| Let's suppose that you have been diagnosed as | | | | removing fragments of protruding discs and spurs |
| having a pinched nerve in your neck, also known as | | | | through an incision in the front of the neck, and then |
| cervical radiculopathy. If so, you probably have pain in | | | | fusing two neck-bones together by means of a |
| the neck and one shoulder. The pain might radiate | | | | bone-graft. Physical therapy involved 15 sessions over |
| into your arm and you might have weakness or | | | | a span of three months and consisted of whatever |
| numbness in the arm as well. Moving your neck in | | | | the physical therapist considered appropriate, |
| certain positions probably worsens the pain.If you're a | | | | variously including any of the following: heat |
| younger adult, the pinch could be due to a herniated | | | | application, cold application, electrical stimulation, |
| (slipped) disc. Discs are the soft spacers that | | | | ultrasound, massage, manipulation, exercise and |
| separate each pair of stacked neck-bones | | | | education. In the cervical collar group, patients wore |
| (vertebrae). If you're an older adult, the pinch is more | | | | rigid, shoulder-resting collars every day for three |
| likely due to a bony spur (spondylosis). In either case, | | | | months. Additionally, some of the subjects wore soft |
| you're in good company. A survey in Sicily showed | | | | collars overnight.How did the study turn out? Three |
| that at any one time there were 3.5 active cases of | | | | of the subjects who were assigned to surgery |
| cervical radiculopathy per population of 100,000. In | | | | refused the procedure because they had already |
| Rochester, Minnesota, another survey showed 85 | | | | improved on their own. For statistical purposes their |
| new cases each year of cervical radiculopathy per | | | | outcomes were included with those who actually |
| population of 100,000.Let's say that your doctor has | | | | received the operation. After three months the |
| evaluated you thoroughly by taking a history of your | | | | surgery and physical therapy groups reported, on |
| symptoms and performing a physical examination. | | | | average, less pain. After an additional 12 months |
| Perhaps with the additional help of an MRI of your | | | | patients in all three groups had less pain than at the |
| cervical spine (neck) and electrical tests of nerve and | | | | beginning of the study and the outcomes of each |
| muscle function (nerve conduction studies and | | | | treatment were statistically alike. Measurements of |
| electromyography) the diagnosis of cervical | | | | mood and overall function following treatment were |
| radiculopathy is deemed definite. Furthermore, there | | | | likewise equal among the groups.So, over the long |
| is no sign that the spinal cord itself is pinched. Now | | | | haul, no treatment was better than the others. Of |
| what?Now what, indeed. Choosing a treatment for | | | | course, within each group some patients did better or |
| this condition is far from straightforward. Out of | | | | worse than others and this spread of outcomes was |
| hundreds of published medical reports concerning | | | | not reflected in the overall averages. In fact, five |
| treatment of cervical radiculopathy, most are case | | | | patients in the collar group and one patient in the |
| reports or case series. A "case series" translates | | | | physical therapy group went on to receive surgery |
| roughly as: "We gave six patients in a row the same | | | | owing to lack of satisfactory improvement. In |
| treatment and five of them got better." What can | | | | addition, eight patients in the surgery group |
| be concluded from a study of this kind? Did the | | | | underwent a second operation that in one case was |
| treatment make the patients better or would they | | | | due to a complication of the first operation.With this |
| have improved anyway? We don't know.The missing | | | | Swedish study representing the only rigorous |
| ingredient here is a comparison group of untreated or | | | | investigation of treatment outcomes in cervical |
| differently treated individuals known as a control | | | | radiculopathy, there are a number of unanswered |
| group. The other mark of a quality study is that the | | | | questions. For example, what are the effects on |
| chosen treatment is randomized, meaning that the | | | | cervical radiculopathy of painkillers, anti-inflammatory |
| research subjects agreed in advance to be assigned | | | | drugs, local injections, systematic traction or other |
| to one treatment group or another based on the | | | | forms of surgery? We don't know. What happens if |
| equivalent of a coin-toss. So out of the hundreds of | | | | there is no treatment whatsoever? We don't know |
| published studies involving treatment of this common | | | | the answer to that question either.Thus, in the care |
| condition, how many were randomized controlled | | | | of individual patients there is a yin-yang balancing act |
| trials? Unfortunately, the answer is just one.Liselott | | | | between the medical edict of "Above all, do no harm" |
| Persson, Carl-Axel Carlsson and Jane Carlsson at the | | | | and the practical dictum of "Do what you have to |
| University Hospital of Lund, Sweden, randomly | | | | do." This balancing act usually means starting with less |
| allocated 81 patients who had symptoms of cervical | | | | intrusive treatments like drugs and physical therapy. |
| radiculopathy present for at least three months to | | | | If symptoms fail to improve or become unbearable, |
| any of three treatments -- surgery, physical therapy | | | | an operation may be helpful.(C) 2006 by Gary |
| or a cervical collar. The patients ranged from 28 to | | | | CordingleyGary Cordingley, MD, PhD, is a clinical |
| 64 years old and 54% of them were male. The | | | | neurologist, teacher and researcher who works in |
| surgeons used the so-called Cloward procedure, | | | | Athens, Ohio. |