Cervical Radiculopathy Treating a Pinched Nerve in the Neck
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Cervical Radiculopathy: How to Address a Pinched Nerve in the Neck
Summary: While various treatments exist for a pinched nerve in the neck, also known as cervical radiculopathy, strong evidence supporting their effectiveness is limited.
Understanding Cervical Radiculopathy
If you've been diagnosed with cervical radiculopathy, you're likely experiencing pain in your neck and shoulder, which may extend into your arm, possibly accompanied by weakness or numbness. Certain neck movements can worsen the pain.
For younger adults, this condition is often caused by a herniated disc, a soft spacer separating neck vertebrae. In older adults, it's more typically due to bony spurs (spondylosis). You're not alone in facing this condition; surveys show its prevalence in populations around the world.
Diagnosis and Initial Steps
Your doctor likely conducted a thorough evaluation, including a symptom history and physical exam. An MRI and nerve tests may have confirmed the diagnosis. Importantly, it's crucial to know that the spinal cord itself isn't pinched.
Exploring Treatment Options
Choosing a treatment path can be complex. Most medical reports on cervical radiculopathy treatments are case studies or series, leaving questions about their true effectiveness.
The gold standard in research is a randomized controlled trial. Unfortunately, only one such study has been conducted.
The Lund Study
Swedish researchers at the University Hospital of Lund conducted a notable randomized trial involving 81 patients with long-standing symptoms. Participants were assigned one of three treatments: surgery, physical therapy, or wearing a cervical collar.
Surgical Approach: The Cloward procedure was used to remove problematic disc fragments and spurs, followed by spinal fusion.
Physical Therapy: This included 15 sessions over three months, using various techniques determined by the therapist, such as heat, cold, electrical stimulation, and exercise.
Cervical Collar: Patients used rigid collars daily for three months and some wore soft collars overnight.
Study Outcomes
Some surgical candidates improved on their own and declined the procedure, but their outcomes were still counted as surgical. After three months, both the surgery and physical therapy groups reported less pain. After a year, all groups had similar improvements in pain and function.
Some patients in each group needed further treatment, highlighting varied individual responses. Five collar patients and one therapy patient eventually opted for surgery, and eight surgical patients required additional procedures.
Remaining Questions and Patient Care
With limited rigorous research, many questions about treatments like painkillers, injections, and traction remain unanswered. We also don't fully understand the outcomes without any intervention.
Clinicians must balance the principle of "do no harm" with practical treatment decisions. Typically, less invasive methods such as medication and therapy are tried first, with surgery considered if symptoms persist or worsen.
Note: This article © 2006 by Gary Cordingley.
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