From the Guidelines
To treat cervical radiculopathy, conservative management should be the initial approach, including rest, activity modification, and over-the-counter pain medications, as most cases resolve spontaneously or with these measures 1. When managing cervical radiculopathy, it's essential to first assess for any "red flags" such as trauma, malignancy, or systemic diseases, which may require immediate medical attention 1. In the absence of these red flags, the following steps can be taken:
- Start with over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks.
- Apply ice for the first 48-72 hours (20 minutes on, 20 minutes off), then switch to heat therapy.
- Physical therapy focusing on gentle neck stretches, posture correction, and strengthening exercises is crucial and should be continued for 6-8 weeks. For moderate pain, muscle relaxants like cyclobenzaprine (5-10mg three times daily) for short-term use (1-2 weeks) or a methylprednisolone dose pack to reduce inflammation may be prescribed by a doctor 1. It's also important to maintain proper ergonomics at work and home, using a supportive pillow while sleeping. Most cases of cervical radiculopathy improve within 4-6 weeks with these conservative approaches 1. If symptoms persist beyond 6-8 weeks or include severe pain, weakness, or numbness, medical attention should be sought, as further interventions like epidural steroid injections or surgery might be necessary 1.
From the Research
Treatment Options for Cervical Radiculopathy
The treatment for cervical radiculopathy can be divided into conservative and surgical approaches.
- Conservative treatment is recommended for at least 6 weeks in the absence of myelopathy or significant muscle weakness 2.
- Conservative treatments consist of:
- Immobilization
- Anti-inflammatory medications
- Physical therapy
- Cervical traction
- Epidural steroid injections
- A multimodal approach to treatment, including medications, physical therapy, and manipulation, may help patients improve 3, 4.
- Guided corticosteroid injections and selected nerve blocks may help control nerve root pain 3, 4.
- Chiropractic manipulative therapy, longitudinal cervical traction, and interferential therapy may also be effective in treating cervical radiculopathy caused by a herniated cervical disc 5.
Surgical Treatment
- Surgical treatment is appropriate for patients who are persistently symptomatic despite conservative treatment, or those who have a significant functional deficit 2.
- Surgical options include:
- Anterior cervical decompression and fusion
- Cervical disk arthroplasty
- Posterior foraminotomy
- Patient selection is critical to optimize outcome 2.
- Surgery is 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 6.