Skip to main content
European Spine Journal logoLink to European Spine Journal
. 1997 Jul;6(4):256–266. doi: 10.1007/BF01322448

Cervical radiculopathy: Pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar A prospective, controlled study

L C G Persson 1,, U Moritz 2, L Brandt 1, C -A Carlsson 1
PMCID: PMC3454639  PMID: 9294750

Abstract

This prospective, randomised study compares the efficacy of surgery, physiotherapy and cervical collar with respect to pain, motor weakness and sensory loss in 81 patients with long-lasting cervical radiculopathy corresponding to a nerve root that was significantly compressed by spondylotic encroachment, with or without an additional bulging disk, as verified by MRI or CT-myelography. Pain intensity was registered on a visual analogue scale (VAS), muscle strength was measured by a hand-held dynamometer, Vigorometer and pinchometer. Sensory loss and paraesthesia were recorded. The measurements were performed before treatment (control 1), 4 months after the start of treatment (control 2) and after a further 12 months (control 3). A healthy control group was used for comparison and to test the reliability of the muscle-strength measurements. The study found that before start of treatment the groups were uniform with respect to pain, motor weakness and sensory loss. At control 2 the surgery group reported less pain, less sensory loss and had better muscle strength, measured as the ratio of the affected side to the non-affected side, compared to the two conservative treatment groups. After a further year (control 3), there were no differences in pain intensity, sensory loss or paraesthesia between the groups. An improvement in muscle strengths, measured as the ratio of the affected to the non-affected side, was seen in the surgery group compared to the physiotherapy group in wrist extension, elbow extension, shoulder abduction and internal rotation, but there were no differences in the ratios between the collar group and the other treatment groups. With respect to absolute muscle strength of the affected sides, there were no differences at control 1. At control 2, the surgery group performed somewhat better than the two other groups but at control 3 there were no differences between the groups. We conclude that pain intensity, muscle weakness and sensory loss can be expected to improve within a few months after surgery, while slow improvement with conservative treatments and recurrent symptoms in the surgery group make the 1-year results about equal.

Key words: Anterior cervical fusion, Cervical collar, Cervical radicular pain, Muscle strength, Physiotherapy

Full Text

The Full Text of this article is available as a PDF (1.1 MB).

