Articles on cervical vertebrae

Cervical Spondylosis

Vijay Bathina
What is Cervical Spondylosis?Cervical spondylosis is usually an age-related condition that affects the joints in your neck. It develops as a result of the wear and tear of the cartilage and bones are of the cervical spine. While it is largely due to age, it can be caused by other factors as well. Alternative names for it include cervical osteoarthritis and neck arthritis.One feature of the degeneration is that the edges of the vertebrae often develop small, rough areas of bone called osteophytes. Also, over many years, the discs become thinner. This degeneration is a normal ageing process which can be likened to having 'wrinkles in the spine'. In many people, the degeneration does not cause any symptoms. For example, routine X-rays of the neck will show these features (osteophytes and disc thinning) in many people who do not have any symptoms.However, in some people, the nearby muscles, ligaments, or nerves may become irritated or 'pressed on' by the degenerative changes. So, cervical spondylosis often causes no problems but can be a cause of neck pain, particularly in older peopleWhat Are the Risk Factors for Cervical Spondylosis?Ageing is the major factor for developing cervical osteoarthritis (cervical spondylosis). In most people older than age 50, the discs between the vertebrae become less spongy and provide less of a cushion. Bones and ligaments get thicker, encroaching on the space of the spinal canal.Another factor might be a previous injury to the neck. People in certain occupations or who perform specific activities -- such as gymnasts or other athletes -- may put more stress on their necks. Poor posture might also play a role in the development of spinal changes that result in cervical spondylosis.What Are the Symptoms of Cervical Spondylosis?The symptoms of cervical spondylosis include:Neck stiffness and painHeadache that may originate in the neckPain in the shoulder or armsInability to fully turn the head or bend the neck, sometimes interfering with drivingGrinding noise or sensation when the neck is turnedSymptoms of cervical spondylosis tend to improve with rest. Symptoms are most severe in the morning and again at the end of the day.If cervical spondylosis results in pressure on the spinal cord (cervical stenosis), it can put pressure on the spinal cord, a condition called cervical myelopathy. Symptoms of cervical spondylosis with myelopathy include:Tingling, numbness, and/or weakness in the arms, hands, legs, or feetLack of coordination and difficulty walkingAbnormal reflexesMuscle spasmsLoss of control over bladder and bowel (incontinence)Another possible complication of cervical spondylosis is cervical radiculopathy, when bone spurs press on nerves as they exit the bones of the spinal column. Pain shooting down into one or both arms is the most common symptom.Physiotherapy Rehabilitation ProgramImmobilization of the cervical spine is the mainstay of conservative treatment for patients with cervical spondylosis. Immobilization limits the motion of the neck, thereby reducing nerve irritation. Soft cervical collars are recommended for daytime use only, but they are unable to appreciably limit the motion of the cervical spine. More rigid orthoses (eg, Philadelphia collar, Minerva body jacket) can significantly immobilize the cervical spine (see Special Concerns). The patient's tolerance and compliance are considerations when any of the braces are used. A program of isometric cervical exercises may help to limit the loss of muscle tone that results from the use of more restrictive orthoses. Molded cervical pillows can better align the spine during sleep and provide symptomatic relief for some patients.Mechanical traction is a widely used technique. This form of treatment may be useful because it promotes immobilization of the cervical region and widens the foraminal openings.The use of cervical exercises has been advocated in patients with cervical spondylosis. Isometric exercises are often beneficial to maintain the strength of the neck muscles. Neck and upper back stretching exercises, as well as light aerobic activities, also are recommended. The exercise programs are best initiated and monitored by a physical therapist.Passive modalities generally involve the application of heat to the tissues in the cervical region, either by means of superficial devices (eg, moist-heat packs) or mechanisms for deep-heat transfer (eg, ultrasound, diathermy).Manual therapy, such as mobilization, may provide further relief for patients with cervical spondylosis. Mobilization is performed by a physical therapist and is characterized by the application of gentle pressure within or at the limits of normal motion, with the goal of increasing the ROM. Manual traction may be better tolerated than mechanical traction in some patients.

Cervical Treatment Diagnosis, Tests and Treatment

Dr. Sonica Chugh, Gynecologist/Obstetrician
Cervical Cancer is most treatable when it is diagnosed and treated early. Problems found can usually be treated, depending on their severity and on the woman’s age, past medical history, and other test results. Most women who get routine cervical cancer screening and follow up as told by their provider can find problems before cancer even develops. Prevention is always better than treatment.Other HPV cancers are also more treatable when diagnosed and treated early. Although there is no routine screening test for these cancers, you should visit your doctor regularly for checkups.Your doctor might recommend the HPV test if:Your Pap test was abnormal, showing atypical squamous cells of undetermined significance (ASCUS)You’re age 30 or olderThe HPV test is available only for women; no HPV test yet exists to detect the virus in men. However, men can be infected with HPV and pass the virus along to their sex partners.What is a HPV Test?The HPV test is a screening test for cervical cancer, but the test doesn’t tell you whether you have cancer. Instead, the test detects the presence of HPV, the virus that causes cervical cancer, in your system. Certain types of HPV — including types 16 and 18 — increase your cervical cancer risk.Knowing whether you have a type of HPV that puts you at high risk of cervical cancer means that you and your doctor can better decide on the next steps in your health care. Those steps might include follow-up monitoring, further testing, or treatment of abnormal or precancerous cells.Pap- HPV Test:HPV spreads through sexual contact and is very common in young women, so, frequently, the test results will be positive. However, HPV infections often clear on their own within a year or two. Cervical changes that lead to cancer take several years — often 10 years or more — to develop. For these reasons, you might follow a course of watchful waiting instead of undergoing treatment for cervical changes resulting from an HPV infection.A combination Pap-HPV test is performed in your doctor’s office and takes only a few minutes. You’ll lie on your back on an exam table with your knees bent, your doctor will gently insert an instrument called a speculum into your vagina. The speculum holds the walls of the vagina apart and a flat scraping device called a spatula or a soft brush is used to take samples of your cervical cells. This doesn’t hurt, and you may not even feel the sample being taken.Results of your HPV test are given as positive or negative Positive HPV test:A positive test result means that you have a type of high-risk HPV that’s linked to cervical cancer. It doesn’t mean that you have cervical cancer now, but it’s a warning sign that cervical cancer could develop in the future. Your doctor will probably recommend a follow-up test in a year to see if the infection has cleared or to check for signs of cervical cancer.Negative HPV test: A negative test result means that you don’t have any of the types of HPV that cause cervical cancer.Depending on your test results, your doctor may recommend one of the following as a next step:Normal monitoring:If you’re over age 30, your HPV test is negative and your Pap test normal, you’ll follow the generally recommended schedule for repeating both tests in five years.Colposcopy: In this follow-up procedure, your doctor uses a special magnifying lens (colposcope) to more closely examine your cervix.Biopsy:In this procedure, sometimes done in conjunction with colposcopy, your doctor takes a sample of cervical cells (biopsy) to be examined more closely under a microscope.Removal of abnormal cervical cells:To prevent abnormal cells from developing into cancerous cells, your doctor may suggest a procedure to remove the areas of tissue that contain the abnormal cells.Seeing a specialist: If your Pap test or HPV test results are abnormal, your health care provider will probably refer you to a gynaecologist for a colposcopic exam. If test results show that you might have cancer, you may be referred to a doctor who specializes in treating cancers of the female genital tract (gynecologic oncologist) for treatment

