Conservative treatment of cervical radiculopathy

To assess the efficacy of nonsurgical treatment of cervical radiculopathy, 50 patients with objective signs and symptoms of cervical discogenic radiculopathy (CDR) without myelopathy, treated conservatively on an outpatient basis with a mean follow-up of 9.4 months were retrospectively reviewed. Then an additional 33 patients were entered sequentially onto a prospective study to assess conservative treatment; they were followed for 100 days or longer with a mean follow-up of 24.7 months. All 83 patients (50 + 33) had objective neurologic deficits (sensory, motor, or both).Of the initial 50 patients, 27 achieved full remission (no neurologic deficits and pain free), 17 were markedly improved (minimal residual sensory or motor deficit and mild to minimal pain), and 6 were unchanged at the time of their last examination. Of the 33 patients followed prospectively, 13 were in full remission and 16 were markedly improved requiring no treatment at the 100-day follow-up evaluation (< 0.05 by one tailed t-test). Of the 33 patients with complicating depression or fibromyalgia, 4 demonstrated minimal or no pain improvement, although 3 of the 4 had full remission of sensory/motor findings. Motor vehicle accidents precipitated symptoms of CDR in 14 patients in the retrospective and 5 in the prospective study. CDR of 15 patients was in full remission by 90 days, and 4 had ongoing chronic and/or mild sensory or motor deficits at 300 days. At the final follow-up, all 33 prospectively studied patients had maintained at least the level of improvement achieved at 100 days (p < 0.05 by one tailed f-test). No one in the total group of 83 patients required surgical intervention or hospitalization.Our results suggest that outpatient nonsurgical conservative management with careful patient education and monitoring of a coordinated conservative regimen can be successful for the majority of patients with CDR.