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Treatment of cervical radiculopathy physiotherapy treatment for cervical spondylosis

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The prognosis varies in part upon whether the cervical radiculopathy is compressive or noncompressive. The majority of radiculopathies arise from nTreatment of cervical radiculopathy physiotherapy treatment for cervical spondylosiserve 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.)

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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 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.

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Neo M, Fujibayashi S, Miyata M, et al. Vertebral artery injury during cervical spine surgery: a survey of more than 5600 operations. Spine (Phila Pa 1976) 2008; 33:779.

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Bednark J, Kadanka Z, Vohnka S, et al. The value of somatosensory- and motor-evoked potentials in predicting and monitoring the effect of therapy in spondylotic cervical myelopathy. Prospective randomized study. Spine (Phila Pa 1976) 1999; 24:1593.

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Peolsson A, Sderlund A, Engquist M, et al. Physical function outcome in cervical radiculopathy patients after physiotherapy alone compared with anterior surgery followed by physiotherapy: a prospective randomized study with a 2-year follow-up. Spine (Phila Pa 1976) 2013; 38:300.

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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 [2]. 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.

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Slipman CW, Lipetz JS, Jackson HB, et al. Therapeutic selective nerve root block in the nonsurgical treatment of atraumatic cervical spondylotic radicular pain: a retrospective analysis with independent clinical review. Arch Phys Med Rehabil 2000; 81:741.

Gao Y, Liu M, Li T, et al. A meta-analysis comparing the results of cervical disc arthroplasty with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease. J Bone Joint Surg Am 2013; 95:555.

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Kuijper B, Tans JT, Beelen A, et al. Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial. BMJ 2009; 339:b3883.

Malhotra G, Abbasi A, Rhee M. Complications of transforaminal cervical epidural steroid injections. Spine (Phila Pa 1976) 2009; 34:731.

Scanlon GC, Moeller-Bertram T, Romanowsky SM, Wallace MS. Cervical transforaminal epidural steroid injections: more dangerous than we think? Spine (Phila Pa 1976) 2007; 32:1249.

Nikolaidis I, Fouyas IP, Sandercock PA, Statham PF. Surgery for cervical radiculopathy or myelopathy. Cochrane Database Syst Rev 2010; :CD001466.

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Given the apparent overall good prognosis for recovery, conservative therapies are preferred in most patients.

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