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