Treatment

The potential clinical manifestations of cervical spondylosis are quite variable with respect to the degree of pain and neurological disability. A variety of operative and non-operative treatment modalities are available to treat clinically symptomatic and significant spondylosis.

The goals of treating patients with symptomatic cervical spondylitic disease include diminishing pain, restoring neurological function and re-establishing spinal stability. Many people have degenerative changes in the cervical spine on imaging studies without symptoms. Treatment is not required for the radiograph findings, but should only be considered for disabling symptoms [6]. It is unclear whether exercise can diminish the progression of cervical spondylosis or if it acts to prevent the development of symptoms. Augmenting paraspinal muscle tone and conditioning will improve the stability of the cervical spine and its resistance to abnormal movement. However, exercise would not alleviate the forces upon the disks and joints of the cervical motion segment complex. In fact, repeated activity and strain, theoretically, could promote degeneration of the joint complexes.

Rarely is there a need for prophylactic surgery to prevent neurological dysfunction in the presence of spondylosis. A clear indication for considering prophylactic surgery would be the presence of instability. Based on the trauma criteria for stability, if the patient has greater than 3.5 mm of translational movement between adjacent vertebrae, then instability exists and should be treated surgically. The need to decompress the intervertebral foramina or the central spinal canal in an asymptomatic patient is not clear. The nerve roots are quite tolerant of compression, as many patients have significant radiographic foraminal stenosis without associated symptoms. It is possible that compensation by the nerve roots takes place during the slow progressive compression. Incidental central spinal canal stenosis is more controversial. This entity is becoming a more frequent finding with the widespread use of MRI studies. A percentage of physicians recommend decompression to prevent an acute spinal cord injury from head or neck trauma, but there are no studies substantiating the merits of prophylactic surgery in these cases. In all likelihood, a patient with focal stenosis from spondylosis has a higher risk of incurring a spinal cord injury from trauma than the general population, but the magnitude of this risk is difficult to define. Given the ubiquity of cervical spondylosis, the increased risk is probably minimal and probably in the same range as the risk of incurring a spinal cord injury during a surgical procedure. Therefore, patient factors should be considered carefully when determining the need to decompress a patient with asymptomatic stenosis. An active patient who participates in high-impact sports and activity may be a suitable candidate for prophylactic decompression [7].

Pain and neurological deficit are the typical manifestations of symptomatic cervical spondylosis, as discussed above. The presence of a significant neurological deficit in the form of motor or sensory impairment or signs of cord compression require primary surgical treatment, without consideration of a course of nonoperative treatment to optimize the chance of neurological recovery. Except in extreme cases, those patients presenting with pain should first be considered for non-surgical treatment.

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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