References

  • 1.Agre JC, Magness JL, Hull SZ, Wright KC, Baxter TL, et al. Strength testing with a portable dynamometer: reliability for upper and lower extremities. Arch Phys Med Rehabil. 1987;68:454–458. [PubMed] [Google Scholar]
  • 2.Altman DG. Practical statistics for medical research. London: Chapman and Hall; 1991. pp. 440–476. [Google Scholar]
  • 3.Backman E, Johansson V, Hager B, Sjoblom P, Henriksson KG. Isometric muscle strength and muscular endurance in normal persons aged between 17 and 70 years. Scand J Rehabil Med. 1995;27:109–117. [PubMed] [Google Scholar]
  • 4.Balogun JA, Onigbinde AT. Hand and leg dominance: do they really effect limb muscle strength? Physiother Theory Pract. 1992;8:89–96. [Google Scholar]
  • 5.Barnes MP, Sanders M. The effect of cervical mobility on the natural history of cervical spondylotic myelopathy. J Neurol Neurosurg Psychiatry. 1984;47:17–20. doi: 10.1136/jnnp.47.1.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Benini A. Clinical features of cervical root compression C5–C8 and their variations. Neuroorthopedics. 1987;4:74–88. [Google Scholar]
  • 7.Bertalanffy H, Egger H-R. Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. Acta Neurochir. 1988;90:127–135. doi: 10.1007/BF01560567. [DOI] [PubMed] [Google Scholar]
  • 8.Blair SJ, McCormick E, Bear-Lehman J, Ewing Fess E, Rader E. Evaluation of impairment of the upper extremity. Clin Orthop. 1987;221:42–58. [PubMed] [Google Scholar]
  • 9.Bohannon RW. Test-retest reliability of hand-held dynamometry during a single session of strength assessment. Phys Ther. 1986;66:206–209. doi: 10.1093/ptj/66.2.206. [DOI] [PubMed] [Google Scholar]
  • 10.Bohannon RW, Andrews AW. Interrater reliability of hand-held dynamometry. Phys Ther. 1987;67:931–933. doi: 10.1093/ptj/67.6.931. [DOI] [PubMed] [Google Scholar]
  • 11.Bohlman HH, Emery SE, Goodfellow DB, Jones PK. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. J Bone Joint Surg [Am] 1993;9:1298–1307. doi: 10.2106/00004623-199309000-00005. [DOI] [PubMed] [Google Scholar]
  • 12.Brigham CD, Tsahakis PJ. Anterior cervical foraminotomy and fusion. Surgical technique and results. Spine. 1995;20:766–770. [PubMed] [Google Scholar]
  • 13.British Association of Physical Medicine Pain in the neck and arm: a multicentre trial of the effects of physiotherapy. BMJ. 1966;1:253–258. doi: 10.1136/bmj.1.5482.253. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Clements DH, O'Leary PF. Anterior cervical discectomy and fusion. Spine. 1990;15:1023–1025. doi: 10.1097/00007632-199015100-00008. [DOI] [PubMed] [Google Scholar]
  • 15.Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958;15:602–617. doi: 10.3171/jns.1958.15.6.0602. [DOI] [PubMed] [Google Scholar]
  • 16.DePalma AF, Subin DK. Study of the cervical syndrome. Clin Orthop. 1965;38:135–141. [PubMed] [Google Scholar]
  • 17.Depassio J. Treatment of cervicobrachial neuralgia in orthopaedic medicine. J Neuroradiol. 1992;19:197–203. [PubMed] [Google Scholar]
  • 18.Desrosiers J, Hébert R, Bravo G, Dutil E. Comparison of the Jamar dynamometer and the Martin vigorimeter for grip strength measurements in a healthy elderly population. Scand Rehabit Med. 1995;27:137–143. [PubMed] [Google Scholar]
  • 19.Ellenberg MR, Hornet JC, Treanor WJ. Cervical radiculopathy. Arch Phys Med Rehabil. 1994;75:342–352. doi: 10.1016/0003-9993(94)90040-x. [DOI] [PubMed] [Google Scholar]
  • 20.Eriksen EF, Buhl M, Frode K, et al. Treatment of cervical disc disease using Cloward's technique. The prognostic value of clinical preoperative data in 1106 patients. Acta Neurochir. 1984;70:181–197. doi: 10.1007/BF01406648. [DOI] [PubMed] [Google Scholar]
  • 21.Espersen JO, Buhl M, Eriksen EF, et al. Treatment of cervical disc disease using Cloward's technique. General results, effects of different operative methods and complications in 1106 patients. Acta Neurochir. 1984;70:97–114. doi: 10.1007/BF01406047. [DOI] [PubMed] [Google Scholar]
  • 22.Fager CA. Identification and management of radiculopathy. Neurosurg Clin N Am. 1993;4:1–12. [PubMed] [Google Scholar]
  • 23.Feinstein B, Langton JNK, Jameson RM, Schiller F. Experiments on pain referred from deep somatic tissues. J Bone Joint Surg [Am] 1954;36:981–997. [PubMed] [Google Scholar]
  • 24.Garfin SR, Rydevik B, Lind B, Massie J. Spinal nerve root compression. Spine. 1995;16:1810–1820. doi: 10.1097/00007632-199508150-00012. [DOI] [PubMed] [Google Scholar]
  • 25.Garvey TA, Eismont F. Diagnosis and treatment of cervical radiculopathy and myelopathy. Orthop Rev. 1991;20:595–603. [PubMed] [Google Scholar]
  • 26.Gore DR, Sepic SB, Gardner GM, Murray MP. Neck pain: a longterm follow-up of 205 patients. Spine. 1987;1:1–5. doi: 10.1097/00007632-198701000-00001. [DOI] [PubMed] [Google Scholar]
  • 27.Hadley MN, Sonntag VKH. Cervical disc herniations. The anterior approach to symptomatic interspace pathology. Neurosurg Clin North Am. 1993;1:45–52. [PubMed] [Google Scholar]
  • 28.Hamilton A, Balnave R, Adams R. Grip strength testing reliability. J Hand Ther. 1994;7:163–170. doi: 10.1016/s0894-1130(12)80058-5. [DOI] [PubMed] [Google Scholar]
  • 29.Henderson CM, Hennessy RG, Shuey HM, Shackelford EG. Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery. 1983;13:504–512. doi: 10.1227/00006123-198311000-00004. [DOI] [PubMed] [Google Scholar]
  • 30.Herkowitz HN, Kurz LT, Overholt DP. Surgical management of cervical soft disc hemiation. A comparison between the anterior and posterior approach. Spine. 1990;10:1026–1030. doi: 10.1097/00007632-199015100-00009. [DOI] [PubMed] [Google Scholar]
  • 31.Highland TR, Dreisinger TE, Vie LL, Russel GS. Changes in isometric strength and range of motion of the isolated cervical spine after eight weeks of clinical rehabilitation. Spine. 1992;6:77–82. doi: 10.1097/00007632-199206001-00003. [DOI] [PubMed] [Google Scholar]
  • 32.Huskisson EC. Measurement of pain. Lancet. 1974;7889:1127–1131. doi: 10.1016/s0140-6736(74)90884-8. [DOI] [PubMed] [Google Scholar]
  • 33.Huston GJ. Collars and corsets. BMJ. 1988;296:276. doi: 10.1136/bmj.296.6617.276. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Kendall HO, Kendall FP, Wadsworth GE. Muscles, testing and function. 2nd edn. Baltimore London: Williams and Wilkins; 1971. [Google Scholar]
  • 35.Krusen EM. Cervical pain syndromes. Arch Phys Med Rehabil. 1968;7:376–382. [PubMed] [Google Scholar]
  • 36.Lunsford LD, Bissonette DJ, Jannetta PJ, Sheptak PE, Zorub DS. Anterior surgery for cervical disc disease. 1. Treatment of lateral cervical disc hemiation in 253 cases. Neurosurgery. 1980;53:1–11. doi: 10.3171/jns.1980.53.1.0001. [DOI] [PubMed] [Google Scholar]
  • 37.MacDermid JC, Kramer JF, Woodbury MG, McFarlane RM, Roth JH. Interrater reliability of pinch and grip strength measurements in patients with cumulative trauma disorders. J Hand Ther. 1994;7:10–14. doi: 10.1016/s0894-1130(12)80035-4. [DOI] [PubMed] [Google Scholar]
  • 38.Mannerfelt L (1966) Studies on the band in ulnar nerve paralysis. A clinical-experimental investigation in normal and anomalous innervation. Acta Orthop Scand Suppl 87 [DOI] [PubMed]
  • 39.Marzo JM, Simmons EH, Kallen F. Intradural connections between adjacent cervical spinal roots. Spine. 1987;12:964–968. doi: 10.1097/00007632-198712000-00002. [DOI] [PubMed] [Google Scholar]
  • 40.Matsunaga S, Sakou T, Imamura T, Morimoto N. Dissociated motor loss in the upper extremities. Spine. 1993;4:1964–1967. doi: 10.1097/00007632-199310001-00007. [DOI] [PubMed] [Google Scholar]
  • 41.Monro P. What has surgery to offer in cervical spondylosis? In: Warlow C, Garfield JC, editors. Dilemmas in the management of neurological patients. Edinburgh: Churchill Livingstone; 1984. pp. 168–187. [Google Scholar]
