Management of cervical radiculopathy

Management

Non operative treatment

• immobilization
  • a soft cervical collar can be used to minimize motion and reduce nerve root irritation
  • although prescribed usually, there is little evidence in the literature supporting their use
  • should be careful when using since long-term immobilization (more than 1 -2 weeks) as it can lead to deconditioning and atrophy of the muscles in the neck
• physical therapy
  • aim is to restore range of motion and strengthen neck muscles
  • gentle range of motion and stretching exercises may be combined with heat, ice and electrical stimulation early on in the treatment
• traction
  • can be applied manually by a physical therapist or mechanically with a series of increasing weights (which range from 5 to 12kg)
• medication
  • NSAIDs
    • first line of therapy
  • muscle relaxants
  • oral corticosteroids
    • sometimes used in the acute phase
    • use must be weighed against the risk of complications
  • opioids
    • may be effective if used up to 8 weeks
• steroid injections
  • cervical epidural spinal corticosteroid injections can be considered as an adjunct to other non-operative methods (1,2,3)

Operative management

• usually reserved for the following patients:
  • patients who are unresponsive after 6 months of conservative surgery
  • patients with concerning signs or symptoms that might merit early surgical intervention e.g. - progressive neurologic deficits, signs of myelopathy, fractures or other signs of cervical instability or ligamentous injury, osseous lesions, or destruction
• surgical techniques include:
  • anterior approach - anterior cervical decompression and fusion (ACDF), cervical disc arthroplasty (CDA)
  • posterior approach - posterior cervical foraminotomy (PCF) (1,2,3)

Over 85% of acute cervical radiculopathy resolves without any specific treatments within 8 to 12 weeks (4)

References:

1. Iyer S, Kim HJ. Cervical radiculopathy. Current Reviews in Musculoskeletal Medicine. 2016;9(3):272-280.
2. Corey DL, Comeau D. Cervical radiculopathy. Med Clin North Am. 2014;98(4):791-9, xii.
3. Onks CA, Billy G. Evaluation and treatment of cervical radiculopathy. Prim Care. 2013 Dec;40(4):837-48, vii-viii
4. Guan Q, Xing F, Long Y, Xiang Z. Cervical intradural disc herniation: A systematic review. J Clin Neurosci. 2018 Feb;48:1-6