Cervical Spondylosis - Treatment

Treatment is by nature conservative. Regimens are most commonly used NSAIDs, physical therapy and lifestyle changes.Cervical spine immobilization is the standard conservative therapy for these patients. Immobilization limits neck motion and reduce nerve irritation. Soft cervical collars are recommended for daily use. More rigid corsets Philadelphia, Minerva can significantly immobilize the spine.
Neck immobilization
It is done with soft collar, Philadelphia collar, ortoza rigid corset Minerva. Despite widespread use, soft collars are considered to have significant placebo effect because it limits the movement of the cervical spine. Demonstrated that they would not change the prognosis. As symptoms improve, the collar may be worn only during demanding activities. Eventually may be removed. Collars sturdier and better devices may limit the movement of the spine, but also reduce muscle tone and cause neck stiffness. It will implement a daily exercise program to limit loss of muscle tone.
Pharmacologic Treatment
NSAIDs are based therapy. They are effective by reducing the biological effects of inflammation and pain. Their management should be monitored for adverse effects and gastropathy, renal toxicity, hypertension, liver disorders and hemorrhage. Inhibitors of COX-2 selective cicloxigenazei celoecoxib as decrease the risk of stomach bleeding.Tricyclic antidepressants are indicated for patients who experience chronic pain. Common side effects include dry mouth, sedation, urinary retention, constipation, cardiac conduction block.Muscle relaxants such as carisoprodol and ciclobenzapina are beneficial in patients with spasm of neck muscles.Opioids are indicated in patients with moderate to severe pain with significant structural spondylosis, which are not candidates for surgery and those who have failed therapy with other agents. For those at risk from NSAID gastropathy, especially opioids are reasonable grounds geriatric population.Steroids are controversial. In some patients with significant radiculopathy a high dose of steroids to reduce pain and shorten the symptoms. Some patients with progressive myelopathy spondylosis also shows the benefits. Epidural steroid injections help patients with radicular symptoms. Patients experiencing acute injury caused by osteophites ventral medullary benefit of high dose methylprednisolone.
Lifestyle changes
Includes relaxation techniques, or ergonomic changes at work, body mechanics training. Instruction in body mechanics include avoidance of neck rotation and stretching, avoiding prolonged extension of the neck, avoiding prolonged sitting position, selecting a suitable seat requirements.
Physical Therapy
It represents one of the oldest treatments for spinal disorders.Medical cervical traction, cervical radiculopathy used to relax those application dura foil, reduce disc compression and irritation and improve circulation in epidural space. Can be used at home three times a day for 15 minutes. It is contraindicated in patients with myelopathy, positive Lhermitte sign or rheumatoid arthritis.Manipulation is practiced by chiropractors and doctors osteopathy.It remains a popular treatment for back pain. Exercise suitable for neck pain include the neck stretches, shoulder stretches, flexibility and aerobic exercises. Other methods used are routine acupuncture for pain, heat, cold, massage, injections in the painful points, transcutaneous electrical nerve stimulation. Most are effective in combination.
Surgical Therapy
Surgery is occasionally performed. Many therapeutic modalities for cervical spondylosis have not been studied yet. Surgery is indicated for patients with cervical radiculopathy with persistent pain, weakness, or progressive symptoms that do not improve with physical therapy. Surgical indications for cervical spondylosis myelopathy still remain controversial.
Surgical anterior or posterior surgical approaches.The above includes:-Disectomia with or without bone graft-Cervical instrumentation.Posterior surgical approaches include:-Laminectomia decompression and foraminotomy-Hemilaminectomia, laminoplastia.
InjectionsCervical steroid injections, zigoapofizeale, articular sinovitele are useful assets. The practice of epidural nerve blocks. Improving the long term can be obtained by rizotomie. Cervical epidural block is useful in cervical spondylosis, especially if there is an inflammatory component. And epidural blocks, selective nerve root radiculopathy are diagnostic and therapeutic. Painful injections may be useful in points.
Bowel and bladder dysfunctionSome patients with bowel dysfunction benefits of suppositories, enemas or oral laxatives. Managing digital stimulation require prior patient so that defecation occur at the set time. Bladder incontinence will be evaluated by urodynamic studies.Pharmacological intervention is possible in some patients, but for most it takes a program of intermittent catheterization and controlling fluid intake.
Prognosis
Evolution of cervical spondylosis may be slow and prolonged, and patients can either remain asymptomatic or mild neck pain.Nonprogressive disability periods are typically long, and in some cases the patient's condition deteriorates. Morbidity ranges from chronic neck pain, radicular pain, reducing space motion, headache, myelopathy leading to weakness and impaired motor coordination until quadripareza sphincter dysfunction and in advanced cases. Patients may become wheelchair dependent.