From the Guidelines
Cervical radiculopathy should be initially managed with conservative measures, including rest, activity modification, and pain management, without immediate imaging, unless red flag symptoms are present, as most cases resolve spontaneously or with conservative treatment measures 1.
Initial Management
- Start with over-the-counter medications like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks for pain relief.
- Physical therapy focusing on gentle neck stretches and strengthening exercises is crucial for recovery and should be continued for 6-8 weeks.
- A soft cervical collar may provide temporary relief but shouldn't be used for more than 1-2 weeks to prevent muscle weakening.
Severe Pain Management
- For severe pain, prescription medications such as muscle relaxants (cyclobenzaprine 5-10mg three times daily) or a short course of oral steroids (prednisone taper starting at 60mg daily for 5 days) may be necessary.
Indications for Imaging
- Imaging may not be required at the time of initial presentation unless red flag symptoms are present, such as trauma, malignancy, prior neck surgery, spinal cord injury, systemic diseases, or neurological deficits 1.
Further Intervention
- If symptoms persist beyond 6-8 weeks of conservative treatment, consider epidural steroid injections.
- Surgery is typically reserved for cases with progressive neurological deficits or persistent severe pain despite conservative measures.
Key Considerations
- Cervical radiculopathy is less prevalent than cervical or neck pain, with an average annual age-adjusted incidence of 83.2 per 100,000 people 1.
- Most cases of acute cervical neck pain with radicular symptoms resolve spontaneously or with conservative treatment measures 1.
- The diagnostic accuracy of red flag symptoms is not validated for the cervical spine, but their presence indicates the need for immediate imaging and further evaluation 1.
From the Research
Definition and Symptoms of Cervical Radiculopathy
- Cervical radiculopathy is a disease process marked by nerve compression from herniated disk material or arthritic bone spurs, leading to neck and radiating arm pain or numbness, sensory deficits, or motor dysfunction in the neck and upper extremities 2.
- Patients with radiculopathy typically present with neck pain, arm pain, or both 3.
- The clinical consequence of radiculopathy is arm pain or paresthesias in the dermatomal distribution of the affected nerve and may or may not be associated with neck pain and motor weakness 4.
Diagnosis of Cervical Radiculopathy
- Diagnosis is suggested by history and corresponding physical examination findings, and confirmation is achieved with MRI 5.
- Patient history and clinical examination are important for diagnosis, and further imaging modalities, such as x-ray, computed tomography, magnetic resonance imaging, and electrophysiologic testing, are of importance 4.
Treatment Options for Cervical Radiculopathy
- A multimodal approach to treatment helps patients improve, including medications to alleviate symptoms and manage pain, physical therapy and manipulation to improve neck discomfort, and guided corticosteroid injections and selected nerve blocks to control nerve root pain 5.
- Most patients improve with a conservative, nonoperative treatment course, and surgery is avoidable for most patients 2, 6.
- Surgical treatment options include anterior cervical decompression with fusion and posterior cervical laminoforaminotomy, and are indicated for patients with clinically significant motor deficits, debilitating pain that is resistant to conservative modalities and/or time, or instability in the setting of disabling radiculopathy 4.