cervicalgia treatment for women working as pc operator?

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Treatment for intermittent neck and shoulder pain (cervicalgia) is usually conservative, with nonsteroidal anti-inflammatory drugs, physical modalities, and lifestyle modifications most commonly used. Surgery is also sometimes performed where warranted.

Neck immobilization (with a soft collar, Philadelphia collar, rigid orthoses, Minerva jacket, or a molded cervical pillow for support) is a common, nonoperative treatment for neck pain and/or suboccipital pain syndromes caused by spondylosis and cervical radiculopathy.

Despite widespread use, soft collars largely are believed to work by placebo effect, since they do not appreciably limit motion of the cervical spine. They have not been demonstrated to change long-term outcome. If worn properly, a soft collar maintains relative flexion. The collar should be worn as long as possible during the day. However, patient comfort is key.

As symptoms improve, it can be worn only during strenuous activity. It eventually can be discontinued. More rigid collars and devices may better limit motion of the cervical spine but may reduce muscle tone and cause neck stiffness from disuse. Implement a daily cervical exercise program to limit loss of muscle tone.

Pharmacologic treatment includes several options.
Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, are the mainstay of pharmacologic treatment. They are effective in reducing the biologic effects of inflammation and pain. Carefully consider the adverse effects (eg, peptic ulcer disease, renal problems, hypertension, liver abnormalities, bleeding). Consider cyclooxygenase 2 (COX-2) inhibitors in any patient who requires prolonged administration of NSAIDs. COX-2 inhibitors have fewer gastrointestinal adverse effects.

Patients who experience more chronic pain symptoms may benefit from tricyclic antidepressants. Muscle relaxants such as carisoprodol and cyclobenzaprine also may be beneficial, particularly in patients with a spasm element in their neck muscles (which can be related to spondylotic changes). Although controversial in treating back pain, some evidence suggests that patients with degenerative spine disease benefit from these agents. Use opiates sparingly and only as needed in the acute period. Do not administer long-term, as tolerance and eventual abuse may occur with minimal pain relief.

Steroid use is another area of controversy. In some patients with severe radiculopathy, a high-dose oral steroid taper may rapidly reduce pain and shorten the course of symptoms. Some patients with progressive CSM also may benefit. Instillation of steroids into the cervical epidural space may help patients who are refractory to other treatments. Perform this carefully to avoid injury to the cervical cord. Patients who present within 8 hours of an acute central cord injury (which can be caused partly by ventral osteophytes) may benefit from high doses of methylprednisolone.

Lifestyle modifications (eg, neck schools, instruction in body mechanics, relaxation techniques, postural awareness, ergonomics and/or workplace modifications) may alleviate symptoms.

Neck school is a form of small group therapy that provides techniques to patients who are willing to actively work toward recovery. It may be of limited clinical value.

Instruction in body mechanics focuses on low-load concepts. These include avoiding forward bending and rotation of the neck, avoiding prolonged extension of the neck, avoiding prolonged sitting or standing, and proper chair selection.

Workplace modifications and ergonomics serve to reduce strenuous neck positions during work and leisure.

Physical modalities are among the oldest treatments used for spine-related disorders.

Cervical mechanical traction, commonly used for cervical radiculopathy, in addition to cervical joint distraction may loosen adhesions within the dural sleeves, reduce compression and irritation of disks, and improve circulation within the epidural space. Studies regarding its efficacy are conflicting, with intermittent traction probably more effective than static traction. Initially, a weight of 10 pounds is recommended, eventually increasing to 20 pounds as tolerated.
It can be used at home 2-3 times daily for 15 minutes at a time. It is contraindicated in patients who have myelopathy, a positive Lhermitte sign, or rheumatoid arthritis with atlantoaxial subluxation. A recent retrospective study by Swezey et al found that cervical traction provided symptomatic relief in 81% of the patients with mild-to-moderately severe cervical spondylosis syndromes.

Manipulation, most commonly practiced by chiropractors and osteopathic physicians, was described as early as 4000 years ago. It remains a popular treatment for back pain. Techniques vary and include low velocity-high amplitude manipulation, high velocity-low amplitude manipulation (eg, thrusting or impulse manipulation), and nonthrusting maneuvers. Studies have reported conflicting results, and few well-controlled studies have been published specifically concerning the treatment of cervical spondylosis symptoms.