Cervical Cancer-Causes and Testing for Diagnosis

Dr. Sonica Chugh, Gynecologist/Obstetrician
What causes cervical Cancer?Genital Human papilloma virus (HPV) is a very common virus in both men and women that can lead to the development of genital warts, abnormal cervical cells or cervical cancer.This virus can cause normal cells on your cervix to turn abnormal. Over many years, abnormal cells can turn into cancer if they are not found and treated by your doctor. It can take 10 to 15 years (or more) for cells to change from normal to abnormal, and then into cancer. Abnormal cells are sometimes called ‘pre cancer ‘ because they are not normal, but they are not yet cancer.You cannot see or feel HPV or these cell changes on your cervix. Screening tests help us to look for these changes or for abnormal cellsHow is HPV spread?HPV is transmitted during genital skin to-skin sexual contact. This includes vaginal or anal sex and possibly oral sex.A person can get HPV even if years have passed since he or she had sex. They will never know it because HPV usually has no signs and symptoms.In most cases, HPV goes away within two years, without causing any health problems. It is thought that the immune system  fights off HPV infection naturallyWhat screening tests exist for HPV- related diseases?Cervical Cancer: Cervical cancer can be detected with routine Cervical cancer screening (Pap test) and follow-up of abnormal results. The Pap test can find abnormal cells on the cervix so that they can be removed before cancer develops.    Abnormal cells often become normal over time, but can sometimes turn into cancer. These cells can usually be treated, depending on their severity and on the woman’s age, past medical history, and other test results.An HPV DNA test, which can find certain HPV types on a woman’s cervix, may also be used with a Pap test in certain cases (called co-testing). The HPV-DNA test is done to determine if you are infected with one of the high-risk types or if your doctor finds certain type of abnormal Pap test result.Even women who were vaccinated when they were younger need regular cervical cancer screening because the vaccines do not protect against all cervical cancer strains.Is there a treatment for HPV or related problems?HPV vaccination could prevent most cancers and other diseases caused by HPV. There is no treatment for the virus itself, but there are treatments for the problems that HPV can cause:Visible genital warts may remain the same, grow more in number, or go away on their own. The warts can be treated when they appear.Abnormal cervical cells (found on a Pap test) often become normal over time, but they can sometimes turn into cancer. If they remain abnormal, these cells can usually be treated to prevent cervical cancer from developing. This may depend on the severity of the cell changes, the woman’s age , past medical history, and other test results. It is critical to follow up with testing and treatment, as recommended by a doctor.Post detection of ovarian cancer the doctors , depending on your cancer stage can recommend the treatment more- surgery, medical treatment, radiation therapy or chemotherapy.

5 Tips to Prevent Cervical Cancer

Dr. Manpreet Singh Bindra, Oncologist
Persistent infection with Human Papilloma Virus (HPV) is a common way of developing cervical cancer, with young women being the most susceptible to infections with the virus. To reduce the risk of developing cervical cancer: 1. Reduce your chances of getting infected with the virus: Young girls and women who engage in sexual activity with multiple partners should use condoms. In case of repeated vaginal infections, visit your healthcare professional for screening.2. Get a Pap test done every 3 years: Pap tests simply involve swabbing the cervix with a speculum to a sample then looking at the cells in the sample under a microscope to check for abnormal changes. Cervical cancer is one of those cancers that can be cured so regular pap testing is VERY important.3. Quit smoking: The nicotine and other components found in cigarettes are able to pass through your blood stream and can become deposited in the cervix where they can alter the growth of cervical cells. Smoking can also suppress your immune system making it more susceptible to HPV infections. You can dramatically reduce your risk of smoking if you give it up.4. Eat a healthy diet: A healthy diet is one that is rich in unrefined food (white foods, processed meat, high-sugar biscuits and confectionary), fruits and vegetables. A diet consisting of whole foods provides a variety of vitamins, minerals, phytonutrients, and antioxidants that work together to nourish your cells and keep them health.5. Maintain a healthy weight: Being overweight or obese increases the risk of insulin resistance, which may lead to type II diabetes and increase the risk of developing cancer. Women who have a waist circumference over 35 inches and men with a waist circumference over 40 inches are considered high-risk for a variety of diseases, including cancers. Check your waist circumference and lose weight if you need to by eating a healthy diet and performing moderate-high intensity exercise for at least 30 minutes a day, five times a week.

