Biological, Mechanical or Physical? Conservative Treatment of Cervical Radiculopathy

Abstract

Background. There is equivocal evidence in support of the effectiveness of each of the three co-existing approaches to conservative treatment of cervical radiculopathy (CR): biological (regenerative), mechanical (decompression) and physical (analgesic and anti-inflammatory). The aim of the study was to compare the effectiveness of the three treatment approaches in CR. Material and methods. A total of 90 patients were assigned to six treatment groups. Biological treatment: 4 ultra­sound-guided periradicular injections of ACS or PRP (1 per week); Mechanical treatment: manual therapy (MT) or traction therapy (TT) - 8 ses­sions (two per week); Physical treatment: laser therapy (LT) or collagen magnetophoresis (CM) - 8 sessions (two per week). As­sessment: before therapy (W0), after completion of the treatment (W1), two months after completion (W2). Assessment tools: NRS (0-10), NDI (0-50), cross section root area in mm2 in ultrasound examination (CRA) and hand sensorimotor function test (DPT). Results. The largest reduction in mean NRS, NDI and CRA values at W2 was observed with the biological treatments (NRS: ACS 71.7%, PRP 70.6%, NDI: ACS 61.5%, PRP 56.6%, CRA: ACS 23.6 %, PRP 25%). Improvement of hand sensorimotor functions was observed at both W1 and W2 only in the PRP group. The PRP group demonstrated a stronger analgesic effect than the ACS group at W1 (58.82% compared to 43.39%), but ACS therapy had the same effectiveness during the follow-up period. Other methods reduced pain and disability at W1, but further reduction of mean NRS values during the follow-up period was only evident in the CM group (32.25%), very mild in the MM (19.35%) and LT groups (18.75%), and the TT group actually demonstrated a regression (-5.58%). In 3 cases, TT exacerbated the symptoms, which resulted in termination of the therapy. Conclusions. 1. Biological treatments were more effective than mechanical and physical therapies in reducing pain, im­proving the disability index and proprioception of the hand both immediately on completion of therapy and after a follow-up period, which may suggest their regenerative properties. 2. Physical and mechanical therapies produced improvement in the above-mentioned indicators on completion of the therapy, but subsequently exerted a very slight effect during the follow-up period without evident regenerative effects; moreover, a regression of the results was actually recorded for traction therapy. 3. Caution should be paid when using traction therapy in the acute period of root oedema, due to possible signs of intolerance of the procedure and exacerbation of the discomfort.

Combination of Cervical Traction with Transcutaneous Electrical Nerve Stimulation on Patient with Cervical Radiculopathy:A Case Report

“…includes deep neck flexors strengthening, cervical collars and a postural correction to maintain the muscle strength and for maintaining the integrity of the widened intervertebral foramen (12)(13). The use of cervical traction is useful as it helps in opening of the intervertebral foramen space, and reduces the pressure over the intervertebral disc.…”