Cervical Radiculopathy to Treat a Pinched Nerve in the Neck
Suppose you have been diagnosed with a pinched nerve in your neck, also known as cervical radiculopathy. If so, you probably have pain in the neck and shoulder. The pain may radiate into your arms and you could have a weakness or numbness in the arm as well. Move your neck in certain positions probably worsens the pain.
If you are a young adult, the pinch could be due to a herniated disc (slipped). The discs are soft spacers that separate each pair of stacked neck-bones (vertebrae). If you are an older adult, the pinch is more likely due to a bone spur (spondylosis). In both cases, you’re in good company. A survey showed that in Sicily moment there are 3.5 active cases of cervical radiculopathy per 100 000 inhabitants. In Rochester, Minnesota, another poll showed 85 new cases each year of cervical radiculopathy per 100 000 inhabitants.
Let your doctor has evaluated you thoroughly by taking a history of your symptoms and performing a physical examination. Perhaps with the additional aid of an MRI of your cervical spine (neck) and electrical tests of nerve and muscle function (nerve conduction studies and electromyography) diagnosis of cervical radiculopathy is deemed final. In addition, there is no sign that the spinal cord itself is squeezed. Now?
Now, in fact. Choosing a treatment for this condition is far from simple. Hundreds of published medical reports concerning the treatment of cervical radiculopathy, most are case reports or case series. A “case series” roughly translated as “we gave six patients in a row the same treatment and five of them were better. “What can be concluded from a study of this kind? The treatment patients better or would they have improved anyway? We do not know.
The missing ingredient here is a comparison group of individuals untreated or treated differently, known as a control group. Another mark of a quality study is that the chosen treatment is random, meaning that the research subjects agreed in advance to be assigned to one group or another based on the equivalent of a coin-throwing. So out of the hundreds of published studies on the treatment of this common condition, how many were randomized controlled trials? Unfortunately, the answer is one.
Liselott Persson, Carl-Axel Carlsson and Jane Carlsson at the University Hospital of Lund, Sweden, randomly assigned 81 patients who had symptoms of cervical radiculopathy present for at least three months in one of three treatments-surgery, physiotherapy or a cervical collar. Patients varied between 28 and 64 years old and 54% of them were men. Surgeons used the so-called Cloward, deletion fragments ears through an incision in the front of the neck and protruding discs and then merge two neck-bones together using a bone graft. Physiotherapy involved 15 sessions over a period of three months and consisted of whatever the therapist deems appropriate, ways in which the following actions: application, application of cold, electrical stimulation, ultrasound, massage, manipulation, exercise and education heat. In the cervical collar group, patients wore necklaces rigid shoulder rest every day for three months. In addition, some of the subjects wore soft collars overnight.
How to prove the study? Three subjects who were assigned to surgery refused the procedure because they had already improved on their own. For statistical purposes, their results have been included with those who actually received the operation. Groups after three months of surgery and physiotherapy reported, on average, less pain. After an additional 12 months, patients in all three groups had less pain at the beginning of the study and the results of each treatment were statistically similar. Measures of mood and overall function after treatment were equally divided between the groups.
Thus, long-term, no treatment was better than the other. Of course, within each group, some patients did better or worse than others, and this spread of results was not reflected in the overall averages. In fact, five patients in the collar and a patient in the physical therapy group went to receive surgery due to lack of satisfactory improvement. In addition, eight patients in the surgery group underwent a second operation, which in one case was due to a complication of the first operation.
With this Swedish study representing the only rigorous investigation of treatment outcomes in cervical radiculopathy, there are a number of unanswered questions. For example, what are the effects on cervical radiculopathy of painkillers, anti-inflammatory medications, local injections, systematic traction or other forms of surgery? We do not know. What happens if there is no treatment whatsoever? We do not know the answer to this question is.
Thus, care of individual patients, there is a balancing act between yin-yang Medical edict “above all do no harm” dictum and practice of “do what you must do.” This usually means balancing act from less invasive treatments such as drugs and physiotherapy. If symptoms fail to improve or become unbearable, surgery may be helpful.