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Treatment

Rehabilitation

Therapeutic exercises are frequently used in combination with many of the previously mentioned modalities and with great results. A variety of exercise regimens are available in patient treatment. An exercise regimen should be modified according to the abilities and weaknesses of the patient ^[1]. Stabilization of the cervicothoracic region is paramount in limiting pain and preventing re-injury. The first part of the stabilization procedure is achieving a pain free full range of motion which can be accomplished through stretching exercises. Subsequently a strengthening exercise program should be designed to restore the deconditioned cervical, shoulder girdle, and upper trunk musculature ^[2]. As reliance on the neck brace diminishes, an isometric exercise regimen should be introduced. This is a preferred method of exercise during the sub-acute phase because it resists atrophy and is least likely to exacerbate the condition. Single plane resistance exercises against cervical flexion, extension, bending, and rotation are used. While minimally invasive methods for rehabilitation are ideal, surgery is still a viable option. Patients with large cervical disk bulges are frequently recommended for surgery, however most often conservative management will help the herniation regress naturally ^[3].

Epidemiology

Cervical radiculopathy is less prevalent in the United States than lumbar radiculopathy with an occurrence rate of 8 cases per 100,000. According to the AHRQ’s 2010 National Statistics for cervical radiculopathy the most affected age group is between 45 and 64 years with 51.03% of incidents. Females are affected more frequently than males and account for 53.69% of cases. Private insurance was the payer in 41.69% of the incidents followed by Medicare with 38.81%. In 71.61% of cases the patients’ income was considered not low for their zipcode. Additionally over 50% of patients lived in large metropolitans (inner city or suburb). The South is the most severely affected region in the US with 39.27% of cases. According to a study performed in Minnesota, the most common manifestation of this set of conditions is the C7 monoradiculopathy, followed by C6. ^[4]

^ Cleland JA, Whitman JM, Fritz JM, Palmer JA. Manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy: A case series. J Orthop Sports Phys Ther. 2005;35:802–811.
^ Saal JA, Saal JS. The nonoperative treatment of herniated nucleus pulposus with radiculopathy: an outcome study. Spine 1989;14:431–7.
^ Heckmann JC, Lang CJ, Zobelein I, et al. Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients. J Spinal Disord 1999;12:396–401.
^ Radhakrishnan, K., Litchy, W., O'Fallon, W., & Kurland , L. (1994). Epidemiology of cervical radiculopathy. a population-based study from rochester, minnesota, 1976 through 1990. Brain, (117), 325-335. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8186959

[1] Cleland JA, Whitman JM, Fritz JM, Palmer JA. Manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy: A case series. J Orthop Sports Phys Ther. 2005;35:802–811.

[2] Saal JA, Saal JS. The nonoperative treatment of herniated nucleus pulposus with radiculopathy: an outcome study. Spine 1989;14:431–7.

[3] Heckmann JC, Lang CJ, Zobelein I, et al. Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients. J Spinal Disord 1999;12:396–401.

[4] Radhakrishnan, K., Litchy, W., O'Fallon, W., & Kurland , L. (1994). Epidemiology of cervical radiculopathy. a population-based study from rochester, minnesota, 1976 through 1990. Brain, (117), 325-335. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8186959

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