Treatment 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 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. Part of the problem is that cervical radiculopathy is a clinical, and to some extent subjective, diagnosis with no "gold standard" test to establish or exclude the disease. Depending upon the diagnostic criteria used, clinical studies evaluating the treatment of cervical radiculopathy have tended to select one subset of patients more than another. As an example, studies that require the presence of a surgically demonstrated lesion to establish the diagnosis of cervical radiculopathy are likely to exclude patients with mild or improving symptoms.
The treatment of cervical radiculopathy will be reviewed here. The clinical features and diagnosis of cervical radiculopathy are discussed separately. (See "Clinical features and diagnosis of cervical radiculopathy".)
The prognosis varies in part upon whether the cervical radiculopathy is compressive or noncompressive. The majority of radiculopathies arise from nerve root compression; the two predominant mechanisms are cervical spondylosis and disc herniation. Noncompressive radiculopathy includes diabetes and infectious, granulomatous, and infiltrating neoplastic disorders. (See "Clinical features and diagnosis of cervical radiculopathy", section on 'Pathophysiology'.)
Compressive radiculopathy — Although data are limited, some, if not most, patients with compressive cervical radiculopathy improve without specific treatment [1,2]. Evidence that improvement is not treatment specific comes from a population-based study of 561 patients with cervical radiculopathy from Rochester, Minnesota . This was not a natural history study, since most patients received some treatment and 26 percent had surgery for cervical radiculopathy. Nevertheless, at last follow-up, 90 percent of patients were asymptomatic or only mildly incapacitated.
Given the apparent overall good prognosis for recovery, conservative therapies are preferred in most patients.
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- Compressive radiculopathy
- - Triage
- Noncompressive radiculopathy
- 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
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS