Treatment options for cervical osteoarthritis typically depend on the severity of symptoms and how often they disrupt daily life. Most often, nonsurgical treatment options will suffice for managing cervical osteoarthritis. In cases where pain worsens and various treatment methods have proven ineffective over a period of 6 to 12 weeks, surgery may be considered as a last resort.
Nonsurgical Treatment Options
If cervical osteoarthritis symptoms are mild, common treatments will include one or more of the following:
- Rest when symptoms flare. Sometimes limiting neck movements for a short while, such as for an afternoon or a day, is enough to let the inflammation go back down and pain dissipate.
- Cold and/or heat therapy. Some people prefer a cold pack, especially after an activity that results in pain, to minimize inflammation. Other patients prefer heat, such as a heating pad or heat wrap; or moist heat, such as a moist heat wrap for the neck or a warm bath or shower.
- Over-the-counter medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (e.g. Advil), naproxen (e.g. Aleve), or COX-2 inhibitors (e.g. Celebrex) may help relieve the pain from the inflammation that usually accompanies arthritis. Acetaminophen (e.g. Tylenol) is another over-the-counter pain reliever that could help.
- Active lifestyle. Moderate exercise is good for the joints, including the neck’s facet joints. While rest is sometimes necessary during a painful flare-up, incorporating more movement into a daily routine oftentimes reduces long-term pain from cervical osteoarthritis. For example, committing to a walking regimen could be a good way to increase daily activity and naturally boost feel-good endorphins.
If cervical osteoarthritis symptoms are more moderate and persistent, other treatment options could include:
- Activity modification. Sometimes limiting or eliminating certain activities can prevent the worst of the flare-ups. For example, a person might find a specific swimming stroke twists the neck in a way that causes more pain than other swimming strokes. In that case, the problematic swimming stroke should be limited or completely avoided in the future. Everyone is different in terms of which activities might be more problematic for triggering cervical osteoarthritis symptoms.
- Physical therapy. A physical therapist or other medical professional can create a program of exercise and stretching that targets the patient’s specific needs. When the neck muscles become stronger and more flexible, they are less likely to spasm and cause pain.
- Prescription medications. A doctor may prescribe opioids, also called narcotics, which block pain receptors in the brain. Another option could be prescription-strength muscle relaxants, which reduce painful muscle spasms in the neck and surrounding muscles. Prescription painkillers tend to be a short-term solution and are not recommended on an ongoing basis.
- Radiofrequency ablation (RFA). A minimally-invasive RFA procedure delivers heat from a needle tip to create lesions on the small nerves that feed into the facet joint. This procedure prevents these nerves from sending pain signals to the brain. While RFA is capable of providing longer-lasting relief than a medial branch nerve block or facet joint injection, it is still a temporary solution because the nerves will likely regenerate in a year or two. RFA is typically not tried until a medial branch nerve block and/or facet joint injection has been successful for the patient and thus identified the facet joint as the likely cause of pain.
This is not a complete list of treatment options. Many others exist, including manual manipulation and massage. Most people with cervical osteoarthritis will find relief and manage symptoms by combining multiple treatment types.
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Surgical Treatment Options
While cervical osteoarthritis tends to be chronic, the symptoms rarely progress enough to require surgery. For patients with severe symptoms that are impeding their ability to function, such as numbness or weakness that goes down into the arm or hand, surgery may be an option.
Two common surgical treatment options include:
- Anterior cervical discectomy and fusion (ACDF). A surgeon approaches through the front of the neck and removes the disc at the vertebral level where degenerative changes are causing severe symptoms. The disc is then replaced with a spacer that maintains enough height for cervical nerve roots to pass unimpeded, and the vertebral level is fused so no further motion (nor degeneration) should occur.
- Posterior cervical laminectomy. A surgeon approaches the cervical spine from the back of the neck and removes the back part of the vertebra (lamina and spinous process) to give more room and decompress the spinal cord. If spine stability is a concern, the laminectomy can be combined with a spinal fusion.
While neck surgery is in general a safe procedure, all surgeries carry risk. The patient and doctor will need to discuss the potential benefits and risks before making a final decision on surgery.