Contraindications to cervical manipulation include vertebral fractures, dislocations, infections, malignancy, spondylolisthesis, myelopathy, various rheumatologic and connective tissue disorders, and the presence of objective signs of nerve root compromise. The most feared complication of cervical manipulation, vertebrobasilar artery dissection, is rare and almost impossible to predict despite multiple proposed risk factors.

Exercises that are designed for cervical pain include isometric neck strengthening routines, neck and shoulder stretching and flexibility exercising, back strengthening exercises, and aerobic exercise. Controlled trials regarding the efficacy of these routines are lacking.

Other commonly used modalities for pain include heat, cold, acupuncture, massage, trigger point injection, transcutaneous electrical nerve stimulation, and low-power cold laser. Most of the passive modalities that are used for degenerative disease of the cervical spine are performed by physical therapists and are most efficacious in combination.
Surgical Care: Surgical care for cervical spondylosis involves anatomic correction of the degenerative pathologic entities that compress a nerve root or the spinal cord.

Indications for surgery include intractable pain, progressive neurologic deficits, and documented compression of nerve roots or of the spinal cord that leads to progressive symptoms. Surgery has not been proven to help neck pain and/or suboccipital pain. Several approaches to the cervical spine have been proposed. The approach selected is determined by the type and location of pathology and by the surgeon's preference.

Cervical radiculopathy traditionally has been approached either via the anterior approach, which was first described by Robinson and Smith in 1955, or by the posterolateral approach, where a "keyhole" foraminotomy is performed.

The anterior approach allows excellent access to midline disease and visualization of pathology without manipulation of neural elements. Robinson and Smith proposed that the anterior approach coupled with fusion using iliac crest bone graft arrests progressive spondylotic spurring, causes existing osteophytes to eventually regress due to spinal stability promoted by fusion, decompresses and enlarges the neural foramen and spinal canal by the distraction of the disk space, and minimizes surgical manipulation of the contents of the spinal canal, thereby minimizing complications.

When performed with fusion, anterior cervical discectomy (ACD) yields good-to-excellent results in almost 90% of patients when no other level of spondylosis is present. When adjacent levels of spondylosis were demonstrated, only 60% of patients had good-to-excellent results.

ACD without fusion has been used based on the nonexistent correlation between successful fusion and clinical outcome and the significant incidence of pseudoarthrosis following ACD and fusion (10-20%). The advantage of this procedure is the lack of bone graft-related complications and decreased manipulation and dissection of the cervical tissues. Patients who do not undergo fusion often report a shorter postoperative hospital stay and an earlier return to daily activities.

ACD without fusion almost inevitably is followed by disk-space collapse. This procedure does not accomplish disk-space distraction and does not mechanically open the neural foramina. It does not promote stabilization of the motion segment to promote resorption of osteophytes. As a result, most surgeons choose ACD with fusion for patients with cervical radiculopathy when taking an anterior surgical approach. Instability of the cervical spine is rarely reported following ACD with or without fusion, but the incidence of postoperative neck pain is higher without fusion.

The posterolateral approach to cervical radiculopathy has similar results as the anterior approach when used for the proper indications. This approach is associated with greater initial postoperative discomfort but avoids the possibility of graft dislodgment and damage to neck structures. It is best used for nerve root decompression, when the pathologic entity is a lateral spondylotic spur or soft disk. In this approach, a keyhole foraminotomy is made by removing the medial third of the facet joint and the most lateral aspects of the lamina at the involved level and side. The underlying lateral aspect of the ligamentum flavum then is removed to visualize the nerve root. The nerve root is unroofed posteriorly, superiorly, and inferiorly so that it lies free and without tension.
The impact of facetectomies on the stability of the cervical spine has been questioned. Bilateral 50% facetectomies have been demonstrated to expose the nerve by 3-5 mm without notable effect on stability. Bilateral facetectomies of 70% reduced the spine's ability to withstand stresses while increasing the exposure of the nerve root. In all likelihood, maintenance of the interspinous and most of the interlaminar ligaments is important in preserving stability in patients undergoing foraminotomy.

Surgical intervention for CSM is controversial.

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cervicalgia treatment for women working as pc operator?

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