Diagnosis and nonoperative management of cervical radiculopathy

Abstract

Study design: Qualitative, comprehensive literature review.

Objective: To discuss and summarize the current peer-reviewed literature related to the management of patients with cervical radiculopathy.

Background: Cervical radiculopathy is a lesion of the cervical spinal nerve root with a reported prevalence of 3.3 cases per 1000 people; peak annual incidence is 2.1 cases per 1000 and occurs in the fourth and fifth decades of life. Nerve root injury has the potential to produce significant functional limitations and disability.

Methods and measures: A search of the MEDLINE, CINAHL, and Web of Science databases for the periods 1966, 1982, and 1996, respectively, to December 1999 was conducted using selected keywords and MeSH headings. The bibliography of all retrieved articles were searched and pertinent articles were obtained. The Cochrane Database of Systematic Reviews was also searched. Literature related to the diagnosis, prognosis, and treatment of cervical radiculopathy were thoroughly reviewed and summarized using a critical appraisal approach.

Results: Although cervical radiculopathy remains largely a clinical diagnosis, the true diagnostic accuracy of the clinical examination for cervical radiculopathy is unknown. Imaging and electrophysiologic tests are capable of detecting clinically significant problems in many patients and each modality has inherent strengths and weaknesses; technical as well as practical factors affect the choice of procedure. The natural course of cervical radiculopathy appears to be generally favorable but no prognostic or risk factors have been firmly established and the efficacy of various nonoperative treatments for the condition is unknown.

Conclusion: A clear definition of terms and further research are required to establish definitive diagnostic criteria and effective treatment for the management of patients with cervical radiculopathy.