Positional Cervical Spondilitis.

Dr. Amita Arora, Homeopath
Dear Readers,With advanced technology, habits of living in comfort zones have given birth to aches and pain in nape of our neck.We use wrong postures while watching T.V,working on desktops,laptops and mobiles for long hours.Unknowingly we are producing harm to our own body and system.Holding cell phones and bending our neck at same side produces lot of traction in muscles of neck.Advancement in technology has brought great revolution in world but with that it has invited lot of problems of health too.We type on laptops for hours and sit for longer durations in one position,this brings on pain, stiffness in neck.Sometimes we get Vertigo along with Cervical pain.MRI reveals the effect or degeneration of Cervical vertebrae.Homoeopathic Medicines arrests the further degeneration and it helps in reducing the Inflammation.Spondilitis is more of inflammation and spondylosis is degeneration of vertebrae.With the help of Homoeopathic Medicines we arrest the stage of inflammation and reduce pain,swelling and stiffness.Its important to discuss your complete case details and your work schedule with your homoeopath and he/she will help you in recovery.Homoeopathic Health: Conium and Gelsimium helps in Cervical problems,and vertigo.But Every Cervical Patient will not recover with Conium or Gelsimium.There are other good remedies which help in healing.A registered homoeopath is the best person to judge your remedy and give you permanent solution.Health Tips: Avoid sitting for too long in one position.Give rest to your eyes and neck every half an hour for 5 to 7 minutes.Shrug your shoulders,rotate in circular movements to ease the muscles.Before going to bed apply Arnica Ointment (Homoeopathic medicine Arnica helps in inflammation and pain) and give HOT fomentation with hot towel.Practice Yoga daily under guidance.(Cervical patients who have Vertigo should avoid Chakrasan. Practice only under guidance.)

Cervical Cancer Is Preventable! And Here Is What You Need To Know!

