Treatment and prognosis of cervical radiculopathy
- Jenice Robinson, MD
Jenice Robinson, MD
- Assistant Professor Case Medical Center
- Neuroscience Institute
- Milind J Kothari, DO
Milind J Kothari, DO
- Professor of Neurology
- Penn State College of Medicine
The treatment of cervical radiculopathy will be reviewed here, focusing on the treatment of compressive radiculopathy due to disc degeneration and cervical spondylosis. The clinical features and diagnosis of cervical radiculopathy are discussed separately. (See "Clinical features and diagnosis of cervical radiculopathy".)
The management of patients with cervical spondylotic myelopathy is reviewed in detail elsewhere. (See "Cervical spondylotic myelopathy", section on 'Treatment'.)
The optimum treatment of compressive cervical radiculopathy is the subject of continued debate, and initial management may vary significantly among practitioners. There is sparse evidence that any treatment improves upon the natural history of the condition.
Despite uncertainty regarding effectiveness, we suggest conservative therapy as initial treatment for most patients with compressive cervical radiculopathy who have clear radicular pain and symptoms of paresthesia or numbness (algorithm 1). In addition, we suggest conservative therapy as initial treatment for patients with cervical radiculopathy who have nonprogressive neurologic deficits, including dermatomal sensory loss, myotomal weakness, and sensory changes, as long as myelopathy is not suspected. All patients with motor weakness should be closely followed for evidence of progression. (See 'Conservative therapy' below.)
Clinical reevaluation should be performed after six to eight weeks of conservative treatment, with assessment for motor weakness and myelopathic findings in patients who have not improved or in those who have progressive symptoms. (See 'Refractory or progressive symptoms' below.)
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- OUR APPROACH
- NONSURGICAL THERAPY
- Conservative therapy
- - Oral glucocorticoids
- - Exercise therapy
- - Cervical traction
- - Refractory or progressive symptoms
- Epidural glucocorticoid injections
- Indications for surgery
- Anterior cervical discectomy and fusion
- Posterior laminoforaminotomy
- Artificial disc replacement
- Compressive radiculopathy
- Nondegenerative radiculopathy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS