Further Outpatient Care
See the list below:
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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
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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.
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Physical therapy is recommended (see Physical Therapy).
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Occupational therapy is often beneficial (see Occupational Therapy).
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The following specialists may be consulted as needed:
Social worker
Psychologist
Recreational therapist
Orthopedist
Neurologist or neurosurgeon
Urologist
Internist
Further Inpatient Care
See the list below:
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In general, patients with uncomplicated cervical spondylosis and mild disability can be followed up on an outpatient basis.
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Patients with severe disability are better examined in the hospital.
Inpatient & Outpatient Medications
See the list below:
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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
Transfer
See the list below:
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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
Deterrence
See the list below:
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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.
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If the patient has only morning stiffness, a long, hot shower every morning may help.
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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
See the list below:
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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.
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Paraplegia
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Tetraplegia
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Recurrent chest infection
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Pressure sores
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
See the list below:
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Cervical spondylosis is a slowly progressive, chronic joint disability, especially when it is associated with neuronal compression.
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Cervical spondylotic myelopathy is the most serious consequence.
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High – signal-intensity lesions can be seen on magnetic resonance images of spinal cord compression; this finding indicates a poor prognosis.
Patient Education
See the list below:
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For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Also, see eMedicineHealth's patient education article Shoulder and Neck Pain.
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A cervical myelogram shows advanced spondylotic changes and multiple compression of the spinal cord by osteophytes.
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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 T2-weighted cervical magnetic resonance imaging scan shows obliteration of the subarachnoid space as a result of spondylotic changes.
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A 48-year-old man presented with neck pain and predominantly left-sided radicular symptoms in the arm. The patient's symptoms resolved with conservative therapy. An axial, gradient-echo magnetic resonance imaging scan shows moderate anteroposterior narrowing of the cord space due to a ventral osteophyte at the C4 level, with bilateral narrowing of the neural foramina (more prominently on the left side).
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A 48-year-old man presented with neck pain and predominantly left-sided radicular symptoms in the arm. The patient's symptoms resolved with conservative therapy. A T2-weighted sagittal magnetic resonance imaging scan shows ventral osteophytosis, most prominent between C4 and C7, with reduction of the ventral cerebrospinal fluid sleeve.
