Cervical bone spurs are bony outgrowths that develop along the edges of the vertebrae in the neck (cervical spine). These growths typically result from age-related wear and tear, a degenerative process known as cervical spondylosis. As the discs between the vertebrae lose hydration and height, the body attempts to stabilize the spine by forming new bone tissue. While the spurs themselves are not painful, they cause discomfort and functional limitations when they press against surrounding structures. Treatment aims to manage the pain and symptoms arising from this compression and irritation.
Identifying the Cause of Pain
Symptomatic bone spurs cause chronic dull pain, localized stiffness, and a reduced range of motion in the neck. If a spur narrows the foramen, compressing a spinal nerve root, it causes cervical radiculopathy: radiating pain, numbness, or tingling extending into the shoulder, arm, and hand. Severe cases where the spur projects inward can compress the spinal cord, potentially leading to myelopathy, which involves balance issues, muscle weakness, and coordination problems.
Diagnosis begins with a thorough physical examination to assess reflexes, muscle strength, and neck movement. Imaging studies confirm the presence and location of the spurs and determine the degree of nerve involvement. Standard X-rays show bony growths and degenerative changes. Computed tomography (CT) scans offer detailed images of the bone structure, while magnetic resonance imaging (MRI) visualizes soft tissues like the spinal cord, nerve roots, and intervertebral discs.
Initial Non-Invasive Treatment Strategies
The initial approach involves conservative, non-invasive therapies, starting with pharmacological management aimed at reducing inflammation and pain. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are recommended to decrease local swelling and subsequent pain around irritated nerve structures. Acetaminophen may be used for temporary relief or managing pain that does not involve inflammation.
Physical therapy is a cornerstone of conservative treatment, focusing on restoring function and strengthening the supporting musculature of the neck. A therapist guides patients through specific stretching and strengthening exercises to improve posture and increase range of motion. Modalities like cervical traction may also be employed, which gently stretches the neck to momentarily relieve pressure on compressed nerve roots.
Activity modification and ergonomic adjustments are important lifestyle changes to manage daily discomfort. Patients are advised to apply heat or cold compresses to manage muscle tension or acute inflammation. Ensuring a proper ergonomic setup at work and using supportive pillows minimizes strain and prevents symptom flare-ups caused by poor posture. These methods seek to provide relief for several months before more aggressive treatments are considered.
Targeted Interventional Procedures
If conservative management fails, targeted interventional procedures deliver powerful anti-inflammatory medication directly to the source of the pain. Epidural steroid injections (ESIs) involve injecting a corticosteroid and a local anesthetic into the epidural space surrounding the spinal nerves. The corticosteroid reduces inflammation and swelling around the irritated nerve root, which can alleviate the radicular pain radiating into the arm.
These injections offer temporary relief, typically lasting several weeks to months, which provides a window for physical therapy to be more effective. Nerve root blocks are similar procedures, injecting medication closer to the specific compressed nerve root for both diagnostic and therapeutic purposes. For pain originating from the facet joints, facet joint injections or medial branch blocks may be performed.
If facet joint pain is persistent, radiofrequency ablation (RFA) may be considered. RFA uses heat from an electrical current to temporarily disable the small nerves that send pain signals from the joint to the brain. These procedures are performed with image guidance, such as fluoroscopy, to ensure precise needle placement. Interventional treatments are typically reserved for moderate to severe symptoms unresponsive to oral medications and physical therapy alone.
Surgical Solutions and Considerations
Surgery is typically reserved for individuals with persistent, debilitating pain unresponsive to conservative and interventional therapies. It becomes an urgent consideration if the patient develops progressive neurological deficits, such as increasing muscle weakness, or evidence of spinal cord compression (myelopathy). The goal of surgery is to remove bone spurs and other compressive elements to decompress the neural structures.
One common technique is the Anterior Cervical Discectomy and Fusion (ACDF), accessed from the front of the neck. The surgeon removes the intervertebral disc and bone spurs pressing on the nerve roots or spinal cord. The adjacent vertebrae are then fused with a bone graft or spacer, which stabilizes the segment but results in a loss of motion at that level.
Alternatively, a posterior approach may be used, such as a foraminotomy or laminoplasty. A cervical foraminotomy enlarges the foramen by removing the bone spur and surrounding tissue causing nerve root compression. Laminoplasty creates more space for the spinal cord by cutting the lamina, the bony arch at the back of the vertebra, and hinging it open. Unlike fusion, these posterior procedures often preserve more neck motion and may offer a shorter recovery time.