Cervical spondylosis - Treatment 

Treating cervical spondylosis 

Non-steroidal anti-inflammatory drugs (NSAIDs) can often be effective in relieving pain 

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Prevent back pain and other related pains with these tips on setting up your work station correctly

Treatment for cervical spondylosis aims to relieve symptoms of pain and prevent permanent damage to your nerves.

Pain relief

Over-the-counter painkillers

Non-steroidal anti-inflammatory drugs (NSAIDs) are thought to be the most effective painkillers for symptoms of cervical spondylosis. Some commonly used NSAIDs include:

If one NSAID fails to help with pain, you should try an alternative.

However, NSAIDs may not be suitable if you have asthma, high blood pressure, liver disease, heart disease or a history of stomach ulcers. In these circumstances, paracetamol is usually more suitable. Your pharmacist or GP can advise you.

Codeine

If your pain is more severe, your GP may prescribe a mild opiate painkiller called codeine. This is often taken in combination with NSAIDs or paracetamol.

A common side effect of taking codeine is constipation. To prevent constipation, drink plenty of water and eat foods high in fibre, such as wholegrain bread, brown rice, pasta, oats, beans, peas, lentils, grains, seeds, fruit and vegetables.

Codeine may be unsuitable for a number of people, especially if taken for long periods of time. Your GP can advise on whether it is safe for you to take codeine.

It is generally not recommended for people who have breathing problems (such as asthma) or head injuries, particularly those that increase pressure in the skull.

Muscle relaxants

If you experience spasms, when your neck muscles suddenly tighten uncontrollably, your GP may prescribe a short course of a muscle relaxant such as diazepam.

Muscle relaxants are sedatives that can make you feel dizzy and drowsy. If you have been prescribed diazepam, make sure you do not drive. You should also not drink alcohol, as the medication can exaggerate its effects.

Muscle relaxants should not be taken continuously for longer than a week to 10 days at a time.

Amitriptyline

If pain persists for more than a month and has not responded to the above painkillers, your GP may prescribe a medicine called amitriptyline.

Amitriptyline was originally designed to treat depression, but doctors have found that a small dose is also useful in treating nerve pain. You may experience some side effects when taking amitriptyline, including:

  • drowsiness
  • dry mouth
  • blurred vision
  • constipation
  • difficulty urinating

Do not drive if amitriptyline makes you drowsy. Amitriptyline should not be taken by people with a history of heart disease.

Gabapentin

Gabapentin (or a similar medication called pregabalin) may also be prescribed by your GP for helping radiating arm pain or pins and needles caused by nerve root irritation.

Some people may experience side effects that disappear when they stop the medication, such as a skin rash or unsteadiness. Gabapentin needs to be taken regularly for at least two weeks before any benefit is judged.

Injection of a painkiller

If your radiating arm pain is particularly severe and not settling, there may be an option of a "transforaminal nerve root injection", where steroid medication is injected into the neck where the nerves exit the spine. This may temporarily decrease inflammation of the nerve root and reduce pain.

Side effects include headache, temporary numbness in the area and, in rare cases, spinal cord injury (limb paralysis).

Your GP would have to refer you to a pain clinic if you wished to explore this option.

Exercise and lifestyle changes

You could consider:

  • doing low-impact aerobic exercises such as swimming or walking  read more about easy exercises
  • using one firm pillow at night to reduce strain on your neck
  • correcting your posture when standing and sitting  read more about how to sit correctly

The long-term use of a neck brace or collar is not recommended, as it can make your symptoms worse. Do not wear a brace for more than a week, unless your GP specifically advises you to.

Surgery

Surgery is usually only recommended in the treatment of cervical spondylosis if:

  • there is clear evidence that a nerve is being pinched by a slipped disk or bone (cervical radiculopathy), or your spinal cord is being compressed (cervical myelopathy)
  • there is underlying damage to your nervous system that is likely to worsen if surgery is not performed

Surgery may also be recommended if you have persistent pain that fails to respond to other treatments.

It's important to stress that surgery often doesn't lead to a complete cure of symptoms. It may only be able to prevent symptoms from getting worse.

The type of surgery used will depend on the underlying cause of your pain or nerve damage. Surgical techniques that may be used include:

  • Anterior cervical discectomy – This is used when a slipped disc or osteophyte (lump of extra bone) is pressing on a nerve. The surgeon will make an incision in the front of your neck and remove the problem disc or piece of bone. This procedure results in a fusion across the disc joint. Some surgeons will insert a bone substitute to encourage fusion, and occasionally put a metal plate across the disc if there is slippage of one vertebra on the one beneath.
  • Cervical laminectomy – The surgeon will make a small incision in the back of your neck and remove pieces of bone that are pressing on your spinal cord. A similar approach is known as a laminoplasty, where bones are spread open to widen the space, but not removed.
  • Prosthetic intervertebral disc replacement – This relatively new surgical technique involves removing a worn disc in the spine and replacing it with an artificial disc. The results of this technique have been promising, but as it is still new, there is no evidence about how well it works in the long term, or whether there will be any complications.

Most people can leave hospital within three to four days, but it can take up to eight weeks before you can resume normal activities. This may have an impact on your employment, depending on the type of work you do.

Many people are recommended to return to work on a part-time basis at first, although you should discuss this with your employer before surgery.

Complications of surgery

Like all surgical procedures, surgery on the cervical spine carries some risk of complications, including:

  • rare complications associated with general anaesthetic – such as heart attack, blood clot in the lung (pulmonary embolism) or a severe allergic reaction (anaphylaxis)
  • some mild difficulties with swallowing (dysphagia) – this usually passes within a few months
  • hoarse voice – this is a rare complication, but when it does occur it can be permanent
  • paralysis (inability to move one or more parts of the body) – which could occur if there is bleeding into the spinal canal after surgery, or the blood supply to spinal nerves is damaged
  • infection of the wound after surgery – which is not usually serious and can be treated with antibiotics (deeper spinal infection is more serious but very rare)
  • damage to nerves, which occurs in rare cases – this can result in persistent feelings of numbness and "pins and needles"

If it's decided that you could benefit from surgery, your consultant will discuss the risks and benefits with you.




Page last reviewed: 12/09/2014

Next review due: 12/09/2016

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Comments

The 13 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Simmo5175 said on 15 September 2014

I had a c6-7 acdf back in 2012 and am due to have another acdf on c5-6 next month. I found the pain eased but the disc above moved resulting in further surgury

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manjurah said on 03 September 2014

I have csm c5 c6 with spinal compression and advised to have fusion...So far no neck ache but do have the ocasional wobble/ balance, tingle 2 small fingers rt hand, and numbness there too, + handwriting can be wobly!!
I though have spinal stenosis as well. which does give the sciatic type pain. but advise dthe c5 c6 must be done first.........

Reading through all the comments and the surgeons prognosis- unlikely teh tingle will disappear .

The numbness could resolve reading through personal comments here.

Can anyone offer advice post surgery! many thanks

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dhe said on 28 August 2014

1998. C Myelopathy, bone fusion c4-5-6. 100% successful. Surgeon said "see you in ten years"

2007. Pins and needles in feet.

2011. Myelopathy, metal insert c6-7. 70% successful.

2013. Plate across c3-4 plus posterior Laminectomy.

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Sxcsox1954 said on 07 May 2014

I have suffered with my spondylosis now for 30 years. My symptoms are now causing huge problems. I am having really bad difficulty swallowing and I now do not have any feeling in the back of my neck. I am in extreme pain down the left side of my neck and my left arm. At the moment I am taking 4G mg ibuprofen, 1,200 mg garage tin, 60 mg codeine, 1,000 mg of paracetamol and 25 mg of am it rippling at night. I have today been for an MRI scan and I am now waiting for the results. This episode began at the beginning of February, and has not got any better since taking all this medication.

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yoursmoin said on 14 December 2012

I had a neck pain and symptoms were very similar to cervical spondylosis. I consulted 2 artheo and one of the view that I don't have spondylosis and other was of the view that I did have a little spondylosis. I tried tracktion, heat therapy but it actually didn't help much.

Then I was suggest by a person that I apply black sesame oil on whole of my body and do yoga. I followed his advise and to my surprise the pain in the back of my neck was nearly gone. I do sometime feel pain after working long, but it is limited to a very very small area. The vertigo which I use to get also disapeared. The person told me that actually if your digestion is weak it creates gas in your body which finally reduces your bone density, also this gas is the reason behind the pain, as this gas disposes at a place where bones have become weak. If you get rid of the gas in your body, you can significantly reduce the pain. But the problem is that the black sesame oil can remove the gas from your body, but your weak digestive system keeps making new gas. If you get make your digestive system strong, I think the pain should not come back.

But I am not a qualified doctor, It helped in my case and that's why I am sharing with you people. Please don't follow before consulting a good ayurvedic consultant, as I dont know what can be side effects of applying black sesame oil.

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Rakesh1 said on 08 June 2012

Hi.

I am in my early 30s and had cervical disectomy at C3/4 and C5/6 with a cage in November 2011. It is now June 2012. Since the operation I have been able to lead a normal life, my job is quite physically and I go to the gym regularly.

Before the operation I experienced weakness and loss of muscle in my legs which has now gone. However I still have very noticeable pins and needles in my hands.

At my 3 month post operation check up I was told that the operation was a success and that I should be grateful. I have had no x-ray or futher MRI scan and I am aware that the operation is to halt the degeneration rather than improve the condition.

However I now just wish that the pins and needles would go away. From time to time I scour the net in the hope of some new information that will give an indication that the pins and needles will disappear but as of yet have not found anything which can be slightly disheartening.

However I have to live in hope that the pins and needles will go away.

Any comments will be very much appreciated.

Thanks

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bubsy47 said on 03 May 2012

I have just been told that I need an operation because of cervical myelopathy on C3, C4 & C5 I am already taking Amitrypteline, Pregabalin & Tramadol for this and also for the pain associated with Fibromyalgia which I was diagnosed with 4 years ago. I just wanted to know if anyone has had this opperation, and has it helped with the pain. I would just like one day when I am not in pain from my head to my toes. I am also a single parent, how long does it take to recover from?

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Jen43 said on 22 April 2012

Amitryteline has changed my husband - he now sleeps well (we often slept apart because of his painful tossing and turning) hasnt fallen over for a while now and although in pain is walking far better than I have ever seen before and he hasnt had any water works leaks. He is more confident about going out on his own. Only downside is the constipation and feeling very drowsy in the mornings which can last until 11am. During the day he controls it with other pain relief tablets - This seems to be working well. Definitently worth a try!

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londonlaura80 said on 21 April 2012

Hi Richard

Would be very interested to know how you are faring a couple years down the line. I am also in my early thirties and have a lot of problems with my C5, right down to my C7 when its really bad. Have been consistently turned down for surgery based on lack of nerve damage but is very limiting and painful during a flare up. Would you recommend surgery?

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mdoot said on 11 February 2012

I have symptoms that seem to relate to cervical spondylosis but my GP says its due to my weight.
I have a crawling feeling on my scalp (as if i had headlice), neck pain, doc put that down to torticolis, i thought it was due to RSI because my neck was in one position all the time for my typing job, the pain in my shoulders due to a fall or bad posture, pelvic pain due to weight gain, but this feels very rigid that I cant bend forward or down without pain, pain under the buttocks i put down to simvistatin, muscle spasms down the back of my legs when i try to kneel and underfoot heel pain due to walking trying to walk off a few pounds, that I cannot walk out of the house. The back pain i suffer during the night that i turn constantly with pain that i get little sleep. I have other ailments
too. Does this sound like Cervical Spondylosis?
Do you think my GP is fobbing me off. He just tells me to lose weight and gives me co-dydromol pain killers.

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alextea804 said on 06 January 2012

Hi Mitch,

I just found out that I have a moderate C.M. in my neck. I will need to have two level fusion done on C4 AND C5. I have done lots of research but I have not talked to anyone that has actually done the surgery.

How is your neck now? Are you still in pain or pain free?

Any information given will be appreciated.

Thanks

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Mitch 1969 said on 13 December 2011

Richard,
I had a Anterior cervical discectomy and fusion 5 years ago - I was only 36 years old and recovered from the op very quickly. I had the op on the Friday and two days later was discharged. This is major spinal surgery and not to be underestimated. Your Neuro-Surgeon will advise you.

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Richard Miller said on 01 November 2011

What sort of in patient and recovery time would be involved with tese surgical procedures?

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