The pathomorphologic changes that accompany the resolution of cervical radiculopathy. A prospective study with repeat magnetic resonance imaging

Abstract

Study design: A prospective study with independent clinical and radiologic review.

Objective: To assess whether regression of cervical intervertebral disc herniations accompanied and correlated with clinical improvement in patients recovering from cervical radiculopathy without undergoing surgical intervention.

Summary of background data: The study subjects were 13 consecutive patients, nine men (69%) and four women (31%), presenting with cervical radiculopathy. All patients but one had objective neurologic signs. All patients had large posterolateral cervical intervertebral disc herniations demonstrated by magnetic resonance imaging.

Methods: Pain was controlled by serial periradicular and epidural corticosteroid injections. Patients were finally examined and discharged from care because of sustained pain control at an average of 6 months (range, 2-12 months). They were interviewed subsequently over the telephone by an independent clinician and rescanned at an average of 12 months (range, 4-31 months). The scans were reviewed by an independent radiologist masked to the sequence of the scans.

Results: Regression of cervical disc herniations was demonstrated in 12 of the 13 patients. All patients had made a satisfactory clinical recovery, but the one with the herniation that had not regressed suffered from persistent minor symptoms.

Conclusions: Most cervical disc herniations regress with time and without the need for surgical resection. Thus, surgical intervention can be avoided with adequate pain control, allowing the herniation time to regress.