Neck Pinched Nerve Treatment: Cervical Radiculopathy

 Neck Pinched Nerve Treatment: Cervical Radiculopathy

Think at it this way: you've just heard that you have cervical radiculopathy, which is shorthand for a pinched nerve in your neck. Soreness in the neck and maybe even a single shoulder could be the result. You may feel a tingling or numbness in your arm in addition to the pain radiating into your arm. The discomfort may be amplified when you move your neck in specific ways.

A herniated (slipped) disc could be the cause of the pinch in younger adults. The cushiony elements that divide the vertebrae of a backbone are called discs. Spondylosis, a bony spur, is the most common cause of pinch in older adults. No matter what, you're not alone. Sicily has 3.5 active cases of cervical radiculopathy per 100,000 people, according to a survey. Another study found that for every 100,000 people in Rochester, Minnesota, 85 new cases of cervical radiculopathy are reported annually.

In this hypothetical situation, your doctor has taken a detailed medical history and conducted a physical examination to determine the root cause of your problems. Electromyography, nerve conduction investigations, and magnetic resonance imaging (MRI) of the neck and cervical spine can help confirm a diagnosis of cervical radiculopathy. And there's zero indication that the spinal cord is actually compressed. Where do we go from here?

Now what? Picking a course of treatment for this illness is quite challenging. A large majority of the numerous medical articles on the topic of cervical radiculopathy treatment are either case reports or case series. The phrase "case series" is basically just a way to say, "We gave six patients in a row the same treatment and five of them got better." After doing such a study, what conclusions can be drawn? Were the patients better after receiving treatment, or would they have been better off without it? We have no idea.

A control group, consisting of people who do not receive treatment or who receive a different treatment, is necessary for this to work. Another indicator of a high-quality study is a randomized treatment, which means that the participants in the research willingly agreed to be divided into two or more groups and allocated to them by a process similar to tossing a coin. Counting all the research on this prevalent ailment, how many of them were controlled trials with a random assignment of participants? Regrettably, there is only one correct response.

A total of eighty-one patients with cervical radiculopathy symptoms that persisted for at least three months were randomly assigned to one of three treatment groups by Liselott Persson, Carl-Axel Carlsson, and Jane Carlsson of Sweden's University Hospital of Lund: surgery, physical therapy, or a cervical collar. The patients' ages varied from 28 to 64, with males making up 54% of the total. Surgeons performed what is known as the Cloward operation, which involves making an incision in the front of the neck, removing parts of bulging discs and spurs, and then using a bone graft to fuse two bones in the neck. During the three months of physical therapy, the patient would attend fifteen sessions that would cover a wide range of topics, including but not limited to: heat/cold applications, electrical stimulation, ultrasound, massage, manipulation, exercise, education, and more. For three months, patients in the cervical collar group were required to wear stiff collars that rested on their shoulders. The subjects also slept with comfortable collars on.

What were the results of the study? Three of the surgical participants declined the operation, claiming they had seen improvement without it. Their results were included in the statistics alongside those of the patients who actually had the procedure. At the end of the third month, patients in the physical therapy and surgery groups reported significantly less discomfort overall. Patients in all three groups reported less pain after an extra year of the trial, and there was no statistically significant difference in the results between the treatments. Mood and general function assessments taken after therapy also showed no significant difference between the groups.

Therefore, there was no superior treatment over time. The overall averages did not account for the fact that certain patients in each group had better or worse results than others. Due to unsatisfactory improvement, five patients in the collar group and one patient in the physical therapy group ultimately underwent surgery. Plus, one of the eight patients in the surgical group had to have a second procedure because something went wrong with the first.

No one knows much because this Swedish study is the only one of its kind to thoroughly examine the results of treatment for cervical radiculopathy. For instance, how can medications like aspirin and NSAIDs, injections of local anesthetic, systematic traction, and various types of surgery affect cervical radiculopathy? We have no idea. In the absence of any treatment, what would occur? Similarly, we are unsure of the response to that inquiry.

For this reason, there is a delicate balancing act involved in patient care between the two competing tenets of "Above all, do no harm" and "Do what you have to do." To strike this delicate balance, it is common practice to begin treatment with less invasive methods, such as medication and physical therapy. An procedure could be beneficial if symptoms do not improve or become intolerable.

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