The treatment of the manifestations of cervical osteoarthritis, apart from its complications, is essentially medical.
- Associates non-pharmacological and pharmacological media.
- Non-pharmacological treatments
Cervical collar
Orthotic treatment
A cervical collar may be used during painful episodes.
The degree of containment will be variable depending on the intensity of the pains: simple foam collars, with or without rigid reinforcement or support of the anterior chin.
Patient education
The learning of preventive measures is part of the patient's education. This education brings together the notions transmitted to patients, designed to modify their potentially harmful postural habits. They have to give advice of subject of the cervical column to avoid the wide movements of the neck and to carry heavy loads.
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Re-education
Rest is imposed during painful episodes.
The kinesitherapy practiced during painful accesses uses different techniques: relaxing massages, physiotherapy by parafangotherapy, short waves and infrared. Among the accesses, kinesitherapy associates active and passive reeducation, with proprioceptive work, domain of saving techniques. The exercises will be explained to the patient so that he can reproduce them periodically in his home.
Spinal manipulations
The publications related to vertebral manipulations are numerous and very contradictory. According to the recommendations from the Cochrane data bank: "Manipulations practiced in isolation are not indicated, since it is their association with other mobilization techniques and exercises that allows obtaining the best results".
Always be done by a well-trained doctor, and as long as there is no contraindication. There may be some serious complications (paresis, dissection of the vertebral artery, transitory deafness).
Cervical tractions
The cervical tractions, performed in the bed for several hours in a hospital environment, or in a medical consultation at an appropriate table, seem to have an analgesic effect, however, the existing clinical studies have been considered insufficient and there are no recommendations regarding this type of techniques in cervico-osteoarthritis.
Pharmacological treatments
Analgesics, NSAIDs
First grade analgesics are always used: paracetamol remains the most used product, often in the long term. When there are more important pains, minor opioid derivatives (possibly associated with paracetamol) can be used. The analgesic doses must be regular and systematic.
Non-steroidal anti-inflammatories are only used during the most acute painful episodes, and with great caution in the elderly. They can be associated with a gastro-protector or replaced with a coxib, respecting possible contraindications.
Corticosteroid therapy can be used in uncomplicated cervico-osteoarthritis during access in case there are contraindications to NSAIDs. A short cure, generally administered at a dose of 1 mg / kg orally, should be given priority.
The muscle relaxants are useful during acute access, but can promote drowsiness. Your prescription will have to be particularly prudent in active people (car driving) and in the elderly (risk of falls). Its ingestion outside the painful accesses will be especially vespertine. Anti-depressants can be used in case of psychic repercussion of chronic pain.
Raquidian infiltrations
Cervical infiltrations are not indicated in uncomplicated arthritic cervicalgia.
However, in the case of associated cervicobranchial neuralgia, resistant to NSAIDs and oral corticosteroid therapy, hydrocortisone infiltrations are performed through the lumbar route followed by tilt (Trendelenburg) during a short hospital stay. Foraminal injections are contraindicated.
Surgical treatment
Surgical treatment is reserved for complicated forms: cervicoarthrosic myelopathy or cervicobrachial neuralgia due to radicular-osteophytic conflict.
Surgical treatment of cervicoarterotic myelopathy is indicated in case of failure of medical measures, that is, in case of aggravation of a neurological deficit or the reappearance of a deficit that had previously decreased in response to medical treatment.
The goal is spinal decompression.
The intervention performed is the best prognosis if the neurological deficit is recent. In the end, it seems that only a small percentage of patients suffering from cervical-ar- tic myelopathy are operated on.
Currently the complications of this surgery are rare (aggravation of the deficit, new radicular deficit, tetraplegia).