Most patients with cervical radiculopathy have a favorable prognosis. The classic study of the natural history of cervical radiculopathy followed 51 patients over two to 19 years. No patient with radicular pain progressed to myelopathy.
In most patients with cervical radiculopathy, nonoperativetreatment Figure 3 2 , 5 is effective. In a one-year cohort study of 26 patients with documented herniated nucleus pulposus and symptomatic radiculopathy, a focused, non-operative treatment program was successful in 92 percent of patients.
Algorithm for nonoperative treatment of acute cervical radiculopathy. Cervical radiculopathy: diagnosis and nonoperative management. J Am Acad Orthop Surg. When approaching the nonoperative management of neck and radicular pain, it is important to distinguish the acuity of the process. Pain emanating from nerve compression by a soft disk herniation typically has a more acute presentation, with or without radiating extremity symptoms.
Chronic, bilateral axial neck and radiating arm pain is usually caused by cervical spondylosis and may emanate from a variety of sources, including the degenerative disk or the facet joints. Although education about these and other components of cervical radiculopathy may benefit some patients, a systematic review did not show that patient education i.
For patients with acute neck pain secondary to radiculopathy, a short course one week of neck immobilization may reduce symptoms in the inflammatory phase. Home cervical traction units may decrease radicular symptoms.
Typically, eight to 12 lb of traction is applied at an angle of approximately 24 degrees of flexion for to minute intervals. Pharmacotherapy may be beneficial in alleviating acute pain associated with cervical radiculopathy. Although medications have no proven benefit for cervical radiculopathy, positive results with their use in the treatment of lumbar radiculopathy and low back pain suggest a potential role.
Nonsteroidal anti-inflammatory drugs have been shown to be effective in treating acute low back pain, 3 , 12 and many physicians consider them first-line agents in the treatment of neck and radiating arm pain. Some patients may benefit from the addition of narcotic analgesics, muscle relaxants, antidepressants, or anticonvulsants.
Although not specific to cervical radiculopathy, a systematic review and a meta-analysis suggest that opioids may be effective in the treatment of neuropathic pain of up to eight weeks duration. Muscle relaxants e. Medications may be effective for patients with chronic radicular pain who decline surgery or have continued pain after surgery. A systematic review suggests that tricyclic antidepressants and venlafaxine Effexor may produce at least moderate relief in patients with chronic neuropathic pain.
Although oral steroids are widely used to treat acute radicular pain via dose packs, no high-quality evidence has shown that oral steroids alter the disease course. A graduated physical therapy program may be beneficial in restoring range of motion and overall conditioning of the neck musculature.
In the first six weeks after onset of pain, gentle range-of-motion and stretching exercises supplemented by massage and modalities such as heat, ice, and electrical stimulation may be used, although this approach has no proven long-term benefit. As the pain improves, a gradual, isometric strengthening program may be initiated with progression to active range-of-motion and resistive exercises as tolerated.
No high-quality evidence has proved the effectiveness of manipulative therapy in the treatment of cervical radiculopathy. However, limited evidence suggests that manipulation may provide short-term benefit in the treatment of neck pain, cervicogenic headaches, 3 , 17 and radicular symptoms.
Cervical steroid injections may be considered in the treatment of radicular pain. Cervical perineural injections e. These blocks attempt to bathe the affected nerve root in steroids. One study demonstrated significant pain relief at 14 days and six months after a series of selective nerve root blocks.
One study of a series of more than 1, blocks showed a minor complication rate of 1. A recent review of the literature suggests that epidural corticosteroids may lead to short-term, symptomatic improvement of radicular symptoms. Approximately one third of patients with cervical radiculopathy who are treated nonoperatively have persistent symptoms.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. At the time this manuscript was written, Dr. Eubanks was a spine fellow at the University of Pittsburgh Pa. Medical Center. Reprints are not available from the author.
Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, through Cervical radiculopathy. Polston DW. Neurol Clin. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults—an evidence-based approach—part 3: spinal disorders. J Manipulative Physiol Ther.
Lees F, Turner JW. Sharp pain in the back, arms, legs or shoulders that may worsen with certain activities, even something as simple as coughing or sneezing. Your specific symptoms will depend on where in the spine the nerve root is pinched. Radiculopathy is typically caused by changes in the tissues surrounding the nerve roots. These tissues include bones of the spinal vertebrae, tendons and intervertebral discs. When these tissues shift or change in size, they may narrow the spaces where the nerve roots travel inside the spine or exit the spine; these openings are called foramina.
The narrowing of foramina is known as foraminal stenosis, which is very similar to spinal stenosis that affects the spinal cord. In most cases, foraminal stenosis is caused by gradual degeneration of the spine that happens as you age.
But it can also be a result of a spinal injury. One common cause of foraminal stenosis and radiculopathy is a bulging or herniated disc.
Spinal discs act as cushions between your vertebrae. On occasion, these discs slip out of place or become damaged and press on nerves. This problem is most likely to occur in your lower back, but it can also affect your neck. Another possible cause of radiculopathy that may lead to narrowing of foramina is bone spurs — areas of extra bone growth.
Bone spurs can form in the spine due to inflammation from osteoarthritis, trauma or other degenerative conditions. Thickening ossification of the spinal ligaments may also lead to narrowing of the space around the nerve roots and subsequent nerve compression. Less common causes of radiculopathy include spinal infections and various cancerous and noncancerous growths in the spine that may press against the nerve roots.
Sometimes, radiculopathy can be accompanied by myelopathy — compression of the spinal cord itself. Start New Search. About the spinal cord and nerve roots The spinal cord originates in the brain, exiting through a hole at the skull base called the foramen magnum and coursing through the spinal canal of the cervical, thoracic and upper lumbar spine before ending most commonly between the first and second lumbar vertebrae.
All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
Not what you're looking for? Want More Information? Cedars-Sinai has a range of comprehensive treatment options. Did you know you can support education and research for neurosurgical conditions while you shop, at no extra cost to you?
Register with AmazonSmile to designate the NREF as your charity, and a percentage of your purchase is donated automatically. Annulus fibrosus — The fibrous, ring-like outer portion of an intervertebral disc. Arachnoiditis — Inflammation of the arachnoid membrane the middle of the three protective layers called the meninges ; most commonly seen around the spinal cord and cauda equina.
Arthritis — Inflammation of a joint, usually accompanied by swelling, pain and restriction of motion. Bone spur — Bony growth or rough edge of bone.
Cauda equina — The collection of nerves at the end of the spinal cord that resembles a horse's tail. Cervical spine — The neck region of the spine consisting of the first seven vertebrae. Coccyx — More commonly known as the tailbone, this is a bony structure in the region of the spine below the sacrum.
Conus medullaris — The cone-shaped bottom of the spinal cord, usually at the level of L1. Disc Intervertebral — A tough, elastic cushion located between the vertebrae in the spinal column; acts as a shock absorber for the vertebrae. Disc degeneration — The deterioration of a disc. A disc in the spine may wear out over time.
A deteriorated disc may or may not cause pain. Facet — A joint formed when a posterior structure of a vertebra that joins with a facet of an adjacent vertebra; this joint allows for motion in the spinal column.
Each vertebra has a right and left superior upper facet and a right and left inferior lower facet. Foramen — An opening in the vertebrae of the spine through which the spinal nerve roots travel. Joint — The junction of two or more bones that permits varying degrees of motion between the bones. Lamina — The flattened or arched part of the vertebral arch that forms the roof or back part of the spinal canal. Ligament — Fibrous connective tissue that links bones together at joints or that passes between bones of the spine.
0コメント