C5-C6 Treatment

Treatment of the C5-C6 spinal motion segment typically begins with nonsurgical methods. In cases where the neck pain and other symptoms do not improve with nonsurgical treatments, or if the health of a nerve root or the spinal cord worsens, surgery may be considered. ¹ Iyer S, Kim HJ. Cervical radiculopathy. Curr Rev Musculoskelet Med. 2016;9(3):272-80.

Nonsurgical Treatment for C5-C6

Nonsurgical treatments of the C5-C6 motion segment include:

• Medication. Both prescription and over-the-counter (OTC) medications are used to help relieve C5-C6 vertebral and nerve pain. Common medications include non-steroidal anti-inflammatory drugs (NSAIDs), pain-relieving medication such as opioids and tramadol, and/or corticosteroids. Some doctors may also prescribe calcium and vitamin D supplements for bone strengthening. ² Ensrud KE, Schousboe JT. Vertebral Fractures. New England Journal of Medicine. 2011;364(17):1634-1642. doi:10.1056/nejmcp1009697

  See Medications for Back Pain and Neck Pain

• Neck brace. A brace helps immobilize and protect the neck during the initial week or two of an acute injury to the C5-C6 vertebral levels, such as a fracture or while recovering from surgery. Immobilization may help promote healing of the vertebrae and surrounding soft tissues such as ligaments and blood vessels. ² Ensrud KE, Schousboe JT. Vertebral Fractures. New England Journal of Medicine. 2011;364(17):1634-1642. doi:10.1056/nejmcp1009697

• Manual therapy. Manual therapy in combination with therapeutic exercise may help improve neck function, decrease pain, and increase the range of motion of the C5-C6 level. This treatment also helps improve head and neck balance and prevent falls. ² Ensrud KE, Schousboe JT. Vertebral Fractures. New England Journal of Medicine. 2011;364(17):1634-1642. doi:10.1056/nejmcp1009697 ^{, 3} Boyles R, Toy P, Mellon J, Hayes M, Hammer B. Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: a systematic review. J Man Manip Ther. 2011;19(3):135-42.

  See Physical Therapy for Neck Pain Relief

• Injection. Injecting steroids into the epidural space, neuroforamen, or in the facet joints may be recommended for the treatment of radicular pain from herniated discs and whiplash injury. ⁴ Epstein NE. Major risks and complications of cervical epidural steroid injections: An updated review. Surg Neurol Int. 2018;9:86. Published 2018 Apr 23. doi:10.4103/sni.sni_85_18 ^{, 5} Kim KH, Choi SH, Kim TK, Shin SW, Kim CH, Kim JI. Cervical facet joint injections in the neck and shoulder pain. J Korean Med Sci. 2005;20(4):659-62. Studies estimate 3 to 11 months of pain relief from these injections, with maximum relief periods for those with herniated discs. ⁵ Kim KH, Choi SH, Kim TK, Shin SW, Kim CH, Kim JI. Cervical facet joint injections in the neck and shoulder pain. J Korean Med Sci. 2005;20(4):659-62. The epidural injections, in general, may carry a risk of hematoma, bleeding, and nerve damage when administered in the cervical region. ⁴ Epstein NE. Major risks and complications of cervical epidural steroid injections: An updated review. Surg Neurol Int. 2018;9:86. Published 2018 Apr 23. doi:10.4103/sni.sni_85_18

  Watch Cervical Epidural Steroid Injection Video

• Self-care. Following certain self-care measures may help prevent cervical vertebral and/or spinal nerve pain from starting or getting worse. A few tips include avoiding:
  • Repeated bending the neck forward and/or backward
  • Sudden, abrupt, and/or jerking movements to the neck, such as from jumping
  • High-intensity exercise and heavy weight lifting

See Treatment for Neck Pain

It is advised to maintain good posture by sitting tall with the shoulders back and withoutprotruding the head forward in order to avoid stress on C5-C6. A doctor can help estimate the degree of movements permissible on the neck to avoid further injury to the C5-C6 vertebral level.

See How Poor Posture Causes Neck Pain

Surgical Treatment for C5-C6

The goals of surgically treating the C5-C6 motion segment include one or more of the following:

• Improve neck stability in the load-bearing C5-C6 vertebral level.
• Relieve compression of the spinal cord and/or C6 spinal nerve(s).
• Prevent further injury to the nerve root(s) and/or spinal cord.

Surgery is more likely to be recommended for those who have persistent pain and neurological and/or muscular deficits, preventing the ability to function in everyday life.

See Surgery for Neck Pain

Surgical methods used in the C5-C6 vertebral levels are described below.

• Anterior cervical discectomy and fusion (ACDF) surgery involves removing the C5-C6 intervertebral disc to relieve pressure on the spinal cord or C6 nerve root. The disc is replaced by an implant or bone graft, allowing biological fusion of the adjacent C5 and C6 vertebrae.

  Watch Anterior Cervical Discectomy and Fusion (ACDF) Video

• Cervical artificial disc replacement (ADR) or cervical disc arthroplasty surgery is done to remove a damaged disc and replace it with an artificial disc in order to maintain motion in the treated segment.

  Watch Cervical Disc Replacement Surgery Video

• Posterior cervical decompression surgery involves the removal of a part of the herniated disc from the back of the cervical spine.

  See Posterior Cervical Decompression (Microdiscectomy) Surgery

• Laminectomy is the removal of a portion of the vertebral arch in the posterior region. Laminectomy helps widen the spinal canal, relieving pressure on the spinal cord. The procedure may involve either the C5, C6, or both vertebrae.

  Watch Cervical Laminectomy Video

• Foraminotomy is the removal of excess or overgrown bone in the intervertebral foramen. Foraminotomy helps relieve pressure on the spinal nerves that pass through these foramen.

  See Outpatient Posterior Cervical Foraminotomy and Discectomy

• Lamnoforaminotomy is a foraminotomy performed at the same time as a laminectomy and is a common procedure performed to relieve C6 nerve root compression. ⁶ Epstein NE. Nursing review of cervical laminectomy and fusion. Surg Neurol Int. 2017;8:300. Published 2017 Dec 11. doi:10.4103/sni.sni_243_17

The type of surgery chosen for C5-C6 may depend on the extent and location of the damage, as well as how many vertebral levels are involved. In some cases, more than one surgery type may be combined.

Commonly, after surgery at C5-C6, signs and symptoms related to the compressed nerve such as reduced pain, tingling, numbness, and/or weakness in the arm may be relieved. Reduced neck pain may also be experienced.

As with any surgery, there is always a small risk of serious complications such as infection, neurologic injury, excessive bleeding, allergic reaction, or death following these surgical procedures. It is important to speak to your surgeon about these risks, the alternatives to surgery, as well as risks if surgery is not performed.

Watch Video: Questions to Ask Your Spine Surgeon