What Is the Treatment for Bone Spurs in the Neck?

Treatment for bone spurs in the neck ranges from over-the-counter pain relievers and physical therapy to steroid injections and, in more severe cases, surgery to decompress pinched nerves or the spinal cord. The right approach depends almost entirely on what the bone spur is doing: a spur that shows up on imaging but causes no symptoms may need no treatment at all, while one pressing on the spinal cord can require urgent surgical attention. Most people improve with conservative measures, and surgery is reserved for cases where nerve or cord compression causes persistent pain, weakness, or functional problems that do not respond to simpler therapies.

Why Bone Spurs Form in the Neck

Bone spurs, called osteophytes in medical terminology, grow along the edges of vertebrae in the cervical spine. They are the body’s response to mechanical stress. As the discs between vertebrae lose water content and height with age, the load on the surrounding bone shifts. A biomechanical study modeling progressive disc degeneration at the C5-C6 level found that stress and strain energy in the vertebral bone increased adjacent to the degenerated disc, especially along the front of the vertebra. Over time, that increased mechanical load triggers bone remodeling, and the body lays down extra bone in the stressed area.¹ The result is a bony projection that can narrow the spinal canal, the openings where nerves exit, or even encroach on the esophagus at the front of the spine.

This process is extremely common with aging. Many people over 60 have cervical osteophytes visible on X-rays without ever experiencing symptoms. Treatment decisions therefore hinge not on whether a bone spur exists, but on whether it is compressing something important.

Symptoms That Drive Treatment Decisions

The symptoms bone spurs cause depend on where they grow and what structures they press against. The most common scenario is a spur that narrows the neural foramen, the small channel through which a spinal nerve exits the vertebral column. A cadaveric imaging study confirmed that decreased foraminal width and area correlate with nerve root compression in the cervical spine.² When a nerve root gets squeezed, the result is cervical radiculopathy: shooting pain down the arm, numbness or tingling in the fingers, and sometimes weakness in specific muscles.

Spurs that grow toward the spinal canal itself can compress the spinal cord, a condition called cervical myelopathy. Myelopathy produces a different set of problems: difficulty with fine motor tasks like buttoning a shirt, an unsteady gait, stiffness or spasticity in the legs, and sometimes bladder dysfunction. Left untreated, cervical myelopathy can cause permanent disability or even quadriplegia in severe cases.³ This distinction matters because myelopathy generally pushes clinicians toward earlier surgical intervention, while radiculopathy often gets a longer trial of conservative care.

Less commonly, large spurs growing off the front of the vertebrae can push against the esophagus and cause difficulty swallowing, voice changes, or a sensation of something stuck in the throat.⁴ These anterior osteophytes are covered in more detail later in this article.

Conservative Treatment as the First Line

For neck pain and radiculopathy caused by bone spurs, the initial approach is almost always non-surgical. The goal is to reduce inflammation around the compressed nerve, manage pain, and restore as much neck mobility as possible while the body’s natural healing processes work.

Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are the standard starting point. They reduce swelling in the tissue around the nerve root and lower pain levels. A large retrospective study comparing NSAIDs to gabapentin for cervical radiculopathy found that patients started on NSAIDs had lower rates of eventually needing surgery, fewer opioid prescriptions, and fewer follow-up imaging studies than those started on gabapentin.⁵ That does not necessarily mean NSAIDs are more effective for everyone, but it suggests they are a reasonable and lower-risk starting medication.
Physical therapy: Structured exercise programs focusing on neck strengthening, postural correction, and gentle stretching are a cornerstone of conservative care. Clinical guidelines consistently recommend combining manual therapy with exercise for better outcomes than either alone.⁶
Activity modification: Reducing repetitive neck strain, adjusting workstation ergonomics, and avoiding sustained awkward head positions can ease symptoms. A study on postural biofeedback during typing found that real-time feedback reduced neck flexion angles and cervical muscle activity, though it did not change self-reported pain during a single session.⁷ The takeaway is that posture habits matter, even if fixing them takes sustained effort rather than a single correction.
Short-term rest and cervical collar: A brief period of reduced activity can calm an acute flare, but prolonged immobilization is counterproductive. Neck muscles weaken quickly with disuse, and the evidence favors returning to movement as soon as tolerable.

Most episodes of cervical radiculopathy from bone spurs improve substantially within six to twelve weeks of conservative care. That timeline helps explain why doctors are often willing to wait before recommending more aggressive interventions.

Epidural Steroid Injections

When oral medications and physical therapy do not provide adequate relief, a cervical epidural steroid injection is the next step up. The procedure delivers a corticosteroid directly into the epidural space around the inflamed nerve root, with the aim of reducing swelling and pain more potently than oral drugs can. A study of fluoroscopy-guided cervical interlaminar epidural steroid injections found that about 72% of patients experienced effective pain relief two weeks after the procedure.⁸

The same study found that the cause of the nerve compression mattered more than anything else in predicting who would benefit. Patients whose pain came from a herniated disc responded better (about 86% improved) than those whose pain came from spinal stenosis, which includes bone spur-related narrowing (about 60% improved).⁸ This is worth knowing if you have bone spurs specifically: injections can still help, but the success rate is somewhat lower than for disc herniations, and the relief may be temporary. Injections are generally limited to a few per year to avoid steroid-related side effects on surrounding tissues.

When Surgery Becomes Necessary

Surgery enters the conversation when conservative treatments have failed after a reasonable trial period, or when there is evidence of spinal cord compression causing myelopathy. Myelopathy in particular is treated more aggressively because the spinal cord does not recover from prolonged compression as reliably as a peripheral nerve root does. Several surgical approaches exist, and the choice depends on where the bone spur sits, how many spinal levels are involved, and the patient’s overall spinal alignment.

Anterior Cervical Discectomy and Fusion

The most common surgery for bone spurs compressing nerves or the cord from the front of the spine is anterior cervical discectomy and fusion, or ACDF. The surgeon approaches through the front of the neck, removes the damaged disc and any bone spurs pressing on neural structures, and then fuses the two adjacent vertebrae together using a small cage or bone graft and a plate. A study of patients with foraminal stenosis treated with ACDF found that arm pain scores dropped from an average of 7.2 out of 10 before surgery to 2.2 after, and the foramen area nearly doubled.⁹ Roughly 79% of patients rated themselves as subjectively improved.

A modified version of the procedure focuses on restoring the natural disc height without over-distraction, which can reduce immediate postoperative pain and help prevent the cage from sinking into the vertebral body over time.¹⁰ ACDF is generally considered a reliable workhorse procedure with decades of track record. Its main trade-off is that fusing two vertebrae together eliminates motion at that segment, which shifts extra stress to the levels above and below.

Cervical Artificial Disc Replacement

An alternative to fusion is cervical artificial disc replacement, where after removing the disc and bone spurs, the surgeon implants a prosthetic disc that preserves motion at the treated level rather than locking it solid. The theoretical advantage is that maintaining movement reduces stress on adjacent segments and lowers the chance of needing additional surgery down the road. A systematic review comparing long-term results from two FDA trials found that artificial disc patients had greater improvements in disability scores, neck and arm pain, and physical function scores compared to fusion patients at five-year follow-up. The rate of adjacent segment disease was lower in the disc replacement group (about 3% versus 5%), and revision surgery rates were also lower.¹¹

A larger health technology assessment confirmed that for both single-level and two-level disease, artificial disc replacement was at least as effective as fusion across multiple outcomes, and was superior in terms of recovery time, return to work, and lower reoperation rates at the treated level.¹² Not everyone is a good candidate for disc replacement, though. Patients with significant instability, severe facet joint arthritis, or osteoporosis are generally steered toward fusion instead. And the evidence on whether disc replacement truly prevents adjacent segment disease in the long run is still not fully settled.

Posterior Foraminotomy

When a bone spur is compressing a nerve root from the back or side of the spinal canal, a surgeon may approach from the back of the neck and widen the neural foramen by removing the spur and a small amount of bone. This avoids the need for fusion or a disc implant entirely and preserves normal motion. A study of patients treated with microsurgical posterior foraminotomy found that preoperative radicular pain completely resolved in all 20 patients, and in those who had muscle weakness, about 80% recovered to full or near-full strength.¹³ The limitation is that this approach works best for laterally placed spurs affecting nerve roots and is less suited for central spurs compressing the spinal cord.

Adjacent Segment Disease After Fusion

One concern that comes up frequently after cervical fusion is adjacent segment disease, where the levels above or below the fused segment degenerate faster because they are absorbing extra mechanical stress. A long-term follow-up study of fusion patients found that when adjacent segment disease did develop and required surgery, it occurred on average about 32 months after the initial fusion. Over half of the cases happened after a single-level fusion, with the C5-C6 level being the most common site of the original procedure. Patients who already had signs of degeneration at adjacent levels at the time of their first surgery were at higher risk, as were those with poor sagittal alignment after the initial procedure.¹⁴

This is not inevitable. Many people live with a cervical fusion for decades without problems at neighboring levels. But the risk is real enough that it drives some of the enthusiasm for motion-preserving alternatives like artificial disc replacement, especially in younger patients who have more years of spinal wear ahead of them.

The Special Case of Anterior Bone Spurs Causing Swallowing Problems

Most neck bone spurs cause problems by pressing on nerves or the spinal cord behind them. But large spurs that project forward from the front of the vertebral body can push against the esophagus and cause dysphagia, or difficulty swallowing. This is uncommon, but it can be serious when it occurs. A case report of a giant anterior cervical osteophyte described the mechanism as direct mechanical compression of the esophagus, irritation of the surrounding tissue, and in some cases spasm of the cricopharyngeal muscle that controls the top of the esophagus.¹⁵ A condition called diffuse idiopathic skeletal hyperostosis, or DISH, is one of the most common causes of this kind of extensive anterior bone growth.

When anterior spurs cause swallowing difficulty that cannot be managed with dietary modification and swallowing therapy, surgical removal of the spurs is the treatment. A small case series described four patients aged 57 to 72 who underwent surgery for anterior osteophytes causing dysphagia, with one patient also experiencing breathing difficulty severe enough to cause respiratory arrest.⁴ The surgery involves shaving down the bony projections to relieve compression on the esophagus. Because these spurs are part of a broader process of abnormal bone growth, they can recur, and monitoring after surgery is standard.

Manual Therapy and Manipulation

Many people with neck bone spurs seek chiropractic manipulation or other manual therapies. The evidence here is mixed, and the risks are worth understanding. A clinical guideline found that manipulation or mobilization alone had effects similar to placebo for neck pain, but when combined with exercise, the combination was superior to either approach alone or to other physical medicine methods.⁶ In other words, manipulation seems to add value primarily as part of a broader exercise-based program, not as a standalone treatment.

The safety profile matters. A systematic review found that mild to moderate adverse effects like soreness and stiffness occur in roughly 30% to 61% of patients receiving spinal manipulation. More concerning, upper spinal manipulation has been linked to rare but serious complications including vertebral artery dissection and stroke.¹⁶ In patients with cervical bone spurs, especially those with any degree of spinal cord compression, aggressive neck manipulation carries additional risk. If you pursue manual therapy, make sure your provider knows about the bone spurs and any imaging findings, and consider gentler mobilization techniques over high-velocity thrusts.

Conditions That Mimic Bone Spur Symptoms

Before committing to a treatment plan for cervical bone spurs, it is worth confirming that the spurs are actually causing your symptoms. Shooting arm pain, numbness, and weakness can come from several other conditions that look a lot like cervical radiculopathy. Shoulder impingement, carpal tunnel syndrome, peripheral neuropathy, and thoracic outlet syndrome can all produce overlapping symptoms. A review in Muscle & Nerve emphasized that recognizing these mimics can shorten the time between symptom onset and correct diagnosis.¹⁷

This is particularly relevant because cervical bone spurs are so common on imaging that they are often found incidentally. A bone spur visible on an MRI does not automatically mean it is the source of your pain. A careful clinical examination, sometimes supplemented with nerve conduction studies, helps distinguish spur-related nerve compression from other culprits before pursuing treatments as aggressive as injections or surgery.

Choosing Between Treatments

The practical decision tree for most people with symptomatic cervical bone spurs looks something like this. You start with NSAIDs, activity modification, and physical therapy. If symptoms persist after six to twelve weeks, you consider an epidural steroid injection, keeping in mind that the response rate for stenosis-related pain is lower than for disc herniations. If significant pain or neurological deficits continue despite these measures, or if imaging shows spinal cord compression with myelopathy symptoms, surgery moves to the front of the list.

The surgical choice between ACDF, artificial disc replacement, and posterior foraminotomy depends on the location and extent of compression, the number of levels involved, your age, and your spine’s overall alignment. Younger patients with single-level disease and healthy facet joints are often good candidates for disc replacement. Patients with multi-level disease, instability, or existing degeneration at neighboring segments may be better served by fusion. Posterior foraminotomy works best for isolated nerve root compression from a laterally placed spur and has the advantage of avoiding fusion altogether.

One piece of context that often gets lost in treatment discussions is that bone spurs themselves do not shrink with medication or therapy. Conservative treatments work by reducing the inflammation and swelling around the spur, not by removing the spur itself. If the spur is large enough to significantly narrow the neural foramen or spinal canal, that structural problem persists. The question is whether the symptoms it produces can be managed well enough that you do not need surgical removal, and for many people, the answer is yes.