Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Cervical Radiculopathy due to Cervical Degenerative Diseases : Anatomy, Diagnosis and Treatment

  • Kim, Kyoung-Tae (Department of Neurosurgery, College of Medicine, Chung-Ang University) ;
  • Kim, Young-Baeg (Department of Neurosurgery, College of Medicine, Chung-Ang University)
  • Received : 2010.07.01
  • Accepted : 2010.12.21
  • Published : 2010.12.28
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Abstract

A cervical radiculopathy is the most common symptom of cervical degenerative disease and its natural course is generally favorable. With a precise diagnosis using appropriate tools, the majority of patients will respond well to conservative treatment. Cervical radiculopathy with persistent radicular pain after conservative treatment and progressive or profound motor weakness may require surgery. Options for surgical management are extensive. Each technique has strengths and weaknesses, so the choice will depend on the patient's clinical profile and the surgeon's judgment.

Keywords

References

  1. Anderberg L, Annertz M, Brandt L, Saveland H : Selective diagnostic cervical nerve root block--correlation with clinical symptoms and mripathology. Acta Neurochir (Wien) 146 : 559-565; discussion 565, 2004 https://doi.org/10.1007/s00701-004-0241-4
  2. Anderberg L, Annertz M, Rydholm U, Brandt L, Saveland H : Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine. Eur Spine J 15 : 794-801, 2006 https://doi.org/10.1007/s00586-005-0931-5
  3. Anderson PA, Sasso RC, Riew KD : Update on cervical artificial disk replacement. Instr Course Lect 56 : 237-245, 2007
  4. Beaurain J, Bernard P, Dufour T, Fuentes JM, Hovorka I, Huppert J, et al. : Intermediate clinical and radiological results of cervical tdr (mobi-c) with up to 2 years of follow-up. Eur Spine J 18 : 841-850, 2009 https://doi.org/10.1007/s00586-009-1017-6
  5. Benini A : Clinical features of cervical root compression c5-8 and their variations. 1987
  6. Bertagnoli R, Duggal N, Pickett GE, Wigfield CC, Gill SS, Karg A, et al. : Cervical total disc replacement, part two : clinical results. Orthop Clin North Am 36 : 355-362, 2005 https://doi.org/10.1016/j.ocl.2005.02.009
  7. Bush K, Hillier S : Outcome of cervical radiculopathy treated with periradicular/epidural corticosteroid injections : a prospective study with independent clinical review. Eur Spine J 5 : 319-325, 1996 https://doi.org/10.1007/BF00304347
  8. Dillin W, Booth R, Cuckler J, Balderston R, Simeone F, Rothman R : Cervical radiculopathy. A review. Spine (Phila Pa 1976) 11 : 988-991, 1986 https://doi.org/10.1097/00007632-198612000-00003
  9. Ferrante FM, Wilson SP, Iacobo C, Orav EJ, Rocco AG, Lipson S : Clinical classification as a predictor of therapeutic outcome after cervical epidural steroid injection. Spine (Phila Pa 1976) 18 : 730-736, 1993 https://doi.org/10.1097/00007632-199305000-00010
  10. Gaetani P, Tancioni F, Spanu G, Rodriguez Y, Baena R : Anterior cervical discectomy : An analysis on clinical long-term results in 153 cases. J Neurosurg Sci 39 : 211-218, 1995
  11. Gala VC, O'Toole JE, Voyadzis JM, Fessler RG : Posterior minimally invasive approaches for the cervical spine. Orthop Clin North Am 38 : 339-349; abstract v, 2007 https://doi.org/10.1016/j.ocl.2007.02.009
  12. Goffin J, Geusens E, Vantomme N, Quintens E, Waerzeggers Y, Depreitere B, et al. : Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech 17 : 79-85, 2004 https://doi.org/10.1097/00024720-200404000-00001
  13. Graham N, Gross AR, Goldsmith C : Mechanical traction for mechanical neck disorders : A systematic review. J Rehabil Med 38 : 145-152, 2006 https://doi.org/10.1080/16501970600583029
  14. Gunnarsson R, Lundgren G, Magnusson G, Ost L, Groth CG : Steroid diabetes--a sign of overtreatment with steroids in the renal graft recipient? Scand J Urol Nephrol Suppl 54 : 135-138, 1980
  15. Hacker RJ, Miller CG : Failed anterior cervical foraminotomy. J Neurosurg 98 : 126-130, 2003
  16. Hadjipavlou AG, Tzermiadianos MN, Bogduk N, Zindrick MR : The pathophysiology of disc degeneration : a critical review. J Bone Joint Surg Br 90 : 1261-1270, 2008 https://doi.org/10.1302/0301-620X.90B10.20910
  17. Heidecke V, Rainov NG, Marx T, Burkert W : Outcome in cloward anterior fusion for degenerative cervical spinal disease. Acta Neurochir (Wien) 142 : 283-291, 2000 https://doi.org/10.1007/s007010050037
  18. Hilibrand AS, Robbins M : Adjacent segment degeneration and adjacent segment disease : the consequences of spinal fusion? Spine J 4 : 190S-194S, 2004 https://doi.org/10.1016/j.spinee.2004.07.007
  19. Honet JC, Puri K : Cervical radiculitis : treatment and results in 82 patients. Arch Phys Med Rehabil 57 : 12-16, 1976
  20. Isaia GC, Pellissetto C, Ravazzoli M, Tamone C : Acute adrenal crisis and hypercalcemia in a patient assuming high liquorice doses. Minerva Med 99 : 91-94, 2008
  21. Ishihara H, Kanamori M, Kawaguchi Y, Nakamura H, Kimura T : Adjacent segment disease after anterior cervical interbody fusion. Spine J 4 : 624-628, 2004 https://doi.org/10.1016/j.spinee.2004.04.011
  22. Jho HD: Microsurgical anterior cervical foraminotomy for radiculopathy : A new approach to cervical disc herniation. J Neurosurg 84 : 155- 160, 1996 https://doi.org/10.3171/jns.1996.84.2.0155
  23. Jho HD, Kim WK, Kim MH : Anterior microforaminotomy for treatment of cervical radiculopathy : Part 1--disc-preserving "Functional cervical disc surgery". Neurosurgery 51 : S46-S53, 2002
  24. Jodicke A, Daentzer D, Kastner S, Asamoto S, Boker DK : Risk factors for outcome and complications of dorsal foraminotomy in cervical disc herniation. Surg Neurol 60 : 124-129; discussion 129-130, 2003 https://doi.org/10.1016/S0090-3019(03)00267-2
  25. Johnson JP, Filler AG, McBride DQ, Batzdorf U : Anterior cervical foraminotomy for unilateral radicular disease. Spine (Phila Pa 1976) 25 : 905-909, 2000 https://doi.org/10.1097/00007632-200004150-00002
  26. Kadanka Z, Bednarik J, Vohanka S, Vlach O, Stejskal L, Chaloupka R, et al. : Conservative treatment versus surgery in spondