nach oben

HSS Journal ®

Erschienen in:

01.10.2011 | Review Article

Cervical Radiculopathy: A Review

verfasst von: John M. Caridi, MD, Matthias Pumberger, MD, Alexander P. Hughes, MD

Erschienen in: HSS Journal ® | Ausgabe 3/2011

Einloggen, um Zugang zu erhalten

Abstract

Background

Cervical radiculopathy is defined as a syndrome of pain and/or sensorimotor deficits due to compression of a cervical nerve root. Understanding of this disease is vital for rapid diagnosis and treatment of patients with this condition, facilitating their recovery and return to regular activity.

Purpose

This review is designed to clarify (1) the pathophysiology that leads to nerve root compression; (2) the diagnosis of the disease guided by history, physical exam, imaging, and electrophysiology; and (3) operative and non-operative options for treatment and how these should be applied.

Methods

The PubMed database was searched for relevant articles and these articles were reviewed by independent authors. The conclusions are presented in this manuscript.

Results

Facet joint spondylosis and herniation of the intervertebral disc are the most common causes of nerve root compression. The clinical consequence of radiculopathy is arm pain or paresthesias in the dermatomal distribution of the affected nerve and may or may not be associated with neck pain and motor weakness. Patient history and clinical examination are important for diagnosis. Further imaging modalities, such as x-ray, computed tomography, magnetic resonance imaging, and electrophysiologic testing, are of importance. Most patients will significantly improve from non-surgical active and passive therapies. Indicated for surgery are patients with clinically significant motor deficits, debilitating pain that is resistant to conservative modalities and/or time, or instability in the setting of disabling radiculopathy. Surgical treatment options include anterior cervical decompression with fusion and posterior cervical laminoforaminotomy.

Conclusion

Understanding the pathophysiology, diagnosis, treatment indications, and treatment techniques is essential for rapid diagnosis and care of patients with cervical radiculopathy.

Carette S, Fehlings MG. Clinical practice. Cervical radiculopathy. N Engl J Med. Jul 28 2005;353(4):392–399CrossRef

Ellenberg MR, Honet JC, Treanor WJ. Cervical radiculopathy. Arch Phys Med Rehabil. Mar 1994;75(3):342–352.CrossRef

Fouyas IP, Statham PF, Sandercock PA. Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy. Spine (Phila Pa 1976). Apr 1 2002;27(7):736–747CrossRef

Humphreys SC, Chase J, Patwardhan A, Shuster J, Lomasney L, Hodges SD. Flexion and traction effect on C5-C6 foraminal space. Arch Phys Med Rehabil. Sep 1998;79(9):1105–1109.CrossRef

Drake RL, Gray H. Gray’s atlas of anatomy. 1st ed. Philadelphia: Churchill Livingstone; 2008.

Benzel EC. Spine surgery : techniques, complication avoidance, and management. 2005.

Bush K, Chaudhuri R, Hillier S, Penny J. The pathomorphologic changes that accompany the resolution of cervical radiculopathy. A prospective study with repeat magnetic resonance imaging. Spine (Phila Pa 1976). Jan 15 1997;22(2):183–186; discussion 187CrossRef

Buttermann GR. Prospective nonrandomized comparison of an allograft with bone morphogenic protein versus an iliac-crest autograft in anterior cervical discectomy and fusion. Spine J. May-Jun 2008;8(3):426–435.CrossRef

Devereaux M. Neck pain. Med Clin North Am. Mar 2009;93(2):273–284, viiCrossRef

10.

Wainner RS, Gill H. Diagnosis and nonoperative management of cervical radiculopathy. J Orthop Sports Phys Ther. Dec 2000;30(12):728–744.CrossRef

11.

Petiot P, Bernard E. [Diagnostic pitfalls in carpal tunnel syndrome]. Rev Neurol (Paris). Jan 2011;167(1):64–71.CrossRef

12.

DeMyer W. Technique of the neurologic examination: a programmed text. 3 d ed. New York: McGraw-Hill; 1980.

13.

Viikari-Juntura E, Porras M, Laasonen EM. Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine (Phila Pa 1976). Mar 1989;14(3):253–257CrossRef

14.

Yoss RE, Corbin KB, Maccarty CS, Love JG. Significance of symptoms and signs in localization of involved root in cervical disk protrusion. Neurology. Oct 1957;7(10):673–683.CrossRef

15.

Youdas JW, Carey JR, Garrett TR. Reliability of measurements of cervical spine range of motion--comparison of three methods. Phys Ther. Feb 1991;71(2):98–104; discussion 105–106CrossRef

16.

Alrawi MF, Khalil NM, Mitchell P, Hughes SP. The value of neurophysiological and imaging studies in predicting outcome in the surgical treatment of cervical radiculopathy. Eur Spine J. Apr 2007;16(4):495–500.CrossRef

17.

Jagannathan J, Shaffrey CI, Oskouian RJ, et al. Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar. J Neurosurg Spine. May 2008;8(5):420–428.CrossRef

18.

Mochida K, Komori H, Okawa A, Muneta T, Haro H, Shinomiya K. Regression of cervical disc herniation observed on magnetic resonance images. Spine (Phila Pa 1976). May 1 1998;23(9):990–995; discussion 996–997CrossRef

19.

Nardin RA, Patel MR, Gudas TF, Rutkove SB, Raynor EM. Electromyography and magnetic resonance imaging in the evaluation of radiculopathy. Muscle Nerve. Feb 1999;22(2):151–155.CrossRef

20.

Radhakrishnan K, Litchy WJ, O’Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. Apr 1994;117 (Pt 2):325–335CrossRef

21.

Sampath P, Bendebba M, Davis JD, Ducker T. Outcome in patients with cervical radiculopathy. Prospective, multicenter study with independent clinical review. Spine (Phila Pa 1976). Mar 15 1999;24(6):591–597CrossRef

22.

Aarabi B, Alexander M, Mirvis SE, et al. Predictors of outcome in acute traumatic central cord syndrome due to spinal stenosis. J Neurosurg Spine. Dec 17 2010.

23.

Fehlings MG, Rabin D, Sears W, Cadotte DW, Aarabi B. Current practice in the timing of surgical intervention in spinal cord injury. Spine (Phila Pa 1976). Oct 1 2010;35(21 Suppl):S166–173CrossRef

24.

Lenehan B, Fisher CG, Vaccaro A, Fehlings M, Aarabi B, Dvorak MF. The urgency of surgical decompression in acute central cord injuries with spondylosis and without instability. Spine (Phila Pa 1976). Oct 1 2010;35(21 Suppl):S180–186CrossRef

25.

Arnasson O, Carlsson CA, Pellettieri L. Surgical and conservative treatment of cervical spondylotic radiculopathy and myelopathy. Acta Neurochir (Wien). 1987;84(1–2):48–53.CrossRef

26.

Dreyer SJ, Boden SD. Nonoperative treatment of neck and arm pain. Spine (Phila Pa 1976). Dec 15 1998;23(24):2746–2754CrossRef

27.

Jette DU, Jette AM. Physical therapy and health outcomes in patients with spinal impairments. Phys Ther. Sep 1996;76(9):930–941; discussion 942–935.CrossRef

28.

Tan JC, Nordin M. Role of physical therapy in the treatment of cervical disk disease. Orthop Clin North Am. Jul 1992;23(3):435–449.PubMed

29.

Anonymous. Pain in the neck and arm: a multicentre trial of the effects of physiotherapy, arranged by the British Association of Physical Medicine. Br Med J. Jan 29 1966;1(5482):253–258.

30.

Swezey RL, Swezey AM, Warner K. Efficacy of home cervical traction therapy. Am J Phys Med Rehabil. Jan-Feb 1999;78(1):30–32.CrossRef

31.

Valtonen EJ, Kiuru E. Cervical traction as a therapeutic tool. A clinical anlaysis based on 212 patients. Scand J Rehabil Med. 1970;2(1):29–36PubMed

32.

van der Heijden GJ, Beurskens AJ, Koes BW, Assendelft WJ, de Vet HC, Bouter LM. The efficacy of traction for back and neck pain: a systematic, blinded review of randomized clinical trial methods. Phys Ther. Feb 1995;75(2):93–104.CrossRef

33.

Wong AM, Lee MY, Chang WH, Tang FT. Clinical trial of a cervical traction modality with electromyographic biofeedback. Am J Phys Med Rehabil. Jan-Feb 1997;76(1):19–25.CrossRef

34.

Bush K, Hillier S. Outcome of cervical radiculopathy treated with periradicular/epidural corticosteroid injections: a prospective study with independent clinical review. Eur Spine J. 1996;5(5):319–325.CrossRef

35.

Castagnera L, Maurette P, Pointillart V, Vital JM, Erny P, Senegas J. Long-term results of cervical epidural steroid injection with and without morphine in chronic cervical radicular pain. Pain. Aug 1994;58(2):239–243.CrossRef

36.

Kwon JW, Lee JW, Kim SH, et al. Cervical interlaminar epidural steroid injection for neck pain and cervical radiculopathy: effect and prognostic factors. Skeletal Radiol. May 2007;36(5):431–436.CrossRef

37.

