Cervical Radiculopathy: A Systematic Review on Treatment by Spinal Manipulation and Measurement with the Neck Disability Index
SOURCE: J Can Chiro Assoc. 2012 (Mar); 56 (1): 18–28 ~ FULL TEXT
Robert J. Rodine, BSc, DC, Howard Vernon, DC, PhD, FCCS(C)
Graduate Education and Research Programs,
Canadian Memorial Chiropractic College,
Toronto, Ontario.
Cervical radiculopathy (CR), while less common than conditions with neck pain alone, can be a significant cause of neck pain and disability; thus the determination of adequate treatment options for patients is essential. Currently, inadequate scientific literature restricts specific conservative management recommendations for CR. Despite a paucity of evidence for high-velocity low-amplitude (HVLA) spinal manipulation in the treatment for CR, this strategy has been frequently labeled as contraindicated. Scientific support for appropriate outcome measures for CR is equally deficient. While more scientific data is needed to draw firm conclusions, the present review suggests that spinal manipulation may be cautiously considered as a therapeutic option for patients suffering from CR. With respect to outcome measures, the Neck Disability Index appears well-suited for spinal manipulative treatment of CR.
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Introduction
Cervical radiculopathy (CR) can be a significant cause of neck pain and disability. The reported annual incidence of CR is 83.2/100,000 persons [1], while the reported prevalence is 3.5/1000 persons. [2] Gender preference varies. [2, 3] Individuals are most commonly affected in the 5th and 6th decades of life. [1, 4] Physical exertion or trauma at onset is rare, involving less than 15%. [1] Causal relationship to an automobile accident ranges from 3–23%. [1, 4]
Patients presenting with CR most frequently complain of neck pain, paresthesia and radicular pain. [1] While sensory symptoms typically present along a dermatome, pain is often myotomal. [5] When present, dermatomal pain patterns are more frequent at the C4 level (60%) as compared to the C7 (34.2% of cases) and C6 levels (35% of cases). [3] Scapular pain is found in 51.6% of cases. [3] Physical examination typically reveals painful cervical spine range of motion (ROM) and decreased deep tendon reflexes. [1] Upper limb weakness involves only 15% of cases. [1] Decreased sensation is found in 1/3 of cases; however, muscle atrophy presents in less than 2% of cases. [1] Level of involvement is most typically the C7 (39.3%–46.3%) and C6 (17.6%–42.6%) nerve roots. [1, 3] Bilateral involvement is reported in 5–36% of cases. [1, 4]
The intervertebral disc has be found to be causative in only 22% of cases, while 68% of cases appear to arise from a combination of discogenic and spondylotic causes. [1] With respect to therapy, the Task Force on Neck Pain and Its Associated Disorders (TFNPAD) extensively reviewed the literature to make best-evidence recommendations on the management of neck pain disorders. The review found insufficient evidence to draw firm conclusions or make appropriate treatment recommendations for CR, or identify contraindicated therapies. [6]
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