Axial neck pain with cervical spondylosis has no cure and is usually considered to deteriorate with age. Yet many patients with severe cervical spondylosis (on radiographic studies) have no axial neck pain; the presence of pain may not necessarily correlate with the degree or severity of radiographic spondylosis. Patients presenting with axial neck pain typically improve over time, although the pain may recur and may be severe. The patient may need lifelong pain management treatment if the pain is persistent and prolonged. Patients presenting primarily with axial neck pain rarely develop a more severe condition in the sense of the degenerative joint disease leading to either radiculopathy or myelopathy.
Long-term outcome studies suggest that cervical radiculopathy eventually resolves in most patients over 1 to 2 years if not treated surgically. The role of surgery is therefore primarily to speed up or enhance the natural degree of recovery, particularly if the patient has severe pain.
Once patients undergo adequate decompressive surgery, their neurologic function typically stabilizes for many years. Clear neurologic worsening can usually be attributable to a specific cause, such as adjacent segment stenosis after limited anterior fusion, instability with subsequent spinal cord pressure, such as kyphotic angulation after laminectomy, or instability, such as C7/T1 subluxation, after C3 to C7 posterior fusion. However, unprotected levels can progressively deteriorate even with surgery and can, over time, cause new areas of spinal cord compression that may need further treatment. Most cervical spine surgery enhances a baseline level of axial neck pain, and patients will often need long-term treatment of their difficult axial neck pain.
There are no studies detailing the best approach to asymptomatic patients who present with worrisome abnormalities such as cervical stenosis. If the abnormality clearly suggests neoplasia involving the cervical spine, or some other equivalent serious disorder, investigation would be required. Most abnormalities are of unknown significance, and treatment (particularly surgery) should not be suggested unless it is clear to the patient that the procedure is not to treat a symptom but to prevent a specific problem from occurring in the future. Surgical treatment may possibly be indicated in some patients with asymptomatic abnormalities who, when followed over time, develop new symptoms suggestive of disease progression.
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