management of cervical radiculopathy

Last edited 06/2018

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)

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