goal of treatment is to relieve pain, help you maintain your usual activities as much as possible, and prevent permanent injury to the spinal cord and nerves.
Treatment of mild cases
Mild cases of cervical spondylosis may respond to:
- Wearing a neck brace (cervical collar) off and on throughout the day to help limit neck motion and reduce nerve irritation.
- Taking OTC pain relievers, such as aspirin, ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others).
- Doing exercises prescribed by a physical therapist to strengthen neck muscles and stretch the neck and shoulders. Low-impact aerobic exercise, such as walking or water aerobics, is strongly recommended.
- Applying heat and ice to relieve pain. You may also get some relief from menthol- or camphor-based creams, massage or stretching.
Treatment of more serious cases
For more severe cases, nonsurgical treatment may include:
- Traction on the neck for a week or two to reduce the pressure on spinal nerves. If your physical therapist determines that traction helps you, he or she may recommend a home traction unit for as-needed use.
- Modified exercise with intermittent rest. People who stay active are likely to avoid deconditioning and recover more quickly. Choose an activity that doesn't worsen your pain, and allow yourself to take short rest breaks in a comfortable position.
- Taking muscle relaxants, nerve pain pills or painkillers such as methocarbamol (Robaxin) or cyclobenzaprine (Flexeril), particularly if neck muscle spasms occur. Your doctor may prescribe newer medications specifically for nerve pain, such as gabapentin (Neurontin), pregabalin (Lyrica) or duloxetine (Cymbalta). In some cases, your doctor may recommend a short course of traditional pain medications, such as tramadol (Ultram) or drugs that contain hydrocodone (Vicodin, Lortab, others) or oxycodone (Percocet, Roxicet, others). Remember that these traditional pain medications often also contain acetaminophen.
- Injecting corticosteroid medications around the disk and nerves between the vertebrae. The injection combines corticosteroid medication with local anesthetic to reduce pain and inflammation. These medications may help prevent the need for surgery.
- Hospitalization for intravenous pain control may be needed in rare cases when other nonsurgical treatments fail.
Surgery
If conservative treatment fails or if your neurological signs and symptoms, such as weakness in your arms or legs, are getting worse, you may need surgery. The surgical procedure will depend on your underlying condition, such as bone spurs or spinal stenosis. The most common surgical options include:
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Frontal approach (anterior). Your surgeon makes an incision in the front of your neck and moves aside the windpipe (trachea) and swallowing tube (esophagus) to expose the cervical spine. Your surgeon can then remove a herniated disk or bone spurs, depending on the underlying problem. Sometimes, with disk removal, your surgeon will fill the gap with a graft of bone or other implant.
With the anterior approach, your surgeon can relieve pressure on your spinal cord from bone or from multiple disk protrusions by removing two disks and the bone between them (corpectomy). Then, to support your head and neck, your surgeon reconstructs the area with bone from your body or a bone bank or with an implant made of metal combined with bone.
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Back approach (posterior). Your surgeon may opt to remove or rearrange bone from the back of your neck, especially if several portions of the channel that houses the cord have narrowed. The operation, called a laminectomy, removes the back part of the bone over the spinal canal through an incision in the back of your neck.
Laminoplasty, an alternative to laminectomy, involves cutting and moving pieces of vertebrae to make more room for the spinal cord. Although laminoplasty takes longer, it is less likely to leave the neck unstable.
Risks of surgery
Risks of these procedures include infection, a tear in the membrane that covers the spinal cord at the site of the surgery, bleeding, a blood clot in a leg vein and neurological deterioration. In addition, the surgery may not eliminate all the problems associated with your condition.
- Aminoff J. Mechanical and other lesions of the spine, nerve roots, and spinal cord. In: Goldman L, et al., eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/176708901-5/933828718/1492/1420.html#4-u1.0-B978-1-4160-2805-5..50428-6--cesec48_17886. Accessed Dec. 31, 2009.
- Robinson J, et al. Clinical features and diagnosis of cervical radiculopathy. http://www.uptodate.com/home/index.html. Accessed Dec. 31, 2009.
- Cervical spondylosis. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00369. Accessed Dec. 31, 2009.
- Levin K. Cervical spondylotic myelopathy. http://www.uptodate.com/home/index.html. Accessed Dec. 31, 2009.
- Isaac Z, et al. Evaluation of the patient with neck pain and cervical spine disorders. http://www.uptodate.com/home/index.html. Accessed Dec. 31, 2009.
- Williams KD, et al. Lower back pain and disorders of intervertebral discs. In: Canale ST, et al. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/176885618-7/934423257/1584/297.html#4-u1.0-B978-0-323-03329-9..50042-8--cesec55_2001. Accessed Dec. 31, 2009.
- Roth D, et al. Cervical radiculopathy. Disease-a-Month. 2009:55;737.
- Robinson J, et al. Treatment of cervical radiculopathy. http://www.uptodate.com/home/index.html. Accessed Dec. 31, 2009.
- Shelerud RA (expert opinion). Rochester, Minn., Jan. 6, 2010.
- Chang-Miller, A (expert opinion). Rochester, Minn., Jan. 1, 2010.
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