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A greater than 75% chance of complete resolution of symptoms
91%
4880/5347
Persistence of symptoms until an appropriate physical therapy regimen is prescribed
2%
88/5347
Persistence of symptoms until surgical intervention is performed
127/5347
A step-wise deterioration of neurologic function until surgery is performed
4%
197/5347
Rapid progression of symptoms with high risk of permanent loss of bowel and bladder function
0%
12/5347
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This patient is presenting with symptoms of cervical radiculopathy, which has reported rates of resolution following non-operative management of greater than 75%. Cervical radiculopathy is a common cause of neck pain. It is often unilateral pain that radiates into the ipsilateral arm in a distribution consistent with the nerve root being compressed. It can be exacerbated with the Spurling Test, or maximal extension and ipsilateral rotation of the neck. The natural history of cervical radiculopathy is generally favorable with 75% or greater rates of resolution reported with various non-operative treatments (pain medication, traction, physical therapy, soft collar immobilization, etc.). For patients with progressive neurologic symptoms or for those who fail extensive non-operative therapies, surgery can provide consistently excellent outcomes. Rhee et al. review current literature regarding cervical radiculopathy. They comment that no specific non-operative treatment has been proven in the literature to be superior to others, and none have proven to change the natural history itself. They state that these treatments simply help control symptoms as they progress to resolution. Rao et al. provide a review of neck pain including cervical radiculopathy. They describe the favorable natural history noting radiculopathy should first be treated non-operatively. However, if non-operative treatment fails to provide relief, either anterior cervical discectomy and fusion (ACDF) or laminotomy/foraminotomy can be performed with typically excellent outcomes. Figure A is an axial MR image demonstrating a left sided cervical disc herniation. Illustration A is an illustration showing a Spurling Test. If this test reproduces the radiating pain experienced by the patient it is considered positive for cervical radiculopathy. Incorrect answers: Answer 2: Physical therapy is potential non-operative treatment for this patient and may be prescribed, but symptoms would not be expected to persist at a greater rate if therapy is not utilized. Answer 3: The natural history of cervical radiculopathy is favorable and symptoms frequently resolve without surgical intervention. Answer 4: This describes the natural history of cervical myelopathy, which has a less favorable natural history and requires surgical treatment. Answer 5: This describes cauda equina syndrome, which this patient is not experiencing.
4.4
(7)
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