Treating cervical radiculopathy begins with a good understanding of the anatomy that’s underlying the radiculopathy so you can focus your efforts appropriately. Essentially, treating a cervical radiculopathy though is like treating most other musculoskeletal ailments, which is that we need to reduce the inflammation, in this case around the nerve root, and then we need to address the biomechanics so we can take the pressure off of that nerve root so that it doesn’t come back.Often, treating cervical radiculopathy starts with physical therapy—stretching, strengthening, postural exercises, getting the biomechanics right to help take the pressure off the spine so that the nerve basically has a chance to heal itself. Along the way, oral medications can be very helpful to help alleviate the symptoms and allow people to participate with the physical therapy.
In addition, within physical therapy there are many passive modalities, such as gentle spinal manipulation, traction, ultrasound, electrical stimulation, soft tissue massage—different modalities that help to control the symptoms and also, ideally, to help take away some of the inflammation from around the nerve roots.
When the symptoms are persistent despite the physical therapy, or if the symptoms are restricting the person’s ability to really fully participate in physical therapy, then sometimes an epidural steroid injection can be very helpful to take away the inflammation. Now it’s important to remember that an epidural doesn’t fix a herniated disc, it doesn’t change the arthritis in the spine, but nor does it simply mask the pain either. What it does is it reduces the inflammation, essentially attempts to reset the inflammatory clock back down to zero. If a person can then take advantage of this time where the inflammation is not there and use it more as a window of opportunity during which he or she can stretch, strengthen, really address the mechanics and tweak the mechanics so that, you know, in three months, six months, nine months, a year, the same stresses aren’t going through the spine, and so they won’t be going through the nerve and, ideally, the pain won’t return and then you won’t have to be sitting back there in several months having to do any more injections.
When symptoms in those rare cases that symptoms aren’t getting better with conservative treatments, there are surgical alternatives. And the surgical alternatives really depend on the underlying anatomy in terms of whether you can do a discectomy, a foraminotomy, or a more extensive surgical procedure. It just depends on the underlying anatomy as to what kind of surgical alternatives would may be appropriate.