Treatment for cervical degenerative disc disease will usually be
non-surgical. However if conservative treatment fails, there may
be a need for surgery. Surgery for neck pain is much less reliable
than surgery for arm pain, and should be avoided if possible.
Conservative treatment
The conservative (non-surgical) treatment options are either passive
(done to the patient) or active (done by the patient). Usually
a combination of treatments will be used, as passive treatments
are rarely effective on their own—some active component
is almost always required.
Common passive treatments include:
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Medications.
Over-the-counter pain medicine such as acetaminophen (e.g. Tylenol)
can help decrease pain and can be used in conjunction with an anti-inflammatory
medication such as ibuprofen (e.g. Advil, Nuprin and Motrin).
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Chiropractic/osteopathic manipulations. These can be useful
to relieve joint dysfunction that can be associated with the pain.
Manipulations work best when combined with an active exercise program.
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Epidural injections. Epidural injections can be used to
help decrease inflammation when there is severe pain. The injection
is done by inserting a needle into the space around the thecal
sac (epidural space) and then injecting a steroid medication. This
helps reduce inflammation in the spinal canal and can reduce pain
in about 50% to 70% of patients. The injection should be used as
part of rehabilitation, as the pain relief can allow the patient
to begin an exercise and physical therapy program. If the injection
works, but the pain returns, it can be repeated up to three times
in a 6-month period.
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Trigger point injections. Tender areas in the muscles
can be injected with a small needle and lidocaine to relieve muscular
stress and tension, which should relieve the tenderness.
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TENS units. Transcutaneous Electrical Stimulation (TENS)
units can be used to provide electrical stimulation to the painful
areas of the back. A low current electrical charge is transmitted
to the skin. Although the mechanism for how this relieves pain
is not exactly known, it has been proven effective for some patients
and allows them to function better with less medication. It is
suspected that the electrical signals help override the pain signals.
In addition, traction may be useful and a home traction unit may
be prescribed for use at home.
Common active treatments include:
- Physical therapy. Exercises and stretching can be very
helpful in strengthening and stabilizing the affected area, thus
reducing pain. It is very important, however, to work with a professional
health provider on the appropriate exercises as each person responds
differently, and what helps one person may actually harm another.
- Quitting smoking. It has been proven that there is a link
between smoking and the ability for the spine to heal. Since there
is no benefit to smoking, quitting is highly advisable.
Surgical treatment
Rarely, a one (or possibly two) level fusion may be required to
help control symptoms and allow a patient to function more fully.
This should only be considered if non-surgical treatments have failed,
and the pain the patient is experiencing is severe enough to limit
his or her activity level or ability to function.
The goal of this surgery is to stop the motion at a painful motion
segment. A small metal plate or a bone graft is placed between the
affected vertebrae of the spine. As the bone fuses to the plate or
graft, the spine stabilizes in that area and reduces or eliminates
the movement that was causing pain.
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