What are the symptoms and treatment options for cervical radiculopathy?

Symptoms and Treatment of Cervical Radiculopathy

Cervical radiculopathy presents with a combination of arm pain, sensory dysfunction, and motor function loss, often accompanied by neck pain, due to compression and inflammation of the cervical nerve roots. 1, 2

Clinical Presentation

• Arm and neck pain following dermatomal distribution of the affected nerve root 2, 3
• Sensory deficits including numbness, tingling, or paresthesias in the affected dermatome 3, 4
• Motor dysfunction manifesting as weakness in specific muscle groups corresponding to the affected nerve root 1, 2
• Reflex changes related to the affected nerve root level 2, 5

Common Causes

• Cervical disc herniation (soft disc) causing direct nerve root compression 1, 2
• Cervical spondylosis with osteophyte formation (hard disc) from facet or uncovertebral joints 1, 2
• Combination of both disc herniation and degenerative changes 1

Diagnostic Approach

• Clinical diagnosis is primarily based on history and physical examination findings 1, 3
• Imaging studies are used to confirm the diagnosis:
  • MRI is the preferred initial imaging modality for suspected cervical radiculopathy 1
  • CT offers superior visualization of bone structures and is complementary to MRI in assessing osseous causes of compression 1
  • Plain radiographs may be useful for initial assessment of spondylosis and degenerative changes 1

Treatment Options

Non-operative Management (First-line)

• Non-operative treatment is the appropriate initial approach for most patients, with 75-90% achieving symptomatic improvement 1, 5, 6
• Treatment modalities include:
  • Short-term immobilization with cervical collar 4, 5
  • Anti-inflammatory medications for pain and inflammation 4, 5
  • Physical therapy for neck strengthening and mobility 4
  • Cervical traction for temporary nerve decompression 4
  • Epidural steroid injections for targeted pain relief 4, 5

Surgical Management

• Surgery should be considered for patients with persistent symptoms despite 6 weeks of conservative treatment, significant functional deficits, or progressive neurological deterioration. 5
• Surgical options include:
  • Anterior cervical decompression and fusion (ACDF) - recommended for rapid relief (within 3-4 months) of arm/neck pain, weakness, and sensory loss 1
  • Anterior cervical foraminotomy - may improve symptoms but has variable success rates (52-99%) 1
  • Posterior cervical foraminotomy - alternative approach for lateral disc herniations 3, 5

Treatment Algorithm

1. Initial 6-week trial of conservative management for all patients without myelopathy or significant muscle weakness 5
2. If symptoms persist or worsen despite conservative care, obtain MRI or CT myelogram to confirm diagnosis 1, 3
3. For persistent radicular pain with corresponding imaging findings:
   • Consider epidural steroid injections if moderate symptoms 4, 5
   • Consider surgical decompression if severe symptoms or functional limitations 1
4. Surgical approach selection:
   • Anterior approach (ACDF) for central or paracentral disc herniations 1
   • Posterior approach for far lateral disc herniations 3, 5

Important Considerations

• Surgical outcomes for relief of arm pain range from 80% to 90% with either anterior or posterior approaches 6
• While surgery provides more rapid relief of symptoms (3-4 months), long-term outcomes (12 months) may be comparable between surgical and non-surgical treatments 1
• Recurrent symptoms have been reported in up to 30% of patients after anterior cervical foraminotomy 1
• MRI findings must always be correlated with clinical symptoms, as false positives and false negatives are common 1