From the Guidelines
Treatment for cervical radiculopathy should begin with conservative management for 6-12 weeks, focusing on pain control, physical therapy, and activity modification, as most cases resolve spontaneously or with conservative treatment measures 1. The initial approach to treating cervical radiculopathy involves a combination of pharmacological and non-pharmacological interventions.
- Pain control can be achieved with NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), which are commonly used to manage pain and inflammation in cervical radiculopathy 1.
- Muscle relaxants such as cyclobenzaprine (5-10mg three times daily) can be added for acute pain management, helping to reduce muscle spasms and discomfort.
- Physical therapy is a crucial component of conservative management, focusing on gentle neck stretches, posture correction, and strengthening exercises to improve range of motion, reduce pain, and enhance functional abilities.
- Activity modification is essential to avoid positions that worsen symptoms, and the use of a soft cervical collar for short periods (no more than 1-2 weeks) can help limit movement during acute pain. For patients who do not respond to initial conservative management, epidural steroid injections may be considered to provide temporary relief for persistent pain 1.
- However, it is essential to note that surgery is typically reserved for cases with progressive neurological deficits, persistent severe pain despite conservative treatment, or spinal cord compression, as identified by the presence of red flag symptoms or significant neurological impairment 1. The underlying mechanism of cervical radiculopathy involves compression or irritation of cervical nerve roots, typically from herniated discs or bone spurs, causing pain, numbness, and weakness radiating down the arm in the affected nerve's distribution 1.
From the Research
Treatment Options for Cervical Radiculopathy
The treatment options for cervical radiculopathy can be categorized into nonoperative and surgical management.
- Nonoperative management includes:
- Cervical collars for short-term immobilization 2
- Traction to temporarily decompress nerve impingement 2
- Medications to alleviate pain and neuropathic symptoms 2
- Physical therapy and manipulation to improve neck discomfort 2, 3
- Selective nerve blocks to target nerve root pain 2
- Manual physical therapy, cervical traction, and strengthening exercises 3
- Patient education and spinal manipulative therapy, specific exercises, and sustained pain-relieving positions in the acute stage 4
- Increasing individualized physical activity, supervised motor control, specific exercises, and/or neurodynamic mobilization in the subacute stage 4
- General aerobic exercise, focused strength training, postural education, and vocational ergonomic assessment in the chronic stage 4
- Surgical management options include:
Effectiveness of Treatment Options
The effectiveness of individual treatments for cervical radiculopathy is controversial, but a multimodal approach may benefit patients with cervical radiculopathy and associated neck pain 2. Most patients improve over time with a focused, nonoperative treatment course 2, 6. Comprehensive, aggressive, nonsurgical management often is successful with respect to functional outcomes, pain reduction, and patient satisfaction 6. Surgery is avoidable for most patients 6.