Management for cervical radiculopathy

Ghasemi, Masaeli, 2013

If cervical myelopathy has been excluded on imaging, management for cervical radiculopathy is similar to the management of acute nonspecific neck pain.

For patients with acute symptoms (duration less than one month), wearing a semihard collar during the day and resting for 3 to 6 weeks may be beneficial; alternatively, a supervised graded exercise program, including home exercises, can be undertaken for 6 weeks. There is limited evidence that adding cervical traction to exercise is beneficial.

Cervical spine manipulation and foraminal nerve root injections are not recommended because the risk of harms outweighs any potential benefits.

There is limited evidence that a short course of oral corticosteroid reduces pain and improves physical function in patients with cervical radiculopathy, although the optimal dosage and duration of treatment are not known. An example dosage is:

Surgical consultation is indicated for all patients with a progressive neurological deficit or concern about a neurological deficit. Consider surgical consultation for patients with severe persistent arm pain at 6 to 8 weeks despite nonsurgical management, provided imaging identifies nerve root compression that is concordant with the patient’s clinical features and could be corrected with surgery. Limited evidence from open trials comparing surgical to nonsurgical management for cervical radiculopathy suggests surgery results in better short-term outcomes; however, longer-term outcomes (up to 2 years) are similarNikolaidis, 2010.

There is no evidence for the use of anticonvulsants (gabapentinoids and topiramate) for cervical radiculopathy. Studies assessing their use for lumbar radiculopathy show a lack of benefit. This lack of benefit is accompanied by an increased risk of harm. These drugs should not be used for cervical radiculopathy.