Cervical Radiculopathy Treatment Options
Cervical Radiculopathy is pain, numbness or weakness radiating from the neck and into the arms. It is usually caused by disc herniation, age-related changes in the cervical spine, or a combination. Cervical radiculopathy peaks at 50-54 years of age. Treatments include surgery and nonoperative approaches. Studies describe a favorable course at an average of six months with complete recovery ranging from 24 to 36 months. Most patients are treated nonsurgically. However, when symptoms persist or worsen surgery may be recommended.
What is nonoperative or conservative treatment?
Conservative treatments include immobilization, rest, anti-inflammatory medications, physical therapy, traction, and epidural steroid injections. Up to 90% of patients find relief from symptoms with nonoperative care. For patients with persistent symptoms and significant functional problems surgery may be recommended.
Medications include over the counter and prescription strength nonsteroidal mediations such as ibuprofen and acetaminophen for pain, and oral and injectable corticosteroids to reduce inflammation. Studies show that physical therapy and therapy combined with pain management can effectively decreases pain and improve function and quality of life in patients with cervical radiculopathy .
What are the surgical treatment options?
The strongest predictor of surgery is a combination of radicular pain, sensory loss, and muscle weakness. The most common surgical procedure is discectomy and fusion. The success of surgical interventions is reported as between 80 and 95%. The primary goal of all surgical options is to decompress the nerve root to relieve symptoms.
Anterior Cervical Discectomy and Fusion (ACDF)
ACDF is surgery to remove the degenerated, damaged, herniated or bulging disc or bone spur to relieve pressure and pain, maintain space for nerve roots that exit the spine, and to realign and stabilize the spine with spinal fusion. It is the gold standard surgery and the most performed procedure for cervical radiculopathy because it is so successful. ACDF is usually an outpatient procedure performed under general anesthetic. It offers very high rates of resolution of neck and arm pain.
This is a very routine surgery with low complication rates. Initial healing occurs in the first 4-6 weeks. Full recovery can take 3-6 months.
The anterior approach means the surgery is done through the front of the neck. A small cut is made in the front of the neck, and the muscles are moved out of the away to reach the discs in front of the spine. Using a microscope, the surgeon removes the damaged disc and any bone spurs. The vertebrae above and below the damaged disc are fused using a cage filled with bone graft material to replace the damaged disc, and titanium plates and screws to hold the repairs in place. As you heal the bones grow together to stabilize the joint.
Artificial Cervical Disc Replacement (ADR)
ADR is an alternative to ACDF for patients with degenerative disc disease. This procedure is also performed from the front of the neck. The goal is to remove the damaged disc and replace it with an artificial disc. The artificial disc is made of metal and plastic. There is no fusion which helps to retain spine flexibility and restore more normal movement. ADR has been shown to be safe and effective. Select patients may be candidates for ADR.
Posterior Cervical Foraminotomy (PCF)
PCF can be performed as a minimally invasive procedure performed through an incision in the back of the neck. It is a popular and proven alternative treatment for cervical radiculopathy that preserves spine mobility and avoids the need for fusion. However, it is reserved for patients with only a single level one sided cervical radiculopathy. For these patients it offers a safe nerve decompression and symptom relief. Length of recovery depends on the severity of symptoms.
This procedure is valuable for patients with degenerative disc disease and osteoarthritis which causes foraminal stenosis which is narrowing of the foramen (the opening in the bone through which the nerve root leaves the spinal cord).
In this procedure your Dallas Neurosurgical & Spine surgeon will remove arthritic bone spurs and the damaged part of the disc where it is compressing the nerve.
When surgery is necessary, the type of procedure will depend on your specific spine condition and imaging findings so that the treatment is tailored specifically for you to optimize your best outcome. Contact Dallas Neurosurgical & Spine for a complete evaluation of your neck pain. You will always be treated with respect and with state-of-the-art medicine.