What is the recommended treatment for cervical lordosis causing tingling in hands?

Treatment of Cervical Lordosis Causing Hand Tingling

For symptomatic loss of cervical lordosis causing hand tingling (cervical radiculopathy), begin with conservative treatment using cervical extension traction combined with physical therapy for at least 6 weeks, reserving surgical intervention (anterior cervical discectomy and fusion with plating) for patients with progressive neurological deficits or failure of conservative management after 3 months. 1

Initial Conservative Management (First-Line Treatment)

Conservative treatment is the appropriate initial approach, with 75-90% of patients achieving symptomatic improvement without surgery 2. The specific components include:

• Cervical extension traction is the cornerstone intervention for restoring lordosis and relieving radicular symptoms, with controlled trials demonstrating 12-18° increases in lordosis over 5-15 weeks 3
• Physical therapy focusing on exercises to strengthen neck muscles and improve posture 1
• Short-term muscle relaxants for associated muscle spasm 1
• Anti-inflammatory medications to reduce pain and inflammation 1
• Activity modification to avoid positions that worsen symptoms 1

Evidence for Extension Traction Effectiveness

The research strongly supports extension traction as a specific intervention for loss of lordosis:

• Extension-compression traction combined with manipulation produces 13-14° improvement in Cobb angles and 17.9° improvement in posterior tangent angles over 14.6 weeks 4
• Three-point bending cervical traction achieves 12.1° improvement in C2-C7 lordosis over 9 weeks, with improvements maintained at 15.5-month follow-up 5
• Critical distinction: Groups receiving extension traction maintain pain relief long-term (up to 1.5 years), while comparison groups without lordosis restoration experience symptom regression toward pre-treatment values by 1 year 3

Duration of Conservative Treatment

• Minimum 6 weeks of structured conservative therapy is required before considering surgical intervention 2
• Optimal trial period is 3 months before surgical referral, as recommended by the American College of Physicians 1
• Document specific dates, frequency, and response to treatment for each conservative modality 2

Surgical Indications

Refer for surgical evaluation if any of the following occur:

• Progressive neurological deficits (worsening weakness, sensory loss, or reflex changes) 1
• Failure to respond to conservative treatment after 3 months 1
• Significant functional deficit impacting quality of life despite adequate conservative therapy 2

Surgical Approach for Loss of Lordosis

When surgery becomes necessary:

• For single-level disease: Anterior cervical discectomy and fusion (ACDF) with plating is recommended to maintain lordosis (Class II evidence, strength C) 1
• For two-level disease: ACDF with instrumentation is recommended over ACDF alone to improve arm pain (Class II evidence, strength C) 1
• Plating reduces pseudarthrosis risk from 4.8% to 0.7% and improves fusion rates from 72% to 91% in two-level disease 6

Surgical Outcomes

• 80-90% success rate for arm pain relief with anterior cervical decompression 2
• 90.9% functional improvement following surgical intervention 2
• Motor function recovery occurs in 92.9% of patients, with improvements maintained over 12 months 2
• Surgery provides more rapid relief (within 3-4 months) compared to continued conservative treatment, though at 12 months outcomes may be comparable 2

Critical Clinical Considerations

• Development of kyphosis predicts poor outcomes in cervical spine conditions (p < 0.05) 1
• MRI findings must correlate with clinical symptoms - false positives and false negatives are common 2
• Long periods of severe stenosis can lead to potentially irreversible spinal cord damage 1
• While ACDF with plating maintains lordosis better than ACDF alone, plating does not necessarily improve clinical outcome alone for single-level disease (Class II evidence, strength B) 1

Common Pitfalls to Avoid

• Premature surgical intervention: The 75-90% success rate with conservative management mandates an adequate trial before surgery 2
• Inadequate documentation: Failure to document duration, frequency, and response to conservative therapies is an absolute barrier to surgical authorization 2
• Anatomic mismatch: Ensure symptoms correlate with cervical pathology on imaging - rule out lumbar or other sources 2
• Ignoring extension traction: Generic physical therapy without specific lordosis restoration techniques may provide only temporary relief that regresses after treatment cessation 3

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