Cervical Spondylosis – Natural History

Untreated axial neck pain in patients with cervical spondylosis tends to improve, but it rarely resolves completely.

Most untreated radiculopathies and mild myelopathies follow a prolonged course. Many will have soft disc herniation resorb (like in the lumbar spine).

In a followup of patients with radiculopathies, nearly 50% improve with no recurrence, 25% have mild continuing symptoms, and 25% have persistent or worsening symptoms. It is unusual for a patient with a radiculopathy to develop a myelopathy.

Unlike radiculopathy, for myelopathy, most have a slow, stepwise, course of progressive deterioration. Symptoms and disability are rarely rapidly progressive. Mild involvement carries the best prognosis – these probably will have a prolonged course with long periods of non-progressive disability.

– because of the benign course, non-surgical management is recommended initially for all patients with radiculopathy, and for patients with a MILD myelopathy.

– note that myelopathy rarely resolves completely, and a more expeditious surgical intervention should be considered for patients with moderate to severe myelopathy or rapidly evolving deficits.

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