Nonoperative Treatment of Herniated Cervical Discs

This study consisted of 26 patients with cervical herniated nucleus pulposus and radiculopathy who were treated with conservative measures, and then re-evaluated one year later.

At the beginning of the study, “All patients had a predominance of radicular upper extremity pain as their chief complaint. Twenty of the 24 nonoperative patients had objective neurologic loss (83%). Fourteen had a motor loss of at least 4/5 (one grade of loss) on the medical research council (MRC) scale in the myotomal distribution of the segmental level of the index disc herniation.”

In terms of treatment, “All patients were treated with ice, relative rest, a hard cervical collar worn for up to 2 weeks in a position to maximize arm pain reduction (all patients), NSAIDs for 6-12 weeks, manual and mechanical traction in physical therapy, followed by home cervical traction (all patients), and progressive strengthening exercises of the shoulder girdle and chest with training in postural control and body mechanics training. Twenty-two patients whose pain was inadequately controlled by the previously mentioned regimen were treated with a single week course of a moderate dose of oral prednisone…Nine patients did not achieve adequate symptom control with these measures and were given a single, radiographic-guided epidural or selective nerve corticosteroid injection (nine patients). Residual symptoms after either corticosteroid treatment were managed with a six-session course of acupuncture and [TENS] for 4 weeks in eight patients.”

One year later, 92% of the patients were still working full-time, with 88% in the same job. “Twenty of 24 nonoperative patients had a good or excellent outcome,” or 83%. “No patients had progressive neurologic loss or reached a neurologic catastrophe (i.e., new onset of myelopathy).” Two patients had surgery.

Significantly, many of these patients, “…had been deemed nonoperative treatment failures by surgeons who had evaluated these patients and recommended surgery.”

The authors conclude, “Until there is a randomized clinical trial comparing surgery and nonsurgical care, it is important to consider that aggressive nonoperative care is indicated in every cervical disc herniation patient before a decision for surgical intervention.”

Saal JS, Saal JA, Yurth EF. Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine 1996;21(16):1877-1883.

 

 

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