eMedicine Specialties > Neurology > Headache and Pain

Cervical Spondylosis, Diagnosis and Management: Follow-up

Author: Sandeep S Rana, MD, Clinical Associate Professor of Neurology, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Aug 14, 2009

Follow-up

Patient Education

For excellent patient education resources, visit eMedicine's Back, Ribs, Neck, and Head Center. In addition, see eMedicine's patient education articles Vertebral Compression Fracture and Neck Strain.

Miscellaneous

Medicolegal Pitfalls

  • The role of cervical spondylosis in postautomobile accident cervical whiplash syndrome has been a controversial medicolegal area.
  • In 1973, Verbiest warned clinicians to be wary of patients who present after minor trauma with symptoms attributable to cervical spondylosis, especially when legal and/or compensatory matters were involved.
  • In one series of 648 patients with ruptured cervical disks, only one patient was noted to experience a typical hyperextension injury as a result of a rear-end car collision.54
  • Repetitive trauma has been implicated (eg, in those carrying baskets on their heads), but the cause-and-effect relationship for auto accidents or other infrequently occurring trauma has not been demonstrated.

Special Concerns

Cervical diskography is a controversial tool used to assess patients with nonradicular or nonmyelopathic symptoms (eg, neck pain and suboccipital pain attributable to cervical spondylosis). It is particularly controversial because some authorities claim that diskography is a useful tool, while others remain skeptical because of a high rate of false-positive results.

  • The technique involves the injection of a small amount of contrast into the disk space. A positive study result occurs when a patient's symptoms are reproduced by the injection. Some authors also use relief of the symptoms (elicited by local injection of anesthetic) as corroborative evidence of diskogenic pain. The morphology of the disk after contrast injection is important to some authorities, while others discount it as a meaningless entity.
  • Regardless, most advocates recommend it as a test of final resort once MRI or myelography results are demonstrated to be within normal limits.
  • In theory, the test can localize the pathologic disk responsible for a patient's symptoms. One study reported that 70% of patients who underwent surgical intervention based on diskography studies experienced excellent or good results.55

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Eli M Baron, MD and William F Young, MD to the development and writing of this article.



More on Cervical Spondylosis, Diagnosis and Management

Overview: Cervical Spondylosis, Diagnosis and Management
Differential Diagnoses & Workup: Cervical Spondylosis, Diagnosis and Management
Treatment & Medication: Cervical Spondylosis, Diagnosis and Management
Follow-up: Cervical Spondylosis, Diagnosis and Management
Multimedia: Cervical Spondylosis, Diagnosis and Management
References
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Further Reading

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Keywords

cervical spondylosis, cervical spondylosis treatment, cervical degenerative joint disease, cervical spine, cervical degenerative disk disease, cervical osteoarthritis, cervical spondylotic myelopathy, CSM, disk degeneration, degenerative cervical disease, osteophytic bars, cervical radiculopathy, neck pain, shoulder pain, cervicalgia, chronic suboccipital headache, paresthesias, pseudoangina, breast pain, nontraumatic paraparesis, nontraumatic tetraparesis, numbness, clumsy hands, loss of manual dexterity, difficulty with writing, central cord syndrome, Tinel sign, Spurling sign, Babinski sign, Hoffman sign, pectoralis muscle reflex, spastic gait, Lhermitte sign

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Contributor Information and Disclosures

Author

Sandeep S Rana, MD, Clinical Associate Professor of Neurology, Drexel University College of Medicine
Sandeep S Rana, MD is a member of the following medical societies: American Academy of Neurology, American Society of Neuroimaging, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Medical Editor

William J Nowack, MD, Associate Professor, Epilepsy Center, Department of Neurology, University of Kansas Medical Center
William J Nowack, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Electroencephalographic Association, American Medical Informatics Association, and Biomedical Engineering Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James H Halsey, MD, Professor, Department of Neurology, University of Alabama Medical Center
James H Halsey, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neuroimaging, Medical Association of the State of Alabama, New York Academy of Sciences, Pan American Medical Association, Sigma Xi, Society for Neuroscience, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Howard A Crystal, MD, Professor, Departments of Neurology and Pathology, State University of New York Downstate; Consulting Staff, Department of Neurology, University Hospital and Kings County Hospital Center
Howard A Crystal, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association
Disclosure: Medivations Honoraria Consulting

 
 
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