eMedicine Specialties > Physical Medicine and Rehabilitation > Cervical Spine Disorders

Cervical Spondylosis: Follow-up

Author: Hassan Ahmad Hassan Al-Shatoury, MD, PhD, MHPE,, Associate Professor, Department of Neurosurgery, Suez Canal University; Co-Director, Center of Research and Development in Medical Education and Health Services Suez Canal University Hospital
Coauthor(s): Ayman Ali Galhom, MD, PhD, Lecturer (Associated Professor), Department of Neurosurgery, Suez Canal University Faculty of Medicine, Egypt
Contributor Information and Disclosures

Updated: Apr 24, 2009

Follow-up

Further Inpatient Care

  • In general, patients with uncomplicated cervical spondylosis and mild disability can be followed up on an outpatient basis.
  • Patients with severe disability are better examined in the hospital.

Further Outpatient Care

  • Obtaining a thorough history and physical examination is required to assess the following:
    • Status of the cervical spine
    • Function of the genitourinary, musculoskeletal, gastrointestinal, vascular, respiratory, and integumentary systems
    • Nutritional, psychological, and vocational aspects of independent living and healthy living habits
  • Laboratory studies may be indicated.
    • Tests can be used to determine the patient's overall state of health and the complete blood picture.
    • Urinalysis and an assessment of renal function may be performed.
  • Physical therapy is recommended (see Physical Therapy).
  • Occupational therapy is often beneficial (see Occupational Therapy).
  • The following specialists may be consulted as needed:
    • Social worker
    • Psychologist
    • Recreational therapist
    • Orthopedist
    • Neurologist or neurosurgeon
    • Urologist
    • Internist

Inpatient & Outpatient Medications

  • Medications may include the following:
    • NSAIDs - Acetylsalicylic acid, naproxen, ibuprofen, indomethacin, mefenamic acid, piroxicam
    • Corticosteroids - Oral prednisone or single IM injection
    • Muscle relaxants - Cyclobenzaprine, methocarbamol, and baclofen
    • Narcotic agents
    • Antidepressants - Doxepin, amitriptyline

Transfer

  • The patient may need to be transferred or referred to a facility in which the following specialists are available:
    • Occupational therapist - The therapist can help to modify the patient's home or work environment. Early referral is indicated to minimize deconditioning caused by further immobility or inactivity.
    • Physical therapist
    • Neurosurgeon
    • Recreational therapist
    • Psychologist

Deterrence

  • Patients may apply the following measures to help prevent cervical spondylosis or its complications:
    • Avoid high-impact exercise (eg, running, jumping).
    • Maintain cervical ROM with daily ROM exercise.
    • Maintain neck muscle strength, especially neck extensor strength.
    • Avoid holding the head in 1 position for a long period (for example, while driving or watching TV).
    • Avoid prolonged neck extension.
    • Be careful when performing physical activities that are done infrequently; such activities can trigger a flare in symptoms.
  • If the patient has only morning stiffness, a long, hot shower every morning may help.
  • Cervical spondylosis is difficult to prevent because it is a part of the normal aging process. Individuals may reduce their risk by maintaining good neck strength and flexibility along with leading an active and healthy lifestyle. Preventing neck injuries (eg, using proper equipment in contact sports, headrest and seatbelt use in automobiles) also may reduce the risk of developing this condition.

Complications

  • Cervical myelopathy - Can cause disabilities, which are categorized as follows (see image below and Image 2):
    • Grade 0 - Root signs and symptoms, with no evidence of cord involvement, are observed.
    • Grade I - Signs of cord involvement are present, but the patient's gait is normal.
    • Grade II - Mild gait involvement is present, and the patient may be employed.
    • Grade III - Gait abnormality prevents the patient's employment.
    • Grade IV - Ambulation is possible only with assistance.
    • Grade V - The patient is chair-bound or bedridden.
  • Paraplegia
  • Tetraplegia
  • Recurrent chest infection
  • Pressure sores
A 59-year-old woman presented with a spastic gait...

A 59-year-old woman presented with a spastic gait and weakness in her upper extremities. A T2-weighted sagittal magnetic resonance imaging scan shows cord compression from cervical spondylosis, which caused central spondylotic myelopathy. Note the signal changes in the cord at C4-C5, the ventral osteophytosis, buckling of the ligamentum flavum at C3-C4, and the prominent loss of disk height between C2 and C5.

