What is the treatment for radiculopathy in the arm causing problems with the fingers?

Treatment for Cervical Radiculopathy Causing Finger Problems

Begin with non-operative management for 6-12 weeks, as 75-90% of patients achieve symptomatic improvement without surgery; if symptoms persist or significant motor deficits affecting finger function are present, proceed with anterior cervical decompression and fusion (ACDF), which provides 80-90% relief of arm pain and 90.9% functional improvement. 1, 2

Initial Non-Operative Management (First-Line Treatment)

Non-operative treatment is the appropriate initial approach for most patients with cervical radiculopathy, given the favorable natural history of this condition 1, 2:

• Physical therapy focusing on neck muscle strengthening, posture correction, and stabilization exercises should be initiated immediately 3
• Cervical collar immobilization may be used for short periods to provide temporary relief 4
• Cervical traction can temporarily decompress nerve root impingement 4
• Medications including anti-inflammatory agents and neuropathic pain medications help alleviate radicular symptoms 4
• Epidural steroid injections may provide temporary relief for radicular symptoms when other conservative measures are insufficient 3

Duration of conservative therapy: A minimum of 6 weeks of structured conservative management is required before considering surgical intervention 1. At 12 months, physical therapy can achieve comparable clinical improvements to surgical interventions, though surgery provides more rapid relief within 3-4 months 1.

Surgical Indications

Surgery is warranted when 1, 5, 6:

• Persistent symptoms despite 6+ weeks of adequate conservative treatment
• Progressive motor deficits affecting finger function (such as wrist drop or grip weakness)
• Significant functional deficits impacting quality of life and activities of daily living
• Debilitating pain resistant to conservative modalities

Surgical Options

Anterior Cervical Decompression and Fusion (ACDF) - Preferred Approach

ACDF is the generally preferred surgical treatment and provides rapid relief (within 3-4 months) of arm/neck pain, weakness, and sensory loss 1, 6:

• Success rates: 80-90% for arm pain relief with 90.9% functional improvement 1, 2
• Indications for ACDF over simple decompression: When significant neck pain accompanies radiculopathy, when disease is centrally located, or when segmental kyphosis is present 6

Instrumentation Considerations

For single-level disease: Both anterior cervical discectomy (ACD) and ACDF are equivalent regarding functional outcomes, though ACDF provides more rapid reduction of neck and arm pain 7. Adding a cervical plate is recommended to reduce pseudarthrosis risk (from 4.8% to 0.7%) and maintain lordosis, but does not necessarily improve clinical outcomes alone 7, 1

For two-level disease: Anterior cervical plating (ACDF with instrumentation) is specifically recommended to improve arm pain better than ACDF alone, with fusion rates improving from 72% to 91% 7, 1

Posterior Laminoforaminotomy - Alternative Approach

This approach is effective for specific presentations 1, 3:

• Indications: Soft lateral disc herniations, cervical spondylosis with lateral recess narrowing, patients preferring motion preservation
• Success rates: Variable, ranging from 52-99% (78-93% in most series) 1, 3
• Advantages: Motion preservation and avoidance of anterior approach risks 1
• Limitation: Recurrent symptoms reported in up to 30% of patients 1, 3

Cervical Arthroplasty

Cervical arthroplasty is recommended as an alternative to ACDF in selected patients for control of neck and arm pain (Class II evidence) 7. However, this requires careful patient selection and absence of contraindications such as segmental instability, recent infection, or adjacent level disease 1.

Critical Diagnostic Requirements Before Surgery

MRI is the preferred initial imaging modality to confirm nerve root compression correlating with clinical symptoms 1, 3. CT provides superior visualization of bone structures when assessing osseous causes of compression 1, 3.

Essential clinical correlation: Imaging findings must correlate with the specific dermatomal distribution of finger symptoms, sensory deficits, and motor weakness 1, 8. MRI findings alone without clinical correlation are insufficient, as false positives and false negatives are common 1.

Common Pitfalls to Avoid

• Premature surgical intervention: The 90% success rate with conservative management mandates an adequate 6-week trial before surgery 1
• Anatomic mismatch: Ensure finger symptoms correlate with cervical pathology rather than other causes (such as carpal tunnel syndrome or ulnar neuropathy) 1
• Inadequate documentation: Formal documentation of conservative therapy duration, frequency, and response is required to establish medical necessity for surgery 1
• Operating on asymptomatic levels: Multilevel fusion should only be performed if all levels meet clinical and radiographic severity criteria 1