From the Guidelines
The recommended treatment for cervical radiculopathy typically begins with conservative management for 4-6 weeks, focusing on rest, activity modification, and over-the-counter pain medications, with physical therapy and other interventions as needed, while avoiding chiropractic therapy due to potential cervical spine complications 1. The initial treatment includes rest, activity modification, and over-the-counter pain medications such as NSAIDs (ibuprofen 400-800mg three times daily or naproxen 500mg twice daily) or acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily).
- Physical therapy focusing on gentle neck stretching, posture correction, and strengthening exercises should be initiated early.
- For moderate to severe pain, short-term oral corticosteroids may be prescribed (prednisone taper starting at 60mg daily for 5 days, then decreasing by 10mg every 5 days).
- Muscle relaxants like cyclobenzaprine (5-10mg three times daily) can help with associated muscle spasms.
- If pain persists, epidural steroid injections may provide relief. Surgery is generally reserved for patients with progressive neurological deficits, intractable pain lasting more than 6-12 weeks despite conservative treatment, or spinal cord compression. Conservative treatment is recommended initially because most cases of cervical radiculopathy (70-90%) resolve spontaneously within weeks to months as inflammation subsides around the affected nerve root 1. Proper ergonomics, maintaining good posture, and avoiding prolonged neck positions that exacerbate symptoms are important for recovery and preventing recurrence. It is also important to note that chiropractic therapy is conditionally recommended against due to the potential cervical spine complications that can occur, particularly in the absence of evidence supporting its use for cervical radiculopathy 1.
From the Research
Cervical Radiculopathy Treatment
- The recommended treatment for cervical radiculopathy typically involves a conservative, nonoperative approach for at least 6 weeks, unless there are significant muscle weaknesses or myelopathy 2.
- Conservative treatments may include:
- Immobilization
- Anti-inflammatory medications
- Physical therapy
- Cervical traction
- Epidural steroid injections
- Nonoperative management can also involve a multimodal approach, including medications to alleviate symptoms and manage pain, physical therapy, and manipulation to improve neck discomfort 3, 4.
- Guided corticosteroid injections and selected nerve blocks may help control nerve root pain 4.
- Surgical treatment options, such as anterior cervical decompression and fusion, cervical disk arthroplasty, and posterior foraminotomy, are considered for patients who are persistently symptomatic despite conservative treatment or have significant functional deficits 2, 5.
- Patient selection is critical to optimize outcome, and understanding the pathophysiology, diagnosis, treatment indications, and treatment techniques is essential for rapid diagnosis and care of patients with cervical radiculopathy 5.
- Most patients (75%-90%) achieve symptomatic improvement with nonoperative care, and the overall prognosis is favorable 2, 6.