From the Guidelines
A high cervical radiculopathy can potentially trigger cervical dystonia, although the exact relationship between the two conditions is not fully understood and may involve complex pathophysiological mechanisms. Cervical radiculopathy occurs when a nerve root in the cervical spine becomes compressed or irritated, typically from a herniated disc or bone spur. When this affects the upper cervical nerve roots (C1-C4), the resulting pain, inflammation, and neurological disruption can sometimes lead to abnormal muscle contractions characteristic of cervical dystonia. This connection likely involves a mechanism where the persistent pain and sensory input from the compressed nerve alters central nervous system processing, leading to abnormal motor output and muscle tone regulation, as suggested by the use of botulinum neurotoxin for treating cervical dystonia, which is effective in reducing muscle tone and improving passive function 1.
Key Considerations
- The treatment of cervical dystonia often involves botulinum toxin injections into affected muscles, with all FDA-approved formulations being commonly used despite differing evidence levels 1.
- Oral medications like anticholinergics (trihexyphenidyl) may also be used in the treatment of cervical dystonia.
- Early diagnosis and treatment of the radiculopathy are crucial to prevent progression to more established dystonia, which can become persistent even after the original nerve compression is resolved.
- The use of botulinum neurotoxin for cervical dystonia is supported by guidelines, which suggest that OnaBoNT-A and incoBoNT-A are equally effective and should be considered for treatment, along with AboBoNT-A and rimaBoNT-B 1.
Treatment Approach
- Addressing the underlying radiculopathy through physical therapy, anti-inflammatory medications like NSAIDs, and muscle relaxants such as baclofen or tizanidine.
- Considering epidural steroid injections for radiculopathy that does not respond to initial treatments.
- Utilizing botulinum toxin injections for cervical dystonia, with the choice of formulation guided by the most recent and highest quality evidence, currently suggesting equal efficacy among OnaBoNT-A, incoBoNT-A, AboBoNT-A, and rimaBoNT-B 1.
From the Research
Cervical Radiculopathy and Cervical Dystonia
- Cervical radiculopathy is a disorder involving dysfunction of cervical nerve roots, commonly manifesting as pain radiating from the neck into the distribution of the affected root 2.
- The clinical consequence of radiculopathy is arm pain or paresthesias in the dermatomal distribution of the affected nerve and may or may not be associated with neck pain and motor weakness 3.
- However, there is no direct evidence in the provided studies to suggest that high cervical radiculopathy can cause cervical dystonia.
- Cervical dystonia is not mentioned in any of the provided studies, which focus on the diagnosis, treatment, and management of cervical radiculopathy 4, 5, 2, 6, 3.
Treatment and Management of Cervical Radiculopathy
- Nonsurgical treatment is the appropriate initial approach for most patients with cervical radiculopathy, with up to a 75% rate of spontaneous improvement 2.
- Conservative treatments consist of immobilization, anti-inflammatory medications, physical therapy, cervical traction, and epidural steroid injections 6.
- Surgical treatment options include anterior cervical decompression and fusion, cervical disk arthroplasty, and posterior foraminotomy, and are typically reserved for patients who are persistently symptomatic despite conservative treatment or have a significant functional deficit 6, 3.