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For acute or sudden neck pain, doctors prescribe pain relief medications such as acetaminophen, anti-inflammatory agents, and muscle relaxants. Temporary bed rest or a brace may also be suggested. Usually patients are encouraged to get up and gradually increase their activities of daily living.

Physical therapy is often prescribed, and usually includes stretching exercises to improve flexibility and extension exercises to help maintain the spine’s natural curve. A hot/cold therapy and gentle massage can also be beneficial for neck pain. Chiropractic care may also be considered at this time.

After acute symptoms subside (usually within two to three weeks), patients are encouraged to begin a daily exercise regimen. This may include low impact aerobics three times per week as well as daily neck exercises.

If symptoms of cervical DDD persist despite these non-operative treatments, further diagnostic tests may be necessary. These tests may include an MRI, CT Scan, Myelogram, or possibly Discography. If the surgeon discovers that one or more of the vertebral discs have herniated, surgery may be necessary. Your surgeon will consider various surgical options. A common technique is an anterior cervical discectomy and fusion (ACDF). This involves an anterior (from the front) approach, removal of the offending disc and then fusion of the adjacent vertebrae usually with instrumentation. However, there are also other surgical options that will be considered, and your surgeon will carefully discuss these with you.

The treatment of cervical disc herniation can be divided into two categories, conservative (non-surgical) and surgical. In some rare cases of very large disc herniation causing significant pressure on the spinal cord, surgery may be considered the conservative option.

In general, conservative management consists of maneuvers to reduce pressure on the nerve root. Immobilization with the neck in a flexed forward position may be helpful. Straining should be avoided. Medication in the form of an anti-inflammatory such as aspirin, ibuprofen, naproxen, celebrex or vioxx may be taken. As these medications have side effects, patients should carefully read the package material or consult their doctor if taking any medications for longer than a few days. Physical therapy may be prescribed. This can consist of traction, mild stretching, exercise, heat, massage and ultrasound. These can be using in various combinations depending on the patient. A course of home cervical traction may be helpful. In some cases, a referral may be made to a pain management specialist or a physiatrist. These are doctors with special training in the diagnosis and treatment of pain. Various injections in and around the cervical spine can be performed. The particular type of injection depends on the individual patient. Up to 95 percent of patients will get better without the need for surgery.

Surgical treatment is reserved for patients who exhibit the signs and symptoms that require urgent decompression, patients who can not or do not wish to spend the time to allow conservative approaches to work and patients who have failed conservative management after a reasonable amount of time (six to eight weeks). Surgery for cervical disc herniation is divided into two approaches, anterior (from the front) and posterior (from the back). Since the disc is located in front of the spinal cord, the anterior approach is the more direct approach. The most common anterior operation is the anterior discectomy and fusion (ACDF). The disc is removed and usually replaced with a small piece of bone (either from the patient’s hip or from cadaver donor). Sometimes, metal plates and screws may be used to assist the fusion. Depending on the type of surgery performed, a cervical collar may need to be worn for anywhere from a week to twelve weeks. The posterior approach is much less commonly performed. In this operation, a small amount of bone is removed from the back of the spine over the affected nerve root. Gentle retraction may allow removal of a soft disc. Few surgeons perform this operation.

Treatment usually involves physical therapy, several weeks of drug therapy with nonsteroidal anti-inflammatory drugs (NSAIDs), and limited use of a cervical collar (to reduce neck movement). Neck traction and heat treatments may also be recommended. In some cases, steroids or anesthetic drugs may be injected into the spinal canal to help alleviate symptoms. Aside from these measures, maintaining good posture and placing a pillow under the neck and head during sleep can be helpful. Treatment may last anywhere from several weeks to three months or more. Neck surgery is not usually advised unless other therapies have failed.

In a spine fusion procedure, the surgeon joins two or more adjacent vertebrae. Bone taken from other parts of the body, usually the pelvis just above the hip joint, is placed across the vertebrae. Plugs of bone shaped like hockey pucks or cages made of metal or plastic are used between the vertebrae anteriorly. Posteriorly the bone is ground up into small pieces and laid down over the spine. The vertebrae and bone graft grow together as healing progresses, eventually forming a single unit without motion across them.

If the spine is in overall good position, spinal implants may not be necessary. So while not all spinal fusions require implants, many patients whose spines are weakened by injury or disease or whose deformities must be corrected are treated with internal fixation or spinal implants. If the spine needs to be placed and maintained in a new position, spinal implants will typically be necessary. The implants can include rods, screws, and hooks to fixate and stabilize the spine. Various types of implants are used depending on the problem that required the fusion, the patient’s age, and the surgeon’s judgment. These implants are usually left implanted indefinitely to minimize the possible loss of spinal alignment. The development of a spine fusion may take up to one year during which time physical activity may be limited and a spine brace may be recommended.

Fusion surgery is inherently more complicated, more painful, and riskier than procedures such as discectomy and laminectomy. There is no consensus in the medical community as to the appropriate indications for fusion surgery.