Dr. Suman Singh, Gynecologist/Obstetrician
What is Cervical Cancer?Cervical Cancer is cancer of the "Cervix", also known as the "mouth of the uterus".In India, it is the 2nd most common cancer in women. This cancer is usually diagnosed too late, in often incurable stages because it shows no symptoms till its too late.The silent killer.Did you know? In India …About 122,844  new cervical cancer cases are diagnosed annually in India Cervical cancer ranks as the 2nd most common cause of female cancer in IndiaAbout 67,477 new cervical cancer deaths occur annually in IndiaCervical cancer kills  One Women/8 Minutes  & is the 2nd leading cause of cancer deaths in women in IndiaHow come you don't hear of it?Because no one likes to talk about it. It is embarrassing,painful and commonly misunderstood. Which is why we need to arm ourselves with the knowledge. It is the first step in learning how to protect yourself and the women you care for.How does one get Cervical Cancer?Cervical cancer is caused by a highly contagious virus called Human Papilloma Virus (HPV) when it infects the cervix. The virus is very common and is transmitted by skin-to-skin contact of the genital area. In fact, it has been shown that this viral infection is so common that 80% of all women would have had this infection at least once in their lifetimes by the time they are 50 years old. This is irrespective of race, personal hygiene,diet, education level, personal habits etc. Cervical Cancer is not hereditary.Human Papilloma Virus (HPV) Causes:Who is likely to get Cervical Cancer?Every normal, sexually active woman is at risk for cervical cancer. It affects women at the prime of their lives when they are indispensable for their families.The risk for HPV infection that eventually leads to cervical cancer begins in adolescence and continues into adulthood. But even though it is the woman who gets cervical cancer, the disease affects her whole family if she loses her health or in many cases, her life. Imagine losing a mom, wife,sister in the prime of her life……...Can Cervical Cancer be prevented?Now it can!The only way to prevent Cervical Cancer before it can even happen is to get vaccinated.How does the vaccine work?Vaccination works by getting your body to produce antibodies against the HPV virus.These antibodies protect your body from an HPV infection by fighting the virus when it tries to attack the cervix. Since HPV infection is the only cause of Cervical Cancer,vaccination against the virus protects against Cervical Cancer.Who should take the vaccine and when?Ideally, the vaccine should be taken as early as possible after the age of 9 years but girls and women of any age up to 45 can benefit from this vaccine. Expectant mothers should not take the vaccine during their pregnancy. Talk to a doctor for advice.What is vaccine and how is the dose schedule?There are two  vaccines   one is  HPV2 (16,18 )  and HPV4 (6,11,16,18 ).HP4 (6,11,16,18 ) prevent Cervical ,Vulvar and Vaginal Cancer and Ano-Genital Warts. HPV4  vaccine is  safe during lactation.Vaccine is given in three doses as follows:  2 months and  6 months.(0,2,6 month).In special cases (ex: impending marriage or travel, planning a pregnancy soon etc.), the doctor can "abbreviate" the schedule to 0,1and 4 months.How soon will the protection work?The full protection comes into effect usually within a month of the last dose. This varies from individual to individual, depending on their own body's immune system. It is important to complete the schedule.How long will the protection last?This is not a relatively new vaccine and has been around for general use since 2006 and is now used in 135  countries and 178 Million doses administered  world wide. It has been tested for a lot longer through clinical trials world wide. So far the data has shown that vaccinated women have been significantly protected from the disease since they got the vaccine ( 10 yrs according to published data).The WHO, CDC (Centre for Disease Control and Prevention)  and various organizations  do not recommend  booster  dose . There is a good  life-long protection as well.  The WHO has recommended to governments and the Immunization Committee of the IAP has in the meanwhile recommended to individuals – If you can afford it, take it.What about side effects?The vaccine has been studied and is generally safe and well tolerated. Like many vaccines, pain at the site of the injection is not uncommon. Talk to a doctor for full details or any other questions on side effects. Cervical Cancer is a serious and life threatening disease.Where can I get more information?The best source of medical information is a qualified and well informed doctor,preferably a specialist. A Gynecologist (or a Pediatrician for your daughter older than 9 yrs) is the person you should talk to. Half knowledge, hearsay and articles / opinions by biased or inexpert opinion leaders can mislead you. Please consult a doctor.

Cervical Cancer Facts That Women Must Know!

Dr. Sandeep Nayak, Surgical Oncologist
We generally shy away from discussing anything related to sexual practices and menstrual hygiene due to our personal and social inhibitions. As these issues are considered as tabooed in developing countries like India, it is quite a task to educate people, especially women about cervical cancer which results mainly from undesirable sexual habits and poor menstrual hygiene.  Being one of the easily preventable as well as curable cancers, creating awareness about the disease has become the need of the hour. This article sheds light on cervical cancer, its causes, early detection and prevention.What is cervical cancer? Who is prone to it?It’s an uncontrolled, unwanted growth of cervical cells. Cervix is a narrow lower part of the uterus or womb. It connects the uterus with vagina. Women in the age group of 30 to 50 are most prone to this disorder.What are cervical cancer symptoms and signs?Bleeding post sexual intercourseBleeding in between menses or after menopauseExcessive white dischargeWhat causes cervical cancer?The human papillomavirus (HPV) has been identified as the major contributing factor to cervical cancer. It might get transmitted sexually.Early age at the time of the first sexual intercourseMultiple sexual partnersHistory of sexually transmitted diseasesFirst pregnancy at an early ageFour or more pregnanciesPoor menstrual and genital hygieneHow can it be detected?Pap smear test is an easy way to detect abnormal cells in the cervix. Every woman should take a Pap smear test once in two years.How to prevent cervical cancer?The best way to prevent cervical cancer is to have the HPV vaccine at the age of 12 or 13. The vaccine can be taken upto the age of 35. Women should have a regular Pap tests done once they turn 21 or 2 years after the first sexual intercourse. Moreover, they should maintain better vaginal and menstrual hygiene.With early detection and prevention techniques at their disposal, protecting themselves against cervical cancer is pretty much in women’s hands. So ladies, make the best use of available practices and facilities and safeguard yourself and every important woman in your life.

