Which treatments are effective for cervical radiculopathy?
Surgery can relieve pain, but has risks
Laminectomy to reduce nerve compression may alleviate pain and improve function, but it has risks. Surgical procedures for cervical radiculomyelopathy have reported death rates of 0% to 1.8%; nonfatal complications occurred in 1% to 8% of patients.
A Cochrane review found only one RCT (N=81) that compared surgery with conservative treatment (physiotherapy and the cervical collar).7 Twenty patients crossed over to another treatment, including 3 surgical patients who improved before surgery and 11 who did postop physiotherapy.8 Patients were still analyzed by intention to treat, however.
The surgery group showed greater pain improvement at 3 months, as assessed by visual analogue scale (0 to 100), than the physiotherapy group (mean difference [MD]=–14; 95% confidence interval [CI], –27.84 to –0.16) and the cervical collar (MD=–21; 95% CI, –33.32 to –8.68). At 1 year, however, no difference was seen between surgery and physiotherapy (MD=–9; 95% CI, –23.39 to 5.39) or between surgery and the cervical collar (MD=–5; 95% CI, –18.84 to 8.84).7
Symptoms often resolve spontaneously
The natural course of cervical radiculopathy is uncertain, but symptoms often resolve with conservative measures or no treatment at all. A 1994 community-based epidemiological survey of 561 patients showed that 75% of patients had a spontaneous symptomatic improvement within 5 years. Earlier studies (6 studies from 1957 to 1972) concluded that untreated patients wouldn’t necessarily develop progressive disability and that patients with severe disability sometimes improve without treatment.7
Recommendations
Brigham and Women’s Hospital’s guideline recommends treating cervical radiculopathy with a soft collar, rest, nonsteroidal anti-inflammatory drugs, and physical therapy with cervical traction. If initial management isn’t effective after 6 weeks, the guideline advises referral to a specialist such as an orthopedic surgeon, neurologist, or rheumatologist. Surgical intervention is indicated if the patient shows signs of spinal cord compression or if pain is hindering function.9
An evidence-based practice guideline from The American Society of Interventional Pain Physicians states that moderate evidence supports the efficacy of interlaminar and transforaminal steroid injections.10