  • 42.Murray MP, Gore DR, Gardner GM, Mollinger LA. Shoulder motion and muscle strength of normal men and women in two age groups. Clin Orthop. 1985;192:268–273. [PubMed] [Google Scholar]
  • 43.Naylor JR, Mulley GP. Surgical collar: a survey of their prescription and use. Br J Rheumatol. 1991;30:282–284. doi: 10.1093/rheumatology/30.4.282. [DOI] [PubMed] [Google Scholar]
  • 44.Nurick S. The natural history and the results of surgical treatment of the spinal cord disorders associated with cervical spondylosis. Brain. 1972;95:101–108. doi: 10.1093/brain/95.1.101. [DOI] [PubMed] [Google Scholar]
  • 45.Oberg T, Oberg U, Karsznia A. Handgrip and finger pinch strength. Physiother Theory Pract. 1994;10:27–34. [Google Scholar]
  • 46.Persson LC, Moritz U. Paindrawing: a quantitative and qualitative model for pain assessment in cervicobrachial pain syndrome. Pain Clin. 1994;1:13–22. [Google Scholar]
  • 47.Persson LC, Carlsson J, Carlsson C-A (1997) Long-lasting cervical radicular pain treated with surgery, physiotherapy or a cervical collar. A prospective randomised study. Spine 22(7) [DOI] [PubMed]
  • 48.Riddle DL, Finucane SD, Rothstein JM, Walker ML. Intrasession and intersession reliability of hand-held dynamometer measurements taken on brain- damaged patients. Phys Ther. 1989;69:182–194. doi: 10.1093/ptj/69.3.182. [DOI] [PubMed] [Google Scholar]
  • 49.Robinson RA, Walker AE, Ferlic DC, Wieckling DK. The results of anterior interbody fusion of the cervical spine. J Bone Joint Surg [Am] 1962;8:1569–1587. [Google Scholar]
  • 50.Rowland LP. Surgical treatment of cervical spondylotic myelopathy: time for a controlled trial. Neurology. 1992;42:5–13. doi: 10.1212/wnl.42.1.5. [DOI] [PubMed] [Google Scholar]
  • 51.Rydevik B, Brown MD, Lundborg G. Pathoanatomy and pathophysiology of nerve root compression. Spine. 1984;1:7–15. doi: 10.1097/00007632-198401000-00004. [DOI] [PubMed] [Google Scholar]
  • 52.Rydevik BL, Pedowitz RA, Hargens AR, Swenson MR, Myers RR, et al. Effects of acute, graded compression on spinal nerve root function and structure. An experimental study of pig cauda equina. Spine. 1991;16:487–493. doi: 10.1097/00007632-199105000-00001. [DOI] [PubMed] [Google Scholar]
  • 53.Samii M, Völkening D, Sephernia A, Penkert G, Baumann H. Surgical treatment of myeloradiculopathy in cervical spondylosis. A report on 438 operations. Neurosurg Rev. 1989;12:285–290. doi: 10.1007/BF01780841. [DOI] [PubMed] [Google Scholar]
  • 54.Simons FA. Cervical disc disease with radiculopathy. In: Rothman RH, Simione FA, editors. The spine. 3rd edn. Philadelphia: Saunders; 1992. pp. 553–559. [Google Scholar]
  • 55.Spijkerman DCM, Snijders CJ, Stijnen T, Lankhorst GJ. Standardization of grip strength measurements. Scand J Rehabil Med. 1991;23:203–206. [PubMed] [Google Scholar]
  • 56.Tan JC, Nordin M. Role of the physical therapy in treatment of cervical disc disease. Orthop Clin North Am. 1992;23:435–449. [PubMed] [Google Scholar]
  • 57.Thorngren K-G, Werner C-O. Normal grip strength. Acta Orthop Scand. 1979;50:255–259. doi: 10.3109/17453677908989765. [DOI] [PubMed] [Google Scholar]
  • 58.Travell JG, Simons DG. Myofascial pain and dysfunction. The trigger points manual. Baltimore: Williams and Wilkins; 1983. pp. 5–44. [Google Scholar]
  • 59.Viikari-Juntura E, Porr SM, Laasonen EM. Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine. 1989;14:253–257. doi: 10.1097/00007632-198903000-00003. [DOI] [PubMed] [Google Scholar]
  • 60.White AA, Southwick WO, Deponte RJ, Gainor JW, Hardy R. Relief of pain by anterior cervical spine fusion for spondylosis. J Bone Joint Surg [Am] 1973;55:525–534. [PubMed] [Google Scholar]
  • 61.Wlliams JL, Allen MB, Harkess JW. Late results of cervical discectomy and interbody fusion: some factors influencing the results. J Bone Joint Surg. 1968;2:277–286. doi: 10.2106/00004623-196850020-00006. [DOI] [PubMed] [Google Scholar]

Articles from European Spine Journal are provided here courtesy of Springer-Verlag

RESOURCES