Treatments to Try Before Cervical Spine Surgery

While surgery for cervical degenerated disc disease is a relatively safe and effective treatment option, it is still major surgery that carries some risks. Before making the decision to have surgery for cervical degenerative disc disease, it is important to first explore nonsurgical treatment options and give them ample time to work.

Nonsurgical Treatments for Cervical Degenerative Disc Disease

When cervical degenerative disc disease progresses to the point of causing cervical radiculopathy symptoms of pain, tingling, and/or numbness to radiate into the arm and/or hand, many tasks that were previously simple—such as carrying objects, typing, or getting dressed—can become difficult. These symptoms are typically the motivation behind seeing a doctor.

Nonsurgical treatments that are normally tried first for cervical degenerative disc disease symptoms include:

Rest and/or activity modification

Initially, it makes sense to rest more and avoid activities that worsen the neck and/or arm pain. For example, if job duties exacerbate the pain, taking some time off or modifying the work day to avoid specific tasks may reduce the pain. Resting or wearing a neck brace more than a few days is typically not advised because the neck muscles may become deconditioned and lead to more pain.

Pain management

Numerous pain relief options are available. Trial and error may be required before finding the combination of treatments that works best. Over-the-counter medications that reduce inflammation and pain are commonly tried first, but stronger prescription medications may also be tried on a short-term basis. Ice packs and/or heat therapy are convenient options to use at home. Alternative therapies, such as manual manipulation, acupuncture, or massage, may provide relief for some people. Epidural steroid injections in the neck may temporarily reduce pain and could also serve as a diagnostic tool for confirming which disc level is causing pain.

Physical therapy

With chronic neck pain, the muscles in the neck, shoulder, and back tend to weaken and tighten. A physical therapist or other qualified medical professional can design a physical therapy program to help strengthen and stretch the neck’s surrounding muscles.

See Physical Therapy for Neck Pain Relief

Behavioral changes

Healthy eating, good sleep, regular exercise, and social support may help reduce stress and alleviate painful symptoms in some people. Quitting smoking can also be beneficial. In fact, smoking increases the risk for spinal surgery to fail, which is why many surgeons refuse to operate on smokers.¹Luszczyk M, Smith JS, Fischgrund, et al. Does smoking have an impact on fusion rate in single-level anterior cervical discectomy and fusion with allograft and rigid plate fixation? Clinical article. J Neurosurg Spine. 2013; 19(5):527-31.^,2Purvis TE, Rodriguez HJ, Ahmed AK, et al. Impact of smoking on postoperative complications after anterior cervical discectomy and fusion. J Clin Neurosci. 2017; 38(4); 106-10.^,3Jackson KL, Devine JG. The effects of smoking and smoking cessation on spine surgery: a systematic review of the literature. Global Spine J. 2016; 6(7): 695-701.

Painful symptoms from cervical degenerative disc disease typically start to get better within 6 months, even if they do not completely go away within that time.⁴Wong JJ, Cote P, Quesnele JJ, et al. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J. 2014; 14(8): 1781–9. However, if symptoms of tingling, numbness, weakness, and/or poor coordination are worsening or severe, surgery may be scheduled sooner rather than waiting for months.

Why Symptoms Sometimes Go Away on Their Own

In some cases, pain from cervical degenerative disc disease alleviates without extensive treatments. A few theories as to why cervical radiculopathy symptoms tend to go away on their own if given enough time include:

• Inflammatory proteins eventually dry out. When a disc herniates, its inflammatory proteins (normally confined inside the disc) leak out and can inflame nearby structures, such as a nerve root, which can radiate pain from the neck to the shoulder, arm, and/or hand. This pain may go away on its own due to the herniated disc eventually drying out and/or no longer leaking, perhaps after many months, and thus no longer causing inflammation and pain.⁵Adams MA, Stefanakis M, Dolan P. Healing of a painful intervertebral disc should not be confused with reversing disc degeneration: implications for physical therapies for discogenic back pain. Clinical Biomechanics. 2010; 25(10): 961-71.
• Unstable vertebral levels naturally re-stabilize over time. As a disc degenerates and loses height, the adjacent vertebrae above and below get closer together and put more stress on the facet joints. With less cushioning in the spinal joints, bone starts grinding against bone and causes more inflammation and pain. Over a period of years, bone grinding leads to more bone growth, reduced joint mobility, and the eventual fusion of the adjacent vertebral bones. This process might stabilize a previously painful spinal level in a manner that reduces or eliminates the pain.⁶Voorhies RM. Cervical spondylosis: recognition, differential diagnosis, and management. Ochsner J. 2001; 3(2): 78-84.

While rare, there have also been documented reports of cervical disc herniations regressing on their own, possibly due to the inflammatory process causing the resorption of the herniated material.⁷RH Seong, Choi CY. Spontaneous regression of cervical disc herniation: a case report. Korean J Spine. 2014; 11(4):235-7.

See Video: Can Herniated Discs Heal on Their Own?

However, cervical degenerative disc disease symptoms do not always go away on their own and should be evaluated by a doctor.