Who treats cervical radiculopathy?

Who Treats Cervical Radiculopathy

Cervical radiculopathy is initially managed by primary care physicians, physiatrists (physical medicine and rehabilitation specialists), and physical therapists, with neurosurgeons and orthopedic spine surgeons consulted when conservative treatment fails or significant neurological deficits are present. 1, 2

Initial Management Team

Primary care physicians and physiatrists should manage the first 6-12 weeks of treatment, as 75-90% of patients achieve symptomatic improvement with conservative management alone. 1, 2 This initial team coordinates:

• Anti-inflammatory medications and topical analgesics for pain control 2
• Physical therapy referrals focusing on neck muscle strengthening, posture improvement, and stabilization exercises 3
• Activity modification and possible cervical collar immobilization for short-term symptom relief 1
• Diagnostic imaging coordination, with MRI as the gold standard for confirming nerve root compression 2, 3

Physical Therapy Role

Physical therapists are central to conservative management, delivering structured rehabilitation that achieves comparable 12-month outcomes to surgical intervention, though surgical approaches provide more rapid relief within 3-4 months. 1 Physical therapy demonstrates statistically significant clinical improvement using validated outcome measures like the cervical North American Spine Society (NASS) questionnaire. 1

Interventional Pain Management

Pain management specialists or physiatrists may perform epidural steroid injections to provide temporary relief for radicular symptoms when initial conservative measures are insufficient. 3 These selective nerve blocks specifically target nerve root pain as part of a multimodal approach. 4

Surgical Consultation Triggers

Neurosurgeons or orthopedic spine surgeons should be consulted when:

• Persistent symptoms despite 6+ weeks of comprehensive conservative treatment 1, 2
• Significant functional deficits impacting quality of life 1
• Progressive neurological deficits (worsening weakness or sensory loss) 2, 5
• Moderate to severe foraminal stenosis with clinical correlation on MRI 1, 2

The American Association of Neurological Surgeons specifically recommends surgical intervention for patients with significant functional deficits impacting quality of life, with anterior cervical decompression and fusion (ACDF) achieving 80-90% success rates for arm pain relief and 90.9% functional improvement. 1, 6

Surgical Approach Selection

Both neurosurgeons and orthopedic spine surgeons perform cervical radiculopathy surgery, with approach selection based on pathology:

• Anterior cervical decompression and fusion (ACDF) for rapid relief (3-4 months) of arm/neck pain, weakness, and sensory loss, particularly effective for disc herniation and anterior compression 1, 2
• Posterior laminoforaminotomy for soft lateral disc displacement or foraminal stenosis, achieving 78-95.5% good-to-excellent results with motion preservation advantage 2, 3

Common Pitfall

Premature surgical referral is a critical error, as the 90% success rate with conservative management mandates an adequate 6-week trial before surgery. 1 However, delaying surgical consultation when progressive neurological deficits are present risks permanent nerve damage. 2, 5 The key is distinguishing between stable radicular pain (managed conservatively) and progressive motor weakness (requiring urgent surgical evaluation). 5, 6