Cervical Spondylosis

Dr. Yogesh Pithwa, Spine Surgeon
What is meant by cervical spondylosis?The term “cervical” refers to the spinal column in the neck region. The term“spondylosis” refers to any ailment of the spine!! The term spondylosisis used loosely for all kinds of neck pain, from the purely innocuous ones to the ones those require surgical intervention. This neck pain may be in the nape of your neck, or very often may be present between the two shoulder blades.What causes cervical spondylosis?Cervical spondylosis can be caused by a slipped disc or a bony overgrowth or a combination of both. What is a slipped disc? Our spine is made up of a number of bones called vertebrae stacked one on top of another. A disc is a soft, gel-like structure present between two adjacent vertebrae. Normally, these discs act like ‘shock-absorbers’ and also allow some movement between the two adjacent vertebrae, giving the spine its flexibility. When this disc slips beyond its normal confines, it can compress the spinal cord or its nerve roots located close by and lead to problems.Why does the disc slip out? Over the years, the disc develops small microscopic tears, which may unite together over a period of time such that with some trivial injury or some innocuous activity, the disc may slip out of its normal confines. As a part of the normal aging process, the spine may develop some extra bone growth, leading to compression of the adjacent spinal cord or its nerve roots leading to pain.How does cervical spondylosis manifest?One of the commonest complaints is neck pain that may be present either at the nape of the neck or between the two shoulder blades. This pain would generally be noted on some kind of neck movement or on coughing or sneezing. Similar to “sciatica” that occurs in the lower back, when the pain starts radiating down into the upper limbs, it is referred to as “radiculopathy”. Another complaint of cervical spondylosis is unsteadiness while walking. This is the most important complaint to note as very often, this complaint gets relegated to the normal aging process in the older population in whom it is most frequently noted.Can any other condition mimic cervical spondylosis?Any compression or problem affecting the nerves after they leave the spinal canal can also lead to pain along the hand. The most common condition that can affect the nerves after they leave the spinal canal is ‘peripheral neuropathy’, a condition wherein the nerves are ‘weakened’ secondary to diabetes, chronic alcoholism, smoking, other forms of tobacco consumption, nutritional deficiencies or other rare causes. A common complaint in patients with peripheral neuropathy is the presence of pain even at rest, pain of a burning nature or numbness in ‘glove and stocking’ distribution i.e. over the hands, just beyond the wrist joints and over the lower limbs, just beyond the knee joints. Additionally, once the nerves leave the spinal cord, they have to travel through a narrow space termed “thoracic outlet” at the base of the neck so as to reach the upper limbs. There may sometimes be compression at this level, leading to pain radiating down into the upper limbs. Neck and back are often termed the mirrors of the mind. Hence, stressful periods are likely to give you some neck or back pain as well! Poor posture is also a common culprit for neck and back pain.How does the doctor diagnose my condition?An accurate history is the most important diagnostic tool. The way the pain started and progressed, specific aggravating and relieving factors of pain, distribution of pain over your body, associated complaints such as weakness or numbness over the upper or lower limbs will be a guide to short listing the possible causes of your neck pain. A very important history relates to difficulty or clumsiness while walking.A detailed clinical examination involving assessment of spinal motion, assessment of your neurology and certain special tests will allow to further narrow down the causes to 2-3 most probable ones. Though this process of history-taking and clinical examination may appear boring and long-drawn, it is the most crucial part towards prescribing the correct treatment to you. So, it is essential to cooperate with your doctor throughout this entire procedure, which gives more information to the doctor regarding your ailment than any other investigation including an MRI.How does the doctor investigate for cervical spondylosis?On the first visit, if your problem is short-lived and there are no major signs or symptoms, you may not need any further investigation. However, if your problem has been present for some time, or if there is some history of trauma, fever, any other major illness, or any notable findings on clinical examination related to neurological dysfunction, you are likely to require some further