Lee JW, Park KW, Chung SK, et al. Cervical transforaminal epidural steroid injection for the management of cervical radiculopathy: a comparative study of particulate versus non-particulate steroids. Skeletal Radiol. Nov 2009;38(11):1077–1082.CrossRef

38.

van Gijn J, Reiners K, Toyka KV, Braakman R. Management of cervical radiculopathy. Eur Neurol. 1995;35(6):309–320.CrossRef

39.

Waldman SD. Complications of cervical epidural nerve blocks with steroids: a prospective study of 790 consecutive blocks. Reg Anesth. May-Jun 1989;14(3):149–151.PubMed

40.

Benny B, Azari P, Briones D. Complications of cervical transforaminal epidural steroid injections. Am J Phys Med Rehabil. Jul 2010;89(7):601–607.CrossRef

41.

Beneliyahu DJ. Chiropractic management and manipulative therapy for MRI documented cervical disk herniation. J Manipulative Physiol Ther. Mar-Apr 1994;17(3):177–185.PubMed

42.

Hubka MJ, Phelan SP, Delaney PM, Robertson VL. Rotary manipulation for cervical radiculopathy: observations on the importance of the direction of the thrust. J Manipulative Physiol Ther. Nov-Dec 1997;20(9):622–627.PubMed

43.

Di Fabio RP. Manipulation of the cervical spine: risks and benefits. Phys Ther. Jan 1999;79(1):50–65.PubMed

44.

Fessler RG, Sekhar LN. Atlas of neurosurgical techniques : spine and peripheral nerves. New York: Thieme; 2006.

45.

Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg. Nov 1958;15(6):602–617.CrossRef

46.

Estridge MN, Smith RA. Anterior Cervical Fusion; Solution of a Particular Problem. J Neurosurg. May 1963;20:441–444.CrossRef

47.

Abd-Alrahman N, Dokmak AS, Abou-Madawi A. Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study. Acta Neurochir (Wien). 1999;141(10):1089–1092.CrossRef

48.

Barlocher CB, Barth A, Krauss JK, Binggeli R, Seiler RW. Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interposition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients. Neurosurg Focus. Jan 15 2002;12(1):E4PubMed

49.

Bohlman HH, Emery SE, Goodfellow DB, Jones PK. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am. Sep 1993;75(9):1298–1307.CrossRef

50.

Heary RF, Ryken TC, Matz PG, et al. Cervical laminoforaminotomy for the treatment of cervical degenerative radiculopathy. J Neurosurg Spine. Aug 2009;11(2):198–202.CrossRef

51.

Madawi AA, Powell M, Crockard HA. Biocompatible osteoconductive polymer versus iliac graft. A prospective comparative study for the evaluation of fusion pattern after anterior cervical discectomy. Spine (Phila Pa 1976). Sep 15 1996;21(18):2123–2129; discussion 2129–2130CrossRef

52.

Watters WC, 3rd, Levinthal R. Anterior cervical discectomy with and without fusion. Results, complications, and long-term follow-up. Spine (Phila Pa 1976). Oct 15 1994;19(20):2343–2347.CrossRef

53.

Jho HD. Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation. J Neurosurg. Feb 1996;84(2):155–160.CrossRef

54.

Jho HD, Kim MH, Kim WK. Anterior cervical microforaminotomy for spondylotic cervical myelopathy: part 2. Neurosurgery. Nov 2002;51(5 Suppl):S54–59.PubMed

55.

Johnson JP, Filler AG, McBride DQ, Batzdorf U. Anterior cervical foraminotomy for unilateral radicular disease. Spine (Phila Pa 1976). Apr 15 2000;25(8):905–909CrossRef

56.

Boakye M, Mummaneni PV, Garrett M, Rodts G, Haid R. Anterior cervical discectomy and fusion involving a polyetheretherketone spacer and bone morphogenetic protein. J Neurosurg Spine. May 2005;2(5):521–525.CrossRef

57.

Davis RA. A long-term outcome study of 170 surgically treated patients with compressive cervical radiculopathy. Surg Neurol. Dec 1996;46(6):523–530; discussion 530–523.CrossRef

58.

McGuire KJ, Harrast J, Herkowitz H, Weinstein JN. Geographic Variation in the Surgical Treatment of Degenerative Cervical Disc Disease: American Board of Orthopedic Surgery (ABOS) Quality Improvement Initiative; Part II Candidates. Spine (Phila Pa 1976). Feb 4 2011.

59.

Fraser JF, Hartl R. Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine. Apr 2007;6(4):298–303.CrossRef

60.

Samartzis D, Shen FH, Lyon C, Phillips M, Goldberg EJ, An HS. Does rigid instrumentation increase the fusion rate in one-level anterior cervical discectomy and fusion? Spine J. Nov-Dec 2004;4(6):636–643CrossRef

61.

