What is the treatment for cervical radiculopathy?

Treatment for Cervical Radiculopathy

Non-operative treatment is the appropriate initial approach for most patients with cervical radiculopathy, with 75-90% achieving symptomatic improvement without surgery. 1, 2

Initial Non-Operative Management

• Conservative treatment should be tried for at least 6 weeks before considering surgical options, unless there is evidence of myelopathy or significant muscle weakness 2
• Treatment options include:
  • Short-term cervical collar immobilization for temporary relief 1, 3
  • Physical therapy focusing on neck exercises 4, 1
  • Anti-inflammatory medications to reduce pain and inflammation 2, 5
  • Cervical traction which may temporarily decompress nerve impingement 5
  • Epidural steroid injections for targeted relief 2

When to Consider Surgical Intervention

Surgical treatment is indicated for patients with:

• Intractable or persistent pain despite 6 weeks of conservative management 4, 2
• Severe or progressive neurological deficits 6, 2
• Significant functional deficit that impacts quality of life 2

Surgical Options

• Anterior Cervical Decompression and Fusion (ACDF):

  • Recommended for rapid relief (within 3-4 months) of arm/neck pain, weakness, and sensory loss 4
  • Provides longer-term (12 months) improvement in wrist extension, elbow extension, shoulder abduction, and internal rotation compared to physical therapy 4
  • Success rates for relief of arm pain range from 80% to 90% 1

• Anterior Cervical Foraminotomy:

  • May improve cervical radicular symptoms but has variable success rates (52-99%) 4, 1
  • Recurrent symptoms have been reported in up to 30% of patients 4, 1

• Posterior Cervical Laminoforaminotomy:

  • Alternative approach that preserves motion segments 7
  • May be preferred for lateral disc herniations 7

Treatment Algorithm

1. Begin with non-operative treatment for 6 weeks:

   • Short-term collar immobilization
   • Physical therapy
   • Anti-inflammatory medications
   • Consider traction and/or epidural injections for persistent symptoms

2. Reassess after 6 weeks:

   • If symptoms are improving, continue conservative management
   • If symptoms persist or worsen, obtain MRI (or CT for better bone visualization) 1

3. For patients with persistent symptoms despite conservative management:

   • Consider ACDF for central or paracentral disc herniations with good evidence of efficacy 4
   • Consider foraminotomy for lateral disc herniations, but be aware of variable success rates 4

Important Caveats

• MRI findings must always be correlated with clinical symptoms, as false positives and false negatives are common 1
• At 12 months, outcomes between surgical and non-surgical treatments may be comparable, suggesting that surgery primarily offers more rapid relief 4
• The natural course of cervical radiculopathy is generally favorable, with most patients improving over time regardless of intervention 3
• Adjacent segment disease is a potential long-term complication of fusion procedures that should be considered when weighing treatment options 4