Treatment of Neck Pain with Radiculopathy
What is neck pain with radiculopathy?
Neck pain with radiculopathy is better known as cervical radiculopathy, which is a normal result of degenerative changes such as creased disc height and zygapophyseal joints hypertrophy, is characterised by neck and shoulder pain with a combination of sensory loss or loss of motor function.
What else can neck pain with radiculopathy be called?
Neck pain with radiculopathy can also be called cervical radiculopathy, a pinched nerve, cervical nerve impingement, nerve impingement, neck and nerve pain, cervical radicular pain.
What are the symptoms of neck pain with radiculopathy?
Presenting symptoms of cervical radiculopathy will include neck pain, arm pain, scapular or periscapular pain, and paresthesias, numbness and sensory changes, weakness, or abnormal deep tendon reflexes in the arm.
Diagnostic criteria for cervical radiculopathy
Diagnosis of cervical radiculopathy can be considered in patients with neck and arm pain, scapular pain, and paresthesias, numbness and other sensory changes, weakness or motor deficits in the arm, hand and fingers, as well as abnormal deep tendon reflexes in the arm.
Provocative tests including the shoulder abduction and Spurling’s tests are supported by low quality evidence.
MRI is suggested for the confirmation of correlative compressive lesions (disc herniation and spondylosis) in cervical spine patients who have failed a course of conservative therapy and who may be candidates for interventional or surgical treatment.
What other conditions could it be?
Cervical myelopathy, cervical radicular pain, cervical spondylosis, cervical disc protrusion, cervical uncovertebral joint hypertrophy.
What are the most appropriate outcome measures to evaluate the treatment of neck pain with radiculopathy?
The Neck Disability Index (NDI), SF-36, SF-12 and VAS are recommended outcome measures for assessing treatment of cervical radiculopathy from degenerative disorders.
Guideline-based treatment of neck pain with radiculopathy
In chronic cervical radiculopathy, epidural steroid injections, medications with physical therapy and the combination of both decreases arm and neck pain. Exercise is considered a good option, with low risk and benefits including pain inhibition, increased muscle strength and stability.
Weak evidence supports the use of CT guided transforaminal epidural steroid injections when developing a medical/interventional treatment plan for patients with cervical radiculopathy from degenerative disorders.
Surgical intervention is suggested for the rapid relief of symptoms of cervical radiculopathy from degenerative disorders when compared to medical/interventional treatment. Surgery may include anterior cervical decompression and fusion (ACDF), cervical disc arthroplasty (CDA), and posterior cervical foraminotomy (PCF).
What guideline/consensus statements does Agility use in the treatment of neck pain with radiculopathy?
North American Spine Society Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care Diagnosis and Treatment of Cervical Radiculopathy from Degenerative Disorders 2010. www.spine.org
Engquist M, et al. Factors Affecting the Outcome of Surgical Versus Nonsurgical Treatment of Cervical Radiculopathy. A Randomized, Controlled Study. Spine 2015; 40: 1553-1563.