From the Guidelines
The best treatment for cervical radiculopathy typically begins with conservative management for 6-8 weeks, focusing on reducing inflammation and pain, and improving functional ability. This approach is supported by the most recent evidence, including the study by 1, which suggests that most cases of acute cervical neck pain with radicular symptoms resolve spontaneously or with conservative treatment measures.
Initial Treatment
Initial treatment includes:
- Rest and activity modification to avoid exacerbating the condition
- Over-the-counter pain medications such as NSAIDs (ibuprofen 400-800mg three times daily or naproxen 500mg twice daily) to reduce inflammation and pain
- Physical therapy focusing on gentle neck stretches, posture correction, and strengthening exercises is crucial for recovery
Additional Measures
For more severe pain, prescription medications may include:
- Muscle relaxants like cyclobenzaprine (5-10mg three times daily) for 1-2 weeks
- Short-term oral steroids such as a methylprednisolone dose pack
- Gabapentin (starting at 300mg daily and titrating up as needed) for neuropathic pain Cervical epidural steroid injections can be considered if pain persists despite these measures.
Surgical Intervention
Surgery (typically anterior cervical discectomy and fusion or cervical disc arthroplasty) is reserved for cases with:
- Progressive neurological deficits
- Intractable pain lasting more than 3 months despite conservative treatment
- Significant spinal cord compression The choice of treatment depends on symptom severity, duration, and the specific anatomical cause of the nerve compression, as noted in the study by 1.
Imaging and Diagnosis
In the absence of red flag symptoms, imaging may not be required at the time of initial presentation, as spondylotic changes are commonly identified on radiographs and MRI in patients >30 years of age and correlate poorly with the presence of neck pain, as discussed in the study by 1. However, MRI can be useful in assessing the presence of nerve root compression and guiding treatment decisions, as noted in the study by 1.
From the Research
Treatment Options for Cervical Radiculopathy
- Nonoperative treatment is often the first line of treatment, which includes physical therapy, nonsteroidal anti-inflammatory drugs, muscle relaxants, and massage 2, 3, 4.
- Epidural steroid injections may be helpful for patients with persistent symptoms, but they have higher risks of serious complications 2, 3, 5.
- Surgical treatment options, such as anterior cervical decompression and fusion, cervical disk arthroplasty, and posterior foraminotomy, are considered for patients with significant muscle weakness, debilitating pain, or instability 3, 4.
- Conservative treatments, including immobilization, anti-inflammatory medications, physical therapy, cervical traction, and epidural steroid injections, can provide symptomatic improvement in 75%-90% of patients 3, 6.
Effectiveness of Conservative Treatment
- There is low-level evidence that a collar is no more effective than physiotherapy at short-term follow-up, and very low-level evidence that a collar is no more effective than traction 6.
- Traction is no more effective than placebo traction, and intermittent traction is no more effective than continuous traction, based on low-level to very low-level evidence 6.
- Regardless of the intervention assignment, patients seem to improve over time, indicating a favorable natural course 6.
Diagnostic Considerations
- Imaging is not required unless there is a history of trauma, persistent symptoms, or red flags for malignancy, myelopathy, or abscess 2, 3, 4.
- Electrodiagnostic testing is not needed if the diagnosis is clear, but has clinical utility when peripheral neuropathy of the upper extremity is a likely alternate diagnosis 2.