Cervical spondylosis - Treating cervical spondylosis

Treatment for cervical spondylosis aims to relieve symptoms of pain and prevent permanent damage to your nerves.

Pain relief

Over-the-counter painkillers

Non-steroidal anti-inflammatory drugs (NSAIDs) are thought to be the most effective painkillers for symptoms of cervical spondylosis. Some commonly used NSAIDs include:

If one NSAID fails to help with pain, you should try an alternative.

However, NSAIDs may not be suitable if you have asthma, high blood pressure, liver disease, heart disease or a history of stomach ulcers. In these circumstances, paracetamol is usually more suitable. Your pharmacist or GP can advise you.

Codeine

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 can advise on whether it is 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 pressure in the skull.

Muscle relaxants

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 dizzy and drowsy. If you have been prescribed diazepam, make sure you do not drive. You should also 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.

Amitriptyline

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 nerve pain. You may experience some side effects when taking amitriptyline, including:

drowsiness
dry mouth
blurred vision
constipation
difficulty urinating

Do not drive if amitriptyline makes you drowsy. Amitriptyline should not be taken by people with a history of heart disease.

Gabapentin

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.

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 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 option.

Exercise and lifestyle changes

You could consider:

doing low-impact aerobic exercises such as swimming or walking – read more about easy exercises
using one firm pillow at night to reduce strain on your neck
correcting your posture when standing and sitting – read more about how to sit correctly

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

Surgery is usually only recommended in the treatment of cervical spondylosis if:

there is clear evidence that a nerve is being pinched by a slipped disk or bone (cervical radiculopathy), or your spinal cord is being compressed (cervical myelopathy)
there is underlying damage to your nervous system that is likely to worsen if surgery is not performed

Surgery may also be recommended if you have persistent pain that fails to respond to other treatments.

It's important to stress that surgery often doesn't lead to a complete cure of symptoms. It may only be able to prevent symptoms from getting worse.

The type of surgery used will depend on the underlying cause of your pain or nerve damage. Surgical techniques that may be used include:

Anterior cervical discectomy – This 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. Some surgeons will insert a bone substitute to encourage fusion, and occasionally put a metal plate across the disc if there is slippage of one vertebra on the one beneath.
Cervical laminectomy – The surgeon will make a small incision in the back of your neck and remove pieces of bone that are pressing on your spinal cord. A similar approach is known as a laminoplasty, where bones are spread open to widen the space, but not removed.
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 new, there is no evidence about how well it works in the long term, or whether there will be any complications.

Most people can leave hospital within three to four days, but it can take up to eight weeks before you can resume normal activities. This may have an impact on your employment, depending on the type of work you do.

Many people are recommended to return to work on a part-time basis at first, although you should discuss this with your employer before surgery.

Complications of surgery

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 (pulmonary embolism) or a severe allergic reaction (anaphylaxis)
some mild difficulties with swallowing (dysphagia) – this usually passes within a few months
hoarse voice – this is a rare complication, but when it does occur it can be permanent
paralysis (inability to move one or more parts of the body) – which could occur if there is bleeding into the spinal canal after surgery, or the blood supply to spinal nerves is damaged
infection of the 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, which occurs in rare cases – this can result in persistent feelings of numbness and "pins and needles"

If it's decided that you could benefit from surgery, your consultant will discuss the risks and benefits with you.