Review of Treatment for Cervical RadiculopathyNeck pain that travels down the arm is called cervical radiculopathy. The pain is usually caused by pressure on a spinal nerve as it exits the spinal canal. Bone spurs and disc herniation are the most common sources of compression on the nerves.
In this article, orthopedic surgeons from Emory University review the pathology and the anatomy of cervical radiculopathy. They offer a summary of important clinical tests and X-rays to perform in making the diagnosis. Nonsurgical and surgical treatment are discussed.
Nonsurgical treatment includes short-term use of a soft, cervical collar; traction; and medications. Manipulation, physical therapy, and steroid injections are also part of a conservative plan of management.
Surgery is the last treatment option considered. It may be advised only after an extended trial of nonsurgical care. The operation may be done from the front of the neck (anterior) or from the back (posterior approach). The most common procedure is an anterior cervical decompression and fusion (ACDF).
With an ACDF, the disc or bone spur pressing on the nerve is removed. This is done without disturbing the nerve tissue. Pulling on the nerve tissue could cause further trauma. Fusing the two vertebral bones together using bone graft material actually lifts the vertebrae apart. This has an added decompressive effect.
Artificial disc replacement (ADR) may become an option in the future. For now the FDA has only approved clinical trials with cervical ADRs. This means the approach is not available outside of an authorized research facility.
Outcomes for cervical radiculopathy are good after surgical decompression. Patients report pain relief and improved function. Since surgery is permanent, every effort is made first to take care of the problem conservatively. And, in fact, three out of four people get the symptom relief they need from nonoperative care.
The decision to choose surgery is made by the patient and surgeon together. Duration and type of symptoms make a difference. Prior surgery and/or the presence of any scar tissue in the neck can make a difference.
It is not possible to predict in advance who will respond well to treatment. Therefore, the authors suggest that even severe symptoms should be treated conservatively first. Conservative care may not change the final outcome, but it can decrease symptoms and improve quality of life. Surgery is not a perfect solution, but it can help many patients at risk for permanent nerve damage.
John M. Rhee, MD, et al. Cervical Radiculopathy. In Journal of the American Academy of Orthopaedic Surgeons. August 2007. Vol. 15. No. 8. Pp.486-494.
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