Cervical Discogenic Pain Syndrome Treatment & Management

Updated: Jul 24, 2014
  • Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Craig C Young, MD  more...
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Treatment

Acute Phase

Rehabilitation Program

Treatment for cervical discogenic pain depends on the clinical presentation and other concomitant medical conditions that can interfere or limit certain interventions. Many cervical disc herniations can be managed successfully with aggressive nonsurgical treatment. Conservative nonsurgical treatment includes use of medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), a short course of steroids on a tapering dose, nonnarcotic analgesics, or short-term narcotic analgesics; partial rest; and instructions on proper posture, proper body mechanics, and a home exercise program. [51, 52]

Physical Therapy

For patients with cervical discogenic pain with or without radiculopathy, physical therapy should be focused on educating the patient about proper posture, proper body mechanics, and how to implement a specific exercise program. The exercise program should be supervised initially to assure proper technique and performance of the exercises.

The McKenzie method of mechanical evaluation and treatment of the cervical spine involves establishing a baseline ROM with single cervical spine motion in each direction, a baseline level of pain, and a baseline of more distal or peripheral symptoms, as well as identifying patterns of movements or positions that decrease symptoms and improve the segmental motion. At times, it is necessary to add force by a mobilization or manipulation to attain end range of movement in the already identified direction of preference. [2, 53, 54, 55]

After obtaining a baseline of ROM and symptoms, test repetitive motion of the cervical spine to the end range of each direction by frequently assessing the changes in the initial symptoms and ROM with repetitive end range movement. [2] If symptoms worsen as a result of repetitive movements in a particular direction, that particular movement should be stopped immediately. [2]

If symptoms and/or ROM improve upon a specific direction of motion (ie, retraction) and no symptoms peripheralize, a direction of preference is established. This direction of preference is used in a specific rehabilitative exercise program. [2, 53, 54, 55]

At times, patients with radicular symptoms can experience the phenomenon of centralization. McKenzie described centralization as the phenomenon whereby as a result of the performance of certain repeated movements or the adoption of certain positions, radiating symptoms originating from the spine and referred distally are caused to move proximally toward the midline of the spine. [2, 53, 54, 55] Centralization is the hallmark sign that a correct movement or position is being performed, whereas peripheralization is a contraindication to further movements in that direction. [2, 53, 54, 55]

Surgical Intervention

Surgical intervention for cervical discogenic pain syndrome (CDPS) is commonly considered in cervical radiculopathy or myelopathy with persistent radicular pain, motor weakness, progressive neurologic deficits, or evidence of cord compression with no response to appropriate conservative treatment.

Anterior cervical discectomy (ACD) using an operating microscope is a safe and effective approach for patients with soft disc herniations. [56, 57, 58, 59] Anterior cervical discectomy with interbody fusion (ACDF) is preferred for patients with advanced spondylosis. A single-level surgery is preferred to multiple levels. [56, 57, 59] Studies report successful outcomes for pain relief, patient satisfaction, and increased function in persons with neck pain in the absence of radicular symptoms that have been managed with anterior cervical discectomy and fusion. [58, 60]

The surgical treatment of cervical degenerative disc disease should be considered only after an adequate trial of conservative treatment has failed. [61] Multiple studies report of patients with herniated cervical intervertebral discs and cervical radiculopathy who experience successful response to nonoperative treatment interventions. [17, 62, 63, 64, 65] Furthermore, studies document the regression of cervical disc herniations accompanying the resolution of cervical radiculopathy. [66, 67, 68]

Other Treatment

At times, patients with cervical discogenic pain syndrome (CDPS) require image-guided interventional procedures to control their pain and facilitate their participation in physical therapy. [17, 65] Cervical epidural injections are commonly used with successful results in patients with cervical radiculopathy. [17, 62, 69, 70] Use of fluoroscopic-guided selective nerve root blocks can be an effective alternative approach for cervical epidural steroid injections in patients with atraumatic cervical spondylotic radicular pain. [71, 70]

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Recovery Phase

Rehabilitation Program

Physical Therapy

This phase of rehabilitation for cervical discogenic pain syndrome (CDPS) focuses on soft-tissue overload and biomechanical dysfunction. The goals of this phase are to eliminate pain, normalize spinal mechanics, and improve neuromuscular control of the injured cervical spine. Restoration of the resting muscle length and full, pain-free, cervical ROM are necessary. Strengthening exercises start in simple planes and progress to complex muscle patterns.

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Maintenance Phase

Rehabilitation Program

Physical Therapy

The final phase of rehabilitation for cervical discogenic pain syndrome (CDPS) requires functional, pain-free cervical ROM and proper spinal and shoulder girdle mechanics. Sport-appropriate flexibility, strength, and skills are necessary before return to play. Sport-specific activities should be reviewed to ensure correct techniques, especially in contact and collision sports.

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