CLINICAL COURSE AND PROGNOSTIC MODELS FOR THE CONSERVATIVE MANAGEMENT OF CERVICAL RADICULOPATHY: A PROSPECTIVE COHORT STUDY

Review written by Dr Xiaoqi Chen info

BACKGROUND & OBJECTIVE

Cervical radiculopathy is related to the compression or inflammation of a cervical nerve root. There is no gold standard to diagnose cervical radiculopathy, but the diagnosis is typically based on clinical presentation and Magnetic Resonance Imaging (MRI). Patients are usually treated conservatively, and surgical option is a last resort.

The objective of this study was to depict the clinical course and to develop models that illustrate the prognosis of cervical radiculopathy in patients who were managed conservatively. Ultimately, this study is targeted at providing accurate information to patients about the prognosis and prognostic factors related to cervical radiculopathy.

METHODS

The study was a prospective cohort study which recruited 61 adult participants with cervical radiculopathy who were referred for conservative management. All participants were screened via MRI, and assessed clinically by a neurosurgeon. Participants were included in the study if they met the following criteria: diagnosis of cervical radiculopathy due to disc herniation, stenosis or a combination; at least 18 years of age; and referred for conservative management. Participants with known serious pathology (e.g. malignancies, fractures, rheumatoid arthritis, infections or myelopathy), multiple sclerosis, diabetes mellitus, polyneuropathy, complex regional pain syndrome, or previous spinal surgery were excluded.

The following outcome measures were collected: perceived recovery (using the 7-point Global Perceived Effect (GPE) scale); neck, arm pain intensity and disability (using the 11-point Numeric Pain Rating (NRS) scale); sick leave due to cervical radiculopathy (duration in weeks); and treatment received (e.g. physical therapy, injections, medications). The participants were followed up at six and 12 months. The primary outcome measure for prognosis was perceived recovery at 12 months. Patients were deemed recovered if they scored “completely recovered” or “much improved” on the GPE scale.

RESULTS

Participants had a mean age of 49.5 years, 54% were female, and the median duration of symptoms was 26 weeks (interquartile range (IQR) 8.5-104 weeks). The causes of nerve root compression in the participants were disc herniation (43%), stenosis (14%),

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