Nonoperative Modalities to Treat Symptomatic Cervical Spondylosis

Abstract

Cervical spondylosis is a common and disabling condition. It is generally felt that the initial management should be nonoperative, and these modalities include physiotherapy, analgesia and selective nerve root injections. Surgery should be reserved for moderate to severe myelopathy patients who have failed a period of conservative treatment and patients whose symptoms are not adequately controlled by nonoperative means. A review of the literature supporting various modalities of conservative management is presented, and it is concluded that although effective, nonoperative treatment is labour intensive, requiring regular review and careful selection of medications and physical therapy on a case by case basis.

Determinants, characteristics and treatment of neck pain in a tertiary care hospital in Kerala

“…In a study done by Kieran Michael et al the diagnosis of cervicobrachialgia was supported by radiological evidence in majority of patients in which 85% of patients had radiological evidence for cervicobrachialgia. 9 In the present study also 98.2% of the patients had relevant radiological findings at the time of inclusion in to the study.…”

“…The results agreed with observations in previous studies which had shown that mentally and physically stressful job is a major risk factor for cervicobracialgia. 9 Although certain occupations such as office and computer workers, manual labourers, and health care workers, have been found in some studies to have a higher incidence of neck pain, the major workplace factors associated with the condition are low job satisfaction and perceived poor workplace environment. 10 Unique risk factors for neck pain include trauma (e.g., traumatic brain and whiplash injuries) and certain sports injuries (eg, wrestling, ice hockey, football).In our study 14.1% of the patients gave a history of neck injury.…”

“…6,9 This goes hand in hand with the study done by Zhen PC, Zhu LG et al, when also it is observed that majority of conditions causing cervicobrachialgia are associated with radiculopathy. 6 Numbness and paresthesia are another common features of cervical radiculopathy and in this study most patients had numbness in arm (82.4%), forearm (61.8%) and hand (59%).…”

“…Several studies have shown that degenerative changes and disease processes in the cervical spine can lead to reflex spasm of related muscles. 9 99.4% of patients experienced neck stiffness and 87.1% patients experienced shoulder stiffness. 98.2% of the total population experienced tenderness due to spasm of paraspinal muscles.…”

“…According to many previous studies in this contest, cervical spondylosis is the commonest cause of cervicobrachialgia and age as the major predisposing factor for developing Cervical spondylosis. 9,12,14 The study done by Okada E, Matsumoto M, et al in Japanese patients showed that majority of patients with cervicobrachialgia had cervical spondylosis. 14 As per the present study, other major causes of cervicobrachialgia are cervical disc prolapse (5.9%), osteoporosis (4.1%), cervical rib (2.4%), rheumatoid arthritis (1.2%) and fibromyalgia (0.6%).…”