Neck pain can be often related to getting older. Like the rest of the body, the disks and joints in the neck (cervical spine) slowly degenerate as we age. Cervical spondylosis, commonly called arthritis of the neck, is the medical term for these age-related, wear-and-tear changes that occur over time.
The condition most often causes pain and stiffness in the neck. In most cases, cervical spondylosis responds well to conservative treatment that includes medication, physiotherapy and injections.
Cervical spondylosis arises from degenerative changes that occur in the spine as we age.
Disk Degeneration and Bone Spurs(osteophytes): As the disks in the spine age, they lose height and begin to bulge. They also lose water content, begin to dry out and weaken. This problem causes settling, or collapse, of the disk spaces and loss of disk space height.
As the facet joints experience increased pressure, they also begin to degenerate and develop arthritis, similar to what may occur in the hip or knee joint. The smooth, slippery articular cartilage that covers and protects the joints wears away.
If the cartilage wears away completely, it can result in bone rubbing on bone. To make up for the lost cartilage, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth, called bone spurs or osteophytes, may narrow the space for the nerves and spinal cord to pass through (stenosis).
For most people, cervical spondylosis causes no symptoms. When symptoms do occur, they typically include pain and stiffness in the neck. This pain can range from mild to severe. It is sometimes worsened by looking up or looking down for a long time, or by activities in which the neck is held in the same position for a prolonged period of time—such as driving or reading a book. The pain usually improves with rest or lying down.
Other symptoms may include:
- Grinding or popping noise or sensation when you turn your neck
- In some cases, cervical spondylosis results in a narrowing of the space needed for the spinal cord or nerve roots. If this occurs, your symptoms may include numbness and weakness in the arms, hands, and fingers
- Trouble walking, loss of balance, or weakness in the hands or legs
- Muscle spasms in the neck and shoulders
In most cases, treatment for cervical spondylosis is nonsurgical. Nonsurgical treatment options include:
Physiotherapy: Physiotherapy is usually the first nonsurgical treatment that your doctor will recommend. Specific exercises can help relieve pain, as well as strengthen and stretch weakened or strained muscles. In some cases, physical therapy may include posture therapy or the use of traction to gently stretch the joints and muscles of your neck. Physiotherapy programs vary in length, but generally last from 6 to 8 weeks. Typically, sessions are scheduled 2 to 3 times per week.
Medications: During the first phase of treatment, your doctor may prescribe several medications to be used together to address both pain and inflammation.
- Acetaminophen – Acetaminophen is an over-the-counter pain reliever that can be effective in reducing mild arthritis pain. Like all medications, however, over-the-counter pain relievers can cause side effects and interact with other medications you are taking. Be sure to discuss potential side effects with your doctor.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – Often prescribed with acetaminophen, NSAIDs such as ibuprofen and naproxen are considered first-line medications for neck pain. They relieve both pain and swelling and may be prescribed for a number of weeks, depending on your specific symptoms. Other types of pain medication can be considered if you have serious contraindications to NSAIDs or if your pain is not well controlled. These medications can irritate the stomach lining and cause internal bleeding. They should be taken with food. Consult with your doctor before taking over-the-counter NSAIDs if you have a history of ulcers or are taking blood thinning medication.
- Muscle relaxants – Medications such as cyclobenzaprine or carisoprodol can be used to treat painful muscle spasms.
- Compound Topical Creams
Soft cervical collar: This is a padded ring that wraps around the neck and is held in place with velcro. Your doctor may advise you to wear a soft cervical collar to limit neck motion and allow the muscles in your neck to rest. A soft collar should only be worn for a short period of time since long-term wear may decrease the strength of the muscles in your neck.
Ice, heat, and other modalities: Your doctor may recommend careful use of ice, heat, massage, and other local therapies to help relieve symptoms.
Injections can be very helpful for this condition and they may include:
- Cortisone (Corticosteroid)
- Platelet Rich Plasma (PRP)
- Trigger Point Injections
Surgery is not commonly recommended for cervical spondylosis and neck pain unless your doctor determines that:
- A spinal nerve is being pinched by a herniated disk or bone (cervical radiculopathy), or
- Your spinal cord is being compressed (cervical spondylotic myelopathy)
Patients who have progressive neurologic symptoms, such as arm weakness, numbness, or falling, are more likely to be helped by surgery.
Surgery may also be recommended if you have severe pain that has not been relieved by nonsurgical treatment. However, some patients with severe neck pain will not be candidates for surgery. This may be due to the widespread nature of their arthritis, other medical problems, or other causes for their pain, such as fibromyalgia or myofascial pain. Optimization of non-surgical therapies will be explored in these cases.