GENERAL MEASURES:
β’ Acute phase - moist heat, gentle massage and temporary immobilization with a cervical collar that holds the
neck in slight fl exion. Intermittent cervical traction may be helpful, but the line of pull should be such that the
neck is slightly fl exed. Ultrasonic treatments, especially combined with gentle muscle stimulation (US-MS) for
15-20 minutes daily or bid may be helpful in the acute phase.
β’ Chronic - no treatment necessary except for nonnarcotic analgesics for symptoms. Any type of activity or work which causes strain of the neck should be avoided.
SURGICAL MEASURES:
β’ Indications: Severe pain unresponsive to conservative measures, signifi cant or progression of neurologic
deficits, long tract signs, vertebral artery syndrome
β’ Most common surgery is anterior interbody fusion with excision of disk and any accessible osteophytes
ACTIVITY : Any activity which does not cause symptoms should be encouraged as the disease is chronic. Needless restrictions can make the patient a medical invalid.
PATIENT EDUCATION :
β’ Personally instruct (or have a therapist instruct) in the proper use of orthopedic appliances. Cervical collars
should produce a slight flexion of the neck as should traction. Avoid extension in all situations.
β’ Instruct patient in home traction to relieve symptoms; instruct patient in home exercise routine to relieve
spasm and discomfort
β’ Instruct patients to report any weaknesses, eye symptoms, bladder or bowel incontinence immediately
DRUG(S) OF CHOICE:
β’ Acetaminophen (Tylenol) 500 mg qid is the safest regimen. Studies have shown it to be at least as effective
as NSAIDs.
β’ NSAIDs - aspirin 1.0 gm qid is effective in many cases. If this fails, any of the other NSAIDs are used with all
having about the same success rate. Piroxicam 10 mg daily, tolmetin 600 mg tid are some examples. If aspirin
therapy is used, salicylate levels should be obtained; therapeutic range is 10-30 mg/dL (0.724-2.17 mmol/L).
Enteric coated aspirin may be helpful to minimize GI upset.
β’ Cortisone should not be used in long term management. Occasional injections of trigger zones with 40 mg
methylprednisolone (Depo-Medrol) may be used, but this should be saved for severe exacerbations.
β’ Trigger point injection of lidocaine 1%, injected into the hot areas, especially in the scapular area. Often as effective in relieving symptoms alone as when combined with methylprednisolone
PATIENT MONITORING : Patients should be seen in 3-4 weeks for evaluation of neurologic status. If
this has not changed follow at intervals of 3-6 months, depending on severity of symptoms.
PREVENTION/AVOIDANCE: The midcervical spine is the area usually involved in spondylosis. This portion will develop a fl exion deformity causing extension of the upper spine as the body tries to keep the head erect. Avoid any extension strain such as a spinal manipulation, extension during intubation for a general anesthesia, or cervical strain from auto accidents, especially rear-end collisions. These can cause a basilar artery thrombosis or thrombosis of the posterior inferior cerebellar artery with a subsequent Wallenberg syndrome. Dysphagia, pain and temperature loss to the same side of the face and opposite side of the body, nystagmus and Horner syndrome are present in Wallenberg syndrome.
POSSIBLE COMPLICATIONS: Loss of motion, especially extension, may require adjustments to certain occupations to prevent uncommonly significant muscle loss and instability of gait, bladder or bowel function
EXPECTED COURSE/PROGNOSIS:
Fortunately, the prognosis is for a benign course in the overwhelming majority of cases, though for most of their lives patients will be plagued by pain which exacerbates often with no known cause