Symptom Finder - Treatment of Herniated Cervical Disc
HERNIATED CERVICAL DISC
1. If there is no clinical evidence of radiculopathy or myelopathy, treat conservatively with NSAIDs, muscle relaxants, and analgesics such as acetaminophen: 325–1,000 mg q4–6hrs PRN.
2. If there is clear evidence of myelopathy clinically or radiographically, refer to a neurosurgeon for laminectomy or other surgical procedures.
3. Patients with clinical evidence of radiculopathy but no evidence of weakness or atrophy of the muscles of the upper extremity, may be treated conservatively, but should be offered the option of referral to a neurosurgeon for evaluation for surgery.
4. Patients with clinical evidence of radiculopathy including atrophy of the muscles of the upper extremity should be referred to a neurosurgeon.
5. Conservative treatment of cervical pain and radiculopathy includes
one or more of the following:
a. Naproxen (Naprosyn): 500 mg bid–tid or other NSAIDs
b. Cyclobenzaprine (Flexeril): 5–10 mg tid or other muscle relaxants
c. Gabapentin Neurontin): 300–1,200 mg tid or other medications for neuropathic pain
d. Cervical collar latched in front to wear at night.
e. Cervical traction, over the door beginning with 7 lb for ½ hr twice a day and gradually increasing 1 lb a week to 15 lb 1–2 hrs twice a day.
f. Facet or nerve root injections with 2–4 cc of 1% lidocaine (Xylocaine) and 20–40 mg of methylprednisolone acetate (Depo-Medrol).
g. Referral to a neurosurgeon or anesthesiologist for epidural steroid injection
h. Prednisone 10–20 mg daily for first 4 days of each week.
i. Physiotherapy evaluation and recommendations for treatment.
j. Except in cases of acute neck pain or radiculopathy use narcotic analgesics only as last resort and then only until more definitive treatment can be instituted.
1. If there is no clinical evidence of radiculopathy or myelopathy, treat conservatively with NSAIDs, muscle relaxants, and analgesics such as acetaminophen: 325–1,000 mg q4–6hrs PRN.
2. If there is clear evidence of myelopathy clinically or radiographically, refer to a neurosurgeon for laminectomy or other surgical procedures.
3. Patients with clinical evidence of radiculopathy but no evidence of weakness or atrophy of the muscles of the upper extremity, may be treated conservatively, but should be offered the option of referral to a neurosurgeon for evaluation for surgery.
4. Patients with clinical evidence of radiculopathy including atrophy of the muscles of the upper extremity should be referred to a neurosurgeon.
5. Conservative treatment of cervical pain and radiculopathy includes
one or more of the following:
a. Naproxen (Naprosyn): 500 mg bid–tid or other NSAIDs
b. Cyclobenzaprine (Flexeril): 5–10 mg tid or other muscle relaxants
c. Gabapentin Neurontin): 300–1,200 mg tid or other medications for neuropathic pain
d. Cervical collar latched in front to wear at night.
e. Cervical traction, over the door beginning with 7 lb for ½ hr twice a day and gradually increasing 1 lb a week to 15 lb 1–2 hrs twice a day.
f. Facet or nerve root injections with 2–4 cc of 1% lidocaine (Xylocaine) and 20–40 mg of methylprednisolone acetate (Depo-Medrol).
g. Referral to a neurosurgeon or anesthesiologist for epidural steroid injection
h. Prednisone 10–20 mg daily for first 4 days of each week.
i. Physiotherapy evaluation and recommendations for treatment.
j. Except in cases of acute neck pain or radiculopathy use narcotic analgesics only as last resort and then only until more definitive treatment can be instituted.
