William C Olivero1, Scott C Dulebohn. 1. Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Illinois 61656, USA.
Abstract
OBJECT: The percentage of patients responding to conservative treatment for cervical radiculopathy secondary to nerve root compression is not well quantified. To clarify this question, the authors retrospectively reviewed the records obtained over a 4-year period in patients with cervical radiculopathy to determine their response to conservative measures (cervical collar therapy and halter cervical traction). METHODS: Cervical radiculopathy was diagnosed in patients if they suffered from radiating arm pain made worse by neck movement and at least one of the following: reflex loss, dermatomal numbness, and/or myotomal weakness. Patients with neck pain alone or arm pain without neurological deficit were excluded from analysis. Those patients without excruciating pain, severe weakness, or evidence of myelopathy were offered a course of halter traction before surgery was to be considered. Ninety-six patients met the inclusion criteria; there were 61 males and 35 females, and the mean age was 47 years. Fifty-five patients presented with C-7, 37 with C-6, two with C-5, and two with C-8 radiculopathy. Eighty-one patients underwent a trial of traction that consisted of wearing a cervical collar and home-based halter cervical traction: 8 to 12 pounds, applied for 15 minutes, three times a day for 3 to 6 weeks The mean duration of symptoms prior to neurosurgical evaluation was 43 days +/- 8.3 days (standard deviation). Sixty-three (78%) of 81 patients responded to therapeutic traction, experiencing significant or total pain relief, three could not tolerate the traction, and traction failed in 15 patients. Of the 81 patients in whom traction was undertaken, 78 underwent magnetic resonance imaging prior to being seen, which revealed herniated discs at the corresponding levels in 71 and foraminal stenosis in seven. Three of the 63 patients in whom an initial response to traction was noted suffered recurrence of symptoms and required surgery. It would appear that in patients in whom symptoms of cervical radiculopathy were present for approximately 6 weeks that 75% will respond to further conservative treatment (halter traction and cervical collar) over the next 6 weeks.
OBJECT: The percentage of patients responding to conservative treatment for cervical radiculopathy secondary to nerve root compression is not well quantified. To clarify this question, the authors retrospectively reviewed the records obtained over a 4-year period in patients with cervical radiculopathy to determine their response to conservative measures (cervical collar therapy and halter cervical traction). METHODS:Cervical radiculopathy was diagnosed in patients if they suffered from radiating arm pain made worse by neck movement and at least one of the following: reflex loss, dermatomal numbness, and/or myotomal weakness. Patients with neck pain alone or arm pain without neurological deficit were excluded from analysis. Those patients without excruciating pain, severe weakness, or evidence of myelopathy were offered a course of halter traction before surgery was to be considered. Ninety-six patients met the inclusion criteria; there were 61 males and 35 females, and the mean age was 47 years. Fifty-five patients presented with C-7, 37 with C-6, two with C-5, and two with C-8radiculopathy. Eighty-one patients underwent a trial of traction that consisted of wearing a cervical collar and home-based halter cervical traction: 8 to 12 pounds, applied for 15 minutes, three times a day for 3 to 6 weeks The mean duration of symptoms prior to neurosurgical evaluation was 43 days +/- 8.3 days (standard deviation). Sixty-three (78%) of 81 patients responded to therapeutic traction, experiencing significant or total pain relief, three could not tolerate the traction, and traction failed in 15 patients. Of the 81 patients in whom traction was undertaken, 78 underwent magnetic resonance imaging prior to being seen, which revealed herniated discs at the corresponding levels in 71 and foraminal stenosis in seven. Three of the 63 patients in whom an initial response to traction was noted suffered recurrence of symptoms and required surgery. It would appear that in patients in whom symptoms of cervical radiculopathy were present for approximately 6 weeks that 75% will respond to further conservative treatment (halter traction and cervical collar) over the next 6 weeks.