Cervical Spondylosis Follow-up

Updated: Mar 30, 2018
  • Author: Hassan Ahmad Hassan Al-Shatoury, MD, PhD, MHPE; Chief Editor: Dean H Hommer, MD  more...
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Follow-up

Further Outpatient Care

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  • 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

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Further Inpatient Care

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  • 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.

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Inpatient & Outpatient Medications

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  • 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

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Transfer

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  • 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

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Deterrence

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  • 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.

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Complications

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  • Cervical myelopathy - Can cause disabilities, which are categorized as follows (see image below):

    • 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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Prognosis

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  • 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.

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Patient Education

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