CERVICAL SPONDYLOSIS - AN UPDATE

Cervical spondylosis is caused by degenerative disc disease and usuall y produces intermittent neck pain in middle-aged and elderly patients. This pain usually responds to activity modification, neck immobilizat ion, isometric exercises, and medication. Neurologic symptoms occur in frequently, usually in patients with congenital spinal stenosis. For t hese patients, magnetic resonance imaging is the preferred initial dia gnostic study. Because involvement of neurologic structures on imaging studies may be asymptomatic, consultation with a neurologist is advis ed to rule out other neurologic diseases. In most cases of spondylotic radiculopathy, the results of conservative treatment are so favorable that surgical intervention is not considered unless pain persists or unless there is progressive neurologic deficit. If indicated, a surgic al procedure may be done through the anterior or posterior cervical sp ine; results are gratifying, with long-term improvement in 70% to 80% of patients. Cervical spondylotic myelopathy is the most serious and d isabling condition of this disease. Because many patients have nonprog ressive minor impairment, neck immobilization is a reasonable treatmen t in patients presenting with minor neurologic findings or in whom an operation is contraindicated. This simple remedy will result in improv ement in 30% to 50% of patients. Surgical intervention is indicated fo r patients presenting with severe or progressive neurologic deficits. Anterior cervical approaches are generally preferred, although there a re still indications for laminectomy. Surgical results are modest, wit h good initial results expected in about 70% of patients. Functional o utcome noticeably declines with longterm follow-up, which raises the q uestion of whether, and how much, surgical treatment affects the natur al course of the disease. Prospective randomized studies are needed to answer these questions.