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A 59-year-old woman presented with a spastic gait...

A 59-year-old woman presented with a spastic gait and weakness in her upper extremities. A T2-weighted sagittal magnetic resonance imaging scan shows cord compression from cervical spondylosis, which caused central spondylotic myelopathy. Note the signal changes in the cord at C4-C5, the ventral osteophytosis, buckling of the ligamentum flavum at C3-C4, and the prominent loss of disk height between C2 and C5.


Prognosis

  • Cervical spondylosis is a slowly progressive, chronic joint disability, especially when it is associated with neuronal compression.
  • Cervical spondylotic myelopathy is the most serious consequence.
  • High – signal-intensity lesions can be seen on magnetic resonance images of spinal cord compression; this finding indicates a poor prognosis.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Medical pitfalls
    • Use of a bed that is too hard
    • Overuse of muscle relaxants or pain medications
    • Prolonged rest, inactivity, or vigorous exercise
    • Overreliance on imaging studies
    • Failure to recognize depression
    • Failure to recognize sleep disturbance
    • Failure to recognize chronic pain syndrome
  • Legal pitfalls
    • The role of trauma in cervical spondylosis is controversial, especially in today's medicolegal climate.
    • In particular, worker's compensation and accidental injury cases may revolve around issues related to cervical spondylosis.

Special Concerns

  • Use and abuse of cervical orthotics
    • One of the most useful cervical orthotic devices for cervical spondylosis is the soft collar. Although it does not actually prevent neck motion, it serves as a reminder to immobilize the neck.
    • Cervical orthotic devices are inexpensive and do not interfere with carotid or vertebral circulation.
    • Cervical orthotic devices should usually be used only for short periods.
    • The center of a cervical orthotic device is wider than the ends. The collar should be worn so that the narrow portion is anterior. This positioning helps to make neck extension (which worsens spondylosis) difficult, while still permitting flexion.
  • Surgical intervention - The decision to pursue surgical intervention should be made with caution, especially in advanced cases with myelopathy. The surgical outcome may be unsatisfactory, and the patient and his/her relatives should be made aware of the expected benefits of surgery.14
 
Acknowledgments

The editors would like to thank Franklin C Wagner, Jr, MD, Former Chief, Division of Spine and Spinal Cord Surgery, Former Professor, Department of Neurosurgery, University of Illinois at Chicago College of Medicine, for his previous association with this article.



More on Cervical Spondylosis

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

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Keywords

cervical spondylosis, spine, back pain, cervical spine, neck pain, herniated disc, spinal stenosis, spondylosis, surgery spine, herniated disk, radiculopathy, spine pain, spinal cervical, stenosis, cervical, cervical spine surgery, cervical spondylotic myelopathy, cervical myelopathy, cervical arthritis, degenerative spondylosis, cervical osteoarthritis, spine spondylosis, degenerative arthropathy of the cervical spine, facet joints, longitudinal ligaments, ligamentum flavum, chronic cervical degeneration, cervical disk degeneration, disk herniation, spur formation, nerve root compression, progressive spinal cord compression, foraminal stenosis, spinal canal stenosis, chronic neck pain, quadriparesis, sphincteric dysfunction, chronic suboccipital headache, cervical radiculopathy, acute herniated disk, cervical intervertebral disk degeneration, transverse lesion syndrome, motor syndrome, central cord syndrome, brachialgia, tandem spinal stenosis, neurogenic claudication, gait abnormality, dysphagia, vertebrobasilar insufficiency, elevated hemidiaphragm, Spurling sign, Lhermitte sign, Hoffman sign, degenerative disk disease

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Contributor Information and Disclosures

Author

Hassan Ahmad Hassan Al-Shatoury, MD, PhD, MHPE,, Associate Professor, Department of Neurosurgery, Suez Canal University; Co-Director, Center of Research and Development in Medical Education and Health Services Suez Canal University Hospital
Disclosure: Nothing to disclose.

Coauthor(s)

Ayman Ali Galhom, MD, PhD, Lecturer (Associated Professor), Department of Neurosurgery, Suez Canal University Faculty of Medicine, Egypt
Ayman Ali Galhom, MD, PhD is a member of the following medical societies: Congress of Neurological Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Curtis W Slipman, MD, Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center
Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, and North American Spine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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