Whereas, in past years, imaging such as myelography carried such risk that it was done only preoperatively, the advent of newer technologies has lowered the threshold for ordering diagnostic studies. Excessive press coverage and fear of litigation also have led to premature and excessive testing. Seen in this light, patient education and reassurance may be the most powerful weapons in the medical armamentarium. After progressive myelopathy has been ruled out, patients with cervical pain should be started on a course of conservative therapy. A specific diagnosis, whether it is disk herniation or facet arthritis, is not required initially because the treatment regimen is standard.
Recumbent rest unloads the cervical structures.
The static weight of the head is eliminated, as well as the dynamic loads imparted by the cervical musculature as they work to balance the head over the spine. A few days of such rest may be necessary, but it should not be continued beyond 48 to 72 hours. A well-fitted cervical collar usually provides sufficient comfort for the symptomatic patient. Patients should initially wear the collar day and night, removing it to bathe and to do isometric exercises. Patients must understand that the neck is particularly unprotected from awkward positions and movements during sleep and that collar wear is important.