Peolsson A, Peolsson M. Predictive factors for long-term outcome of anterior cervical decompression and fusion: a multivariate data analysis. Eur Spine J. Mar 2008;17(3):406–414.CrossRef

62.

Park HW, Lee JK, Moon SJ, Seo SK, Lee JH, Kim SH. The efficacy of the synthetic interbody cage and Grafton for anterior cervical fusion. Spine (Phila Pa 1976). Aug 1 2009;34(17):E591–595CrossRef

63.

Jawahar A, Cavanaugh DA, Kerr EJ, 3 rd, Birdsong EM, Nunley PD. Total disc arthroplasty does not affect the incidence of adjacent segment degeneration in cervical spine: results of 93 patients in three prospective randomized clinical trials. Spine J. Dec 2010;10(12):1043–1048.CrossRef

64.

Song KJ, Choi BW, Kim GH, Song JH. Usefulness of polyetheretherketone (PEEK) cage with plate augmentation for anterior arthrodesis in traumatic cervical spine injury. Spine J. Jan 2010;10(1):50–57.CrossRef

65.

Papadopoulos EC, Huang RC, Girardi FP, Synnott K, Cammisa FP, Jr. Three-level anterior cervical discectomy and fusion with plate fixation: radiographic and clinical results. Spine (Phila Pa 1976). Apr 15 2006;31(8):897–902CrossRef

66.

Uribe JS, Sangala JR, Duckworth EA, Vale FL. Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up. Eur Spine J. May 2009;18(5):654–662.CrossRef

67.

Coric D, Nunley PD, Guyer RD, et al. Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex|C artificial disc investigational device exemption study with a minimum 2-year follow-up. J Neurosurg Spine. Jun 24 2011.

68.

Caspar W, Geisler FH, Pitzen T, Johnson TA. Anterior cervical plate stabilization in one- and two-level degenerative disease: overtreatment or benefit? J Spinal Disord. Feb 1998;11(1):1–11.CrossRef

69.

Kozak JA, Hanson GW, Rose JR, Trettin DM, Tullos HS. Anterior discectomy, microscopic decompression, and fusion: a treatment for cervical spondylotic radiculopathy. J Spinal Disord. Mar 1989;2(1):43–46.CrossRef

70.

Ducker TB, Zeidman SM. The posterior operative approach for cervical radiculopathy. Neurosurg Clin N Am. Jan 1993;4(1):61–74.CrossRef

71.

Korinth MC, Kruger A, Oertel MF, Gilsbach JM. Posterior foraminotomy or anterior discectomy with polymethyl methacrylate interbody stabilization for cervical soft disc disease: results in 292 patients with monoradiculopathy. Spine (Phila Pa 1976). May 15 2006;31(11):1207–1214; discussion 1215–1206CrossRef

72.

Witzmann A, Hejazi N, Krasznai L. Posterior cervical foraminotomy. A follow-up study of 67 surgically treated patients with compressive radiculopathy. Neurosurg Rev. Dec 2000;23(4):213–217CrossRef

73.

Jagannathan J, Sherman JH, Szabo T, Shaffrey CI, Jane JA. The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 years’ clinical and radiographic follow-up. J Neurosurg Spine. Apr 2009;10(4):347–356.CrossRef

74.

Grieve JP, Kitchen ND, Moore AJ, Marsh HT. Results of posterior cervical foraminotomy for treatment of cervical spondylitic radiculopathy. Br J Neurosurg. Feb 2000;14(1):40–43.CrossRef

75.

Herkowitz HN, Kurz LT, Overholt DP. Surgical management of cervical soft disc herniation. A comparison between the anterior and posterior approach. Spine (Phila Pa 1976). Oct 1990;15(10):1026–1030CrossRef

76.

Campbell PG, Yadla S, Malone J, et al. Early complications related to approach in cervical spine surgery: single-center prospective study. World Neurosurg. Aug-Sep 2010;74(2–3):363–368.CrossRef

Titel: Cervical Radiculopathy: A Review
verfasst von: John M. Caridi, MD
Matthias Pumberger, MD
Alexander P. Hughes, MD
Publikationsdatum: 01.10.2011
Verlag: Springer New York
Erschienen in: HSS Journal ® / Ausgabe 3/2011
Print ISSN: 1556-3316
Elektronische ISSN: 1556-3324
DOI: https://doi.org/10.1007/s11420-011-9218-z

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Background

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2011

Instability Following Total Knee Arthroplasty

Degenerative Scoliosis: A Review

Letter from the Editor

Locking and Non-locking Constructs Achieve Similar Radiographic and Clinical Outcomes for Internal Fixation of Intra-articular Distal Humerus Fractures

Technique for Margin Convergence in Rotator Cuff Repair