o Workplace modifications and ergon

o Workplace modifications and ergonomics serve to reduce strenuous neck positions during work and leisure.
• Physical modalities are among the oldest treatments used for spine-related disorders.
o Cervical mechanical traction, commonly used for cervical radiculopathy, in addition to cervical joint distraction, may loosen adhesions within the dural sleeves, reduce compression and irritation of discs, and improve circulation within the epidural space.
 Studies regarding its efficacy are conflicting, with intermittent traction probably being more effective than static traction. Initially, a weight of 10 lb is recommended, eventually increasing to 20 lb as tolerated.
 It can be used at home 2-3 times daily for 15 minutes at a time. It is contraindicated in patients who have myelopathy, a positive Lhermitte sign, or rheumatoid arthritis with atlantoaxial subluxation. A retrospective study found that cervical traction provided symptomatic relief in 81% of the patients with mild-to-moderately severe cervical spondylosis syndromes.[34]
o Manipulation, most commonly practiced by chiropractors and osteopathic physicians, was described as early as 4000 years ago. It remains a popular treatment for back pain.
 Techniques vary and include low-velocity, high-amplitude manipulation; high-velocity, low-amplitude manipulation (eg, thrusting or impulse manipulation); and nonthrusting maneuvers. Studies have reported conflicting results, and few well-controlled studies specifically concerning the treatment of cervical spondylosis symptoms have been published.
 Contraindications to cervical manipulation include vertebral fractures, dislocations, infections, malignancy, spondylolisthesis, myelopathy, various rheumatologic and connective-tissue disorders, and the presence of objective signs of nerve root compromise. The most feared complication of cervical manipulation, vertebrobasilar artery dissection, is rare and almost impossible to predict despite multiple proposed risk factors.
• Exercises designed for cervical pain include isometric neck strengthening routines, neck and shoulder stretching and flexibility exercises, back strengthening exercises, and aerobic exercises. Controlled trials regarding the efficacy of these routines are lacking.
• Other commonly used modalities for pain include heat, cold, acupuncture, massage, trigger-point injection, transcutaneous electrical nerve stimulation, and low-power cold laser. Most of the passive modalities used for degenerative disease of the cervical spine are performed by physical therapists and are most efficacious in combination.
Surgical Care
Surgical care for cervical spondylosis involves anatomic correction of the degenerative pathologic entities that compress a nerve root or the spinal cord.
Indications for surgery include intractable pain, progressive neurologic deficits, and documented compression of nerve roots or of the spinal cord that leads to progressive symptoms. Surgery has not been proven to help neck pain and/or suboccipital pain. Several approaches to the cervical spine have been proposed. The approach selected is determined based on the type and location of pathology and the surgeon's preference.
• Cervical radiculopathy traditionally has been approached either via the anterior approach, which was first described by Robinson and Smith in 1955, or the posterolateral approach, during which a "keyhole" foraminotomy is performed.
o The anterior approach allows excellent access to midline disease and visualization of pathology without manipulation of neural elements. Robinson and Smith proposed that the anterior approach coupled with fusion using an iliac crest bone graft (autograft) arrests progressive spondylotic spurring, causes existing osteophytes to eventually regress as a result of spinal stability promoted by fusion, decompresses and enlarges the neural foramen and spinal canal by the distraction of the disk space, and minimizes surgical manipulation of the contents of the spinal canal, thereby minimizing complications.

Kết quả (Việt) 1:

o sửa đổi nơi làm việc và Thái nhằm mục đích làm giảm vị trí cổ vất vả trong công việc và giải trí.• Phương thức vật lý là một trong những phương pháp điều trị lâu đời nhất được sử dụng cho chứng rối loạn liên quan đến cột sống.o lực kéo cơ khí cổ tử cung, thường được sử dụng cho radiculopathy cổ tử cung, ngoài cổ tử cung phân tâm chung, có thể nới lỏng adhesions trong tay áo dural, giảm nén và kích thích của đĩa, và cải thiện lưu thông trong không gian ngoài màng cứng. nghiên cứu liên quan đến hiệu quả của nó được mâu thuẫn, với lực kéo liên tục có thể hiệu quả hơn lực kéo tĩnh. Ban đầu, một trọng lượng 10 Pound được khuyến khích, dần dần tăng lên 20 lb như khoan dung. Nó có thể được sử dụng ở nhà 2 - 3 lần hàng ngày 15 phút một lần. Nó chống chỉ định ở những bệnh nhân có myelopathy, một dấu hiệu Lhermitte tích cực hoặc bệnh thấp khớp với atlantoaxial subluxation. Một nghiên cứu quá khứ cho thấy rằng lực kéo cổ tử cung cung cấp cứu trợ có triệu chứng trong 81% của bệnh nhân với bệnh gai cột sống cổ tử cung nghiêm trọng nhẹ-để-vừa phải hội chứng.[34]o thao tác, phổ biến nhất được thực hiện bởi các chiropractors và osteopathic, bác sĩ, được mô tả sớm nhất là 4.000 năm trước đây. Nó vẫn còn một phổ biến điều trị cho bệnh đau lưng. kỹ thuật khác nhau và bao gồm vận tốc thấp, cao-biên độ thao tác; thao tác vận tốc cao, thấp-biên độ (ví dụ:, thrusting hoặc xung thao tác); và nonthrusting thao tác. Nghiên cứu đã báo cáo kết quả mâu thuẫn, và vài nghiên cứu cũng kiểm soát cụ thể liên quan đến việc điều trị các triệu chứng bệnh gai cột sống cổ tử cung đã được công bố. Contraindications to cervical manipulation include vertebral fractures, dislocations, infections, malignancy, spondylolisthesis, myelopathy, various rheumatologic and connective-tissue disorders, and the presence of objective signs of nerve root compromise. The most feared complication of cervical manipulation, vertebrobasilar artery dissection, is rare and almost impossible to predict despite multiple proposed risk factors.• Exercises designed for cervical pain include isometric neck strengthening routines, neck and shoulder stretching and flexibility exercises, back strengthening exercises, and aerobic exercises. Controlled trials regarding the efficacy of these routines are lacking.• Other commonly used modalities for pain include heat, cold, acupuncture, massage, trigger-point injection, transcutaneous electrical nerve stimulation, and low-power cold laser. Most of the passive modalities used for degenerative disease of the cervical spine are performed by physical therapists and are most efficacious in combination.Surgical CareSurgical care for cervical spondylosis involves anatomic correction of the degenerative pathologic entities that compress a nerve root or the spinal cord.Indications for surgery include intractable pain, progressive neurologic deficits, and documented compression of nerve roots or of the spinal cord that leads to progressive symptoms. Surgery has not been proven to help neck pain and/or suboccipital pain. Several approaches to the cervical spine have been proposed. The approach selected is determined based on the type and location of pathology and the surgeon's preference.• Cervical radiculopathy traditionally has been approached either via the anterior approach, which was first described by Robinson and Smith in 1955, or the posterolateral approach, during which a "keyhole" foraminotomy is performed.o The anterior approach allows excellent access to midline disease and visualization of pathology without manipulation of neural elements. Robinson and Smith proposed that the anterior approach coupled with fusion using an iliac crest bone graft (autograft) arrests progressive spondylotic spurring, causes existing osteophytes to eventually regress as a result of spinal stability promoted by fusion, decompresses and enlarges the neural foramen and spinal canal by the distraction of the disk space, and minimizes surgical manipulation of the contents of the spinal canal, thereby minimizing complications.