investigations.Commonly, plain x-rays of the spine may be ordered with or without some basic blood investigations such ashemoglobin, erythrocyte sedimentation rate [ESR], CRP, RA test, serum calcium, phosphorus and alkaline phosphatase.Based on these tests, or sometimes, in the presence of some significant signs or symptoms, you may be asked to undergo MRI scanning. Plain x-rays demonstrate bony features, while MRI demonstrates the spinal cord, its nerve roots, the intervertebral disc between the two bones of the spine. Both these tests are complementary in nature, doing one does not necessarily mean that the other one is not needed.In some cases such as peripheral neuropathy orthoracic outlet syndrome, additional investigation in the form of EMG-NCVtest, to assess the function of each of the various nerves in your limbs may be required. Rarely, a Color Doppler examination of the upper limb blood vessels may be asked for.Is there any non surgical treatment for cervical spondylosis?The treatment would depend on the duration of your problem, presence of similar episode in the past, neurological function, response to previous nonoperative treatment and lastly, the subjective severity of your pain. Various nonoperative means of treatment include painkillers, muscle relaxants, various modalities such as heat and electrical stimulation, cervical traction, activity restrictions, etc. Painkillers will be prescribed to allow a smoother and easier return to normal function. You would generally be prescribed these on a shorter term or on a longer-term tapering program so as to guard against possible over dependence on these agents, as these are associated with significant side effects if used excessively in the long term. These side effects may range from hyper acidity, gastric ulcer, kidney damage, bleeding disorders, constipation, addiction, etc.  In addition, based on individual merit, you may also be prescribed muscle relaxants so as to relax and soothe your neck and back muscles. This is so because whenever you have neck or back pain, your muscles tend to go into spasm[sustained contraction] and hence, lead to pain. It is essential to break this spasm with a muscle relaxant so as to give effective pain relief.Physiotherapy modalities may be used. This consists broadly of passive and active physiotherapy. During acute pain, generally, only passive physiotherapy would be used. This would be in the form of heat or electrical stimulation in various forms such as SWD [short-wave diathermy], TENS [transcutaneous electrical nervestimulation] and IFT [interference therapy]. Cervical traction too, aids in relaxing the aching neck. In severe cases, you may be recommended to get admitted in the hospital for a day or two to get this physiotherapy on a more aggressive note.  After pain relief, you would be prescribed active physiotherapy i.e., spinal exercises. Based on your complaints, your exercise protocol would be decided by the doctor.You would need to have some activity modifications and restrictions to help your spine get back into shape and stay that way!! If you have a job on hand that requires you to sit continuously for hours on end, then you can sit for 15-20 minutes and then get up and walk around for about 5 minutes, gently shrug your shoulders and perform circular movements in the air with your shoulders, first in the clockwise direction and then in the anti - clockwise direction. Bifocal lenses in spectacles would require you to bend your neck backwards while reading which is not a very healthy practice for your neck spine. Smoking interferes with the nutrition of the disc in between the vertebrae and hence, would need to be abandoned forever! Try to sit in a chair that has a high backrest that supports your neck as well. Try to keep the computer at your eye-level. Do not stack up pillows underneath your head so as to be able to read while sleeping! Ideal position to sleep is sideways with a pillow underneath the head just about adequate to fill up the gap between the side of your head and your shoulder. While lying down with the face upwards, use a very thin pillow or just fold a bed sheet and keep it underneath the head. When is surgery essential?Surgery would be indicated when there is no pain relief despite symptomatic treatment as mentioned above or, when there is significant neurological deficit or, repeated episodes of pain so as to get a permanent solution to the problem. What is the nature of surgery?Microdiscectomy is the usual surgery for cervical spondylosis. This is a surgery performed through the microscope so as to make this a relatively safe procedure. When many levels are involved, the surgery may be done from the backside, otherwise, it would be from the front. Is it a major surgery? We were told that we should not get a spine surgery done as it can lead to paralysis! Or, inother words, what are the risks involved? Even if you are walking out on the streets, you never know when some vehicle will come from behind you and knock you over! So, would you stop walking on the street for fear of this risk? Everything in life carries some inherent risk associated with it. The option for surgery would be offered only if the benefits of surgery significantly outweigh the risks. Rather than asking as to what are the risks of going in for surgery, it would be more prudent to ask as to what are the risks and benefits of getting the surgery done as compared to not getting the surgery done? Spine surgery has had a lot of advances in the past decade or two, there are better imaging facilities like MRI, better surgical instruments, surgical microscope to aid vision in the surgery, computer navigation system to further increase the safety level of surgery, better training and information in an overall sense making spine surgery no longer the taboo that it once was! So, if you have a problem that genuinely requires surgery, there is no point in tying yourself down to the bed for days or months on end because ultimately life is mobility and mobility is life! Discuss the details of your surgery and its attendant risks with your doctor to quell any fears and to clear any and every doubt of yours! If you so desire, your doctor can even arrange to give you references of patients who have undergone similar surgeries. Can we replace the disc? In other words, won’t it be harmful to remove the disc? The disc that has slipped out can no longer carry out its normal function, rather, it is causing harm to the body rather than doing anything good! So, trying to replace the disc back into its position is not a viable option. However, it is possible to replace the damaged disk with an artificial disk that would function similar to the natural disk.How is the post operative recovery and rehabilitation?Generally, you will be admitted one day prior to the day of surgery. You will be advised to fast after dinner the previous night. Surgery would generally be carried out the next day morning. After surgery, on the 2nd or 3rd day, you will be made to walk with a cervical collar. You may be discharged after 3-4 days. Sutures [stitches] would be removed generally on the 10th–14th day following the surgery. By this time, you will be walking around and essentially be independent in doing activities of daily life. You will be allowed to take bath 48 hours after the suture removal. For 3-4 weeks, you will be allowed restricted mobilization within the house. During this period, you will be encouraged to increase all your activities in gradual weekly increments. A month later, you will be starting with spinal strengthening exercises. You will have to use the cervical collar for about 1-3 months at all times other than while taking bath. You will not be allowed to smoke for life!Will I be able to return to work after the surgery?Though you would be up and about, walking about within the first ten days following the surgery, you will be allowed only limited mobilization within the house in the first one month following surgery. Thereafter, if you are having a sedentary light job, then you may be allowed to resume work, provided you do not have to travel for a prolonged time on some bumpy road(s). If you were having some job that requires some moderate labor, you would be allowed to resume work up to three months after surgery. If you were involved in heavy manual labor, it would be wiser to seek some permanent job modification in these situations. Staying off work for more than three months post-surgery is not recommended at all.What about alternative techniques such as manipulation, bone setting, homeopathy, acupressure?Death has been reported following violent manipulation of the neck by some people. Hence, it is not at all recommended. As long as no neurological deficit [loss of sensation, weakness or clumsiness while walking] is present, alternative medicines may be tried. However¸ procrastination in the presence of neurological deficit is not recommended.What about newer advances in the treatment of this condition?Microscope allows for the use of both eyes while working, giving binocular vision and thereby, good depth perception that is very essential for the safe performance of these surgeries. This binocular vision is lacking in endoscopic discectomy. Percutaneous laser discectomy has not been proven to be scientifically superior to microdiscectomy. Rather than doing the conventional surgery of fusion at the level of discectomy, it is possible to replace the disk with an artificial one.This would simulate normal spinal function and hence, is a better surgery than the conventional fusion. However, it is costlier than the conventional fusion surgery·.