Cervical spondylosis or arthritis of the neck, commonly known as stiff neck is generally caused due to age-related, wear-and-tear changes causing degeneration of the disks and joints of the neck (cervical spine). About 85% of people over the age of 60 may get cervical spondylosis with pain and stiffness in the neck as the commonest symptom. However,  many people with cervical spondylosis may not experience any noticeable symptoms. 

In the majority of the cases, cervical spondylosis can be treated conservatively with medication and physical therapy, severe cases may require surgical treatment. In this health article we discuss the various treatment options for cervical spondylosis.

Nonsurgical Treatment

Physical therapy

  • Physical therapy involves specific exercises that stretch and strengthen the weakened or strained muscles and relieve pain. It is usually the first nonsurgical treatment recommended for cervical spondylosis.
  • In addition to exercises physical therapy may also involve correction of posture (posture therapy) and application of traction. 
  • The recommended duration for physical therapies is variable based on the severity of the condition and generally lasts from 6-8 weeks with therapy sessions scheduled 2 to 3 times per week.

Medications

  • Pain relievers such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, and naproxen are the first-line medications considered for relieving neck pain. These medicines relieve both pain and inflammation (swelling). These medications can be prescribed for several weeks. 
  • Other classes of medications are recommended if the pain persists and include oral corticosteroids and muscle relaxants.

Cervical Orthosis

  • Soft cervical collar -  A padded collar that is wrapped around the neck to limit neck motion and provide rest to the neck muscles. The cervical collar is often recommended for a short period of time as long-term use may adversely affect the muscles of the neck by decreasing their strength.

Heat or cold application

  • Application of ice packs or hot-water bags and other modalities may be recommended to help relieve symptoms.

Minimally invasive interventions

Steroid-based injections - Patients may benefit for a short-term and have pain relief from steroid injections. The most common steroid injection procedures for neck pain include:

  • Cervical epidural block - Steroid and anesthetic medicine injection into the epidural space (space next to the covering of the spinal cord) typically used for neck and/or arm pain caused by cervical disk herniation, also known as a pinched nerve or radiculopathy.
  • Cervical facet joint block - Steroid and anesthetic medicine injection into the capsule of the facet joint (the joints located in the back of the neck that provide stability and movement to the neck).
  • Medial branch block and radiofrequency ablation - Used for both diagnosis and pain relieving. The procedure is usually used in cases of chronic neck pain. 

Surgical Treatment

  • Surgery is often not recommended for cervical spondylosis and neck pain unless there is a pinched spinal nerve by a herniated disk or bone (cervical radiculopathy) or in case of cervical spondylotic myelopathy a condition where the spinal cord is being compressed. 
  • Patients with progressive neurologic symptoms, such as numbness and weakness in the arm, or unsteadiness while walking, or falling, may benefit by the surgery.
  • Surgery may also be recommended if the neck pain is severe (without nerve compression) that has not been relieved by nonsurgical treatment.

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