Treatment for symptoms due to cervical spondylosis aims to relieve pain and prevent any permanent damage to your nerves.
Non-steroidal anti-inflammatory drugs (NSAIDs) are thought to be the most effective painkillers for symptoms due to cervical spondylosis. The NSAID ibuprofen is normally recommended instead of aspirin, as there is less chance of adverse side effects.
However, NSAIDs may not be suitable if you have asthma, high blood pressure, liver disease, heart disease or a history of stomach and digestive disorders. In these circumstances, paracetamol would probably be more suitable. Your pharmacist or GP will be able to advise you.
If your pain is more severe, your GP may prescribe a mild opiate painkiller called codeine. This is often taken in combination with NSAIDs or paracetamol.
A common side effect of taking codeine is constipation. To prevent constipation, drink plenty of water and eat foods high in fibre, such as wholegrain bread, brown rice, pasta, oats, beans, peas, lentils, grains, seeds, fruit and vegetables.
Codeine may be unsuitable for a number of people, especially if taken for long periods of time. Your GP will be able to advise whether it safe for you to take codeine.
It is generally not recommended for people who have breathing problems (such as asthma) or head injuries, particularly those that increase the pressure in the skull.
Paracetamol is a medicine that is used to ease mild to moderate pain or to control a fever. It works as a painkiller by affecting chemicals in the body called prostaglandins. Prostaglandins are substances released in response to illness or injury. Paracetamol blocks the production of prostaglandins, making the body less aware of the pain or injury. Paracetamol reduces temperature by acting on the area of the brain that is responsible for controlling temperature.
If you experience spasms, when your neck muscles suddenly tighten uncontrollably, your GP may prescribe a short course of a muscle relaxant such as diazepam.
Muscle relaxants are sedatives that can make you feel drowsy and dizzy. If you have been prescribed diazepam, do not drive. Also, do not drink alcohol as the medication can exaggerate its effects.
Muscle relaxants should not be taken continuously for longer than a week to 10 days at a time.
If pain persists for more than a month and has not responded to the above painkillers, your GP may prescribe a medicine called amitriptyline.
Amitriptyline was originally designed to treat depression, but doctors have found that a small dose is also useful in treating pain. You may experience some side effects when taking amitriptyline, including:
- dry mouth
- blurred vision
- difficulty urinating
Do not drive if amitriptyline makes you drowsy. Amitriptyline should not be taken by people with a history of heart disease.
Gabapentin (or a similar medication called pregabalin) may also be prescribed by your GP for helping radiating arm pain or pins and needles caused by nerve root irritation. This medicine is otherwise used as an anti-epileptic drug.
Some people may experience side effects that disappear when they stop the medication, such as a skin rash or unsteadiness. Gabapentin needs to be taken regularly for at least two weeks before any benefit is judged.
Injection of a painkiller
If your radiating arm pain is particularly severe and not settling, there may be an option of a 'transforaminal nerve root injection', where steroid medication is injected into the neck where the nerves exit the spine. This may temporarily decrease inflammation of the problem nerve root and reduce pain.
Side effects include headache, temporary numbness in the area and, in rare cases, spinal cord injury (limb paralysis).
Your GP would have to refer you to a pain clinic if you wished to explore this as an option.
Exercise and lifestyle changes
You could consider:
- doing low-impact aerobic exercises such as swimming or walking
- using one firm pillow at night to reduce the strain on your neck
- correcting your posture when standing and sitting
The long-term use of a neck brace or collar is not recommended as it can make your symptoms worse. Do not wear a brace for more than a week, unless your GP specifically advises you to.
Surgery is usually only recommended in the treatment of cervical spondylosis if:
- you have severe radiating arm pain that is not settling and nerve root compression is shown on your MRI scan
- you have symptoms and signs of a progressive myelopathy
Surgery can sometimes be useful for radiating arm pain due to cervical spondylosis, but it does not benefit neck pain. Most people with radiating arm pain and cervical radiculopathy will actually get better themselves eventually. Therefore the idea of surgery is simply to speed up natural recovery.
Cervical myelopathy does not always need an operation either. If the symptoms are mild or not progressing, it may be better to leave things alone and 'wait and see'.
If surgery for cervical myelopathy is carried out, the surgeon will usually tell the patient that the operation is to stop things getting worse rather than to improve any symptoms that have already occurred.
The type of surgery used will depend on the underlying cause of your pain or nerve damage, such as a slipped disc or a narrowing of your spinal canal. Surgical techniques that may be used include:
- Anterior cervical discectomy, which is used when a slipped disc or osteophyte (lump of extra bone) is pressing on a nerve. The surgeon will make an incision in the front of your neck and remove the problem disc or piece of bone. This procedure results in a fusion across the disc joint.
- Cervical laminectomy. The surgeon will make an incision (small cut) in the back of your neck and remove the pieces of bone contributing to compression of your spinal cord.
- Cervical foraminotomy. This is where a particular nerve root is released by making a cut in the back of your neck. It is used in more select circumstances than an anterior cervical discectomy.
- Prosthetic intervertebral disc replacement. This relatively new surgical technique involves removing a worn disc in the spine and replacing it with an artificial disc. The results of this technique have been promising, but as it is still a very new technique, there is no evidence about how well it works in the long term or whether there will be any complications.
Like all surgical procedures, surgery on the cervical spine carries some risk of complications, including:
- rare complications associated with general anaesthetic, such as heart attack, blood clot in the lung or an allergic reaction
- paralysis, which could occur if there is bleeding into the spinal canal after surgery or the blood supply of spinal nerves is damaged
- infection of your wound after surgery, which is not usually serious and can be treated with antibiotics (deeper spinal infection is more serious but very rare)
- damage to nerves and blood vessels, which occurs in rare cases
If it is decided that you could benefit from surgery, your consultant will discuss the specific risks and benefits in your situation.