At different disease stages
- In an acute cervical radiculopathy without evidence of major neurological deficit, analgesic agents, including opioids and NSAID, are often used as first-line therapy. Many physicians advocate a short course of oral steroids for 7 days7.
- In the setting of subacute cervical radiculopathy not responding to medical/rehabilitative management, interventional management can play a role. The principle of epidural administration of corticosteroids relies on the anti-inflammatory response from the inhibition of the phospholipase A2-initiated arachidonic acid cascade. There are two administration routes:
- Cervical Interlaminar Epidural Steroid Injections: A systematic review8 on the effectiveness of this procedure in the management of chronic neck pain included 3 randomized control trials: The global conclusion was a positive pain releiving effect on cervical radicular pain.
- Pros: May be useful in multiple level pathology and bilateral symptoms.
- Cons: Lacks specificity.
- Cervical Transforaminal Epidural Steroid Injections: This gained in popularity because of the more accurate administration of the active product at the level of the affected nerve root.
- Pros: Specifically deposits medication closest to the site of pathology. May give diagnostic information to determine the primary pain generator in cervical pathology.
- Cons: Reports of serious and/or even fatal complications including stroke, spinal cord injury, and death have been reported due to close proximity to vertebral artery, other vascular structures.
- In the setting of a Sub-Acute to Chronic cervical radiculopathies, a surgical consultation is recommended when the patient still has persistent and severe disabling pain after at least 6 to 12 weeks of nonsurgical management, and progression of neurologic deficits3.
Rehabilitation interventions depend on the extent and type of deficits. These include: physical modalities, activity modifications, mobilization techniques, kinetic chain analysis, and addressing flexibility and weakness. There should be a progression to normalizing spine mechanics and incorporating a dynamic functional strengthening finalizing in restoring pre-injury range of motion and strength.
Neuromodulation has been shown to be effective in patients who fail conservative management and undergo spinal surgery, but continue to have pain symptoms even after surgery (cervical post-laminectomy syndrome). It might also be recommended for patients who do not meet the criteria for good outcomes post-surgery.
Complications of radiculopathy, such as chronic pain, loss of motor strength and function, or potential progression to cervical myelopathy should be prevented and promptly managed9.