Treatment of Cervical Spondylosis with Degenerative cervical myelopathy: Cervical spondylotic myelopathy

Ross Hauser, MD

Treatment of Cervical Spondylosis

Many patients who visit us have stories of a long medical history. They will tell us about their decades-long battle managing their “health problems.”

Degenerative cervical myelopathy – a lack of understanding

These people are in our examination rooms because they are looking for answers that they have not found in years of searching and they are fighting the feeling of abandonment from doctors who they believe have a lack of understanding of how to help them.

The patients will describe diagnosis after diagnosis, medical test after medical test, medication after medication, all with no or short-term help for them. When all these treatments have failed, the patients tell us they get recommended for psychological counseling because they are depressed nothing has helped them. Some will tell us that even their family and friends have started to doubt that their symptoms are real. Especially when stomach problems and nausea become common.

Degenerative cervical myelopathy – a lack of understanding discussed in the medical literature

Let’s look at an April 2021 study in the Journal of neurosurgery. Spine, (1) lead by researchers at the University of Toronto. What the researchers said was that while “Degenerative cervical myelopathy is among the most common pathologies affecting the spinal cord but its natural history is poorly characterized.” To help with this understanding the researchers then, “investigating functional outcomes in patients with Degenerative cervical myelopathy who were managed nonoperatively (after they had cervical spine surgery that did not alleviate many of their symptoms or conditions) as well as the utility of quantitative clinical measures and MRI to detect deterioration.”

Looking at patients after they had surgery

Symptoms

Neurological Functional Assessments

These researchers discovered that progressive deterioration was best detected with grip strength, hand dexterity, and gait stability. Using an MRI to assess symptoms was considered a poor diagnostic choice.

So what does this mean? It’s an understanding. 

Patients who had cervical spine surgery to address functional symptoms of degenerative cervical myelopathy following the surgery can have the severity of their degenerative condition better understood by loss of grip strength and gait instability. MRIs, for the most part will not help diagnosis or treatment for this patient group. Okay, we have this information. What do we do with it?

Treatment for degenerative changes in the cervical spine

It typically begins with repetitive actions “overuse injury,” that results in sprains (ligament damage) and rotational strains or compressive forces to the spine. This causes injury to the cervical facet joints which in turn can jeopardize the natural function of the cervical ligaments and cause cervical facet joint pain. Further degeneration can lead to abnormal motion in the cervical spine and cartilage breakdown.

In our own published research, we documented that the use of conventional modalities for chronic neck pain remains debatable, most treatments have had limited success and despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures.(2)

In this research, our team led by Danielle Steilen-Matias, MMS, PA-C, noted that the capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Such pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions such as:

Cervical Spondylosis cervical ligament damage

In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability.

Understanding Prolotherapy treatment is understanding that we are treating Cervical Spondylosis by treating cervical instability

In the our research study cited above we looked at how Cervical Spondylosis was described in the medical literature:

The degenerative cascade that causes Cervical Spondylosis, however, begins long before symptoms become evident.

When the ligaments aren’t strong enough to support the cervical spine – Doctors do not expect recovery with conventional treatments

Korean doctors writing in the medical publication the Asian spine journal give a good summary of the problem Ossification of the posterior longitudinal ligament.

Ossification of the posterior longitudinal ligament is a condition of abnormal calcification of the posterior longitudinal ligament. The most common location is at the cervical spine region. Compression of spinal cord caused by ossification of the posterior longitudinal ligament  may lead to neurologic symptoms and in the cases with severe neurologic deficit, surgical treatments are required.

However, the exact pathogenesis (origins) and natural history (progression) of  ossification of the posterior longitudinal ligament remain unclear, there is no standard treatment for patients with asymptomatic  ossification of the posterior longitudinal ligament, and there is disagreement about the best surgical approach for cervical fusion surgery.(3)

The same research team also gives us a good idea of the progression of treatments that lead to unsure surgery recommendation

As symptomatic treatments, pain medication, topical agents, anti-inflammatory drugs, antidepressants, anticonvulsants, non-steroidal anti-inflammatory drugs and opioid can be applied, and bed rest and assist devices, such as a brace, are recommended for local stabilization. However, once the symptoms of myelopathy, such as gait disturbance and disorders of fine motor movement in the hand develop, appropriate recovery is not expected with conservative treatments. The patient moves onto surgery.

The research cited above comes from 2011, in a new study from August 2017, doctors at the Fujian Medical University in China published research in the medical journal Medicine that evaluated the effectiveness of various surgical interventions for the management of cervical spondylosis due to the ossification of the posterior longitudinal ligament.(4)

What is interesting in this study is that the doctors found success in treating patients surgically in a manner similar to the concepts of Prolotherapy. Let’s look at this fascinating comparison in bullet points:

Let’s finish up this comparison with conclusion notes from surgeons:

In our clinical and research observations, we have documented that Prolotherapy can offer answers for sufferers of cervical instability, as it treats the problem at its source. Prolotherapy to the various structures of the neck eliminates the instability and the sympathetic symptoms without many of the short-term and long-term risks of cervical fusion. We concluded that in many cases of chronic neck pain, the cause may be underlying joint instability and capsular ligament laxity. Furthermore, we contend that the use of comprehensive Prolotherapy appears to be an effective treatment for chronic neck pain and cervical instability, especially when due to ligament laxity. The technique is safe and relatively non-invasive as well as efficacious in relieving chronic neck pain and its associated symptoms.

Medical research validating the use of Comprehensive Prolotherapy, from simple dextrose injections to stem cell prolotherapy injections is not new. There are 55 years of research supporting the use of Prolotherapy for problems of the neck and head.(5)

If you have questions about Cervical Spondylosis, you can get help and information from our Caring Medical Staff

 

References for this article:

1 Martin AR, Kalsi-Ryan S, Akbar MA, Rienmueller AC, Badhiwala JH, Wilson JR, Tetreault LA, Nouri A, Massicotte EM, Fehlings MG. Clinical outcomes of nonoperatively managed degenerative cervical myelopathy: an ambispective longitudinal cohort study in 117 patients. Journal of Neurosurgery: Spine. 2021 Apr 9;1(aop):1-9. [Google Scholar]
2. Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. Open Orthop J. 2014 Oct 1;8:326-45. doi: 10.2174/1874325001408010326. eCollection 2014. [Google Scholar]
3. Choi BW, Song KJ, Chang H. Ossification of the posterior longitudinal ligament: a review of literature. Asian spine journal. 2011 Dec 1;5(4):267-76.  [Google Scholar]
4. Wu D, Liu CZ, Yang H, Li H, Chen N. Surgical interventions for cervical spondylosis due to ossification of posterior longitudinal ligament: A meta-analysis. Medicine. 2017 Aug 1;96(33):e7590. [Pubmed] [Google Scholar]
5. HACKETT GS, Huang TC, RAFTERY A. Prolotherapy for headache. Headache: The Journal of Head and Face Pain. 1962 Apr 1;2(1):20-8. [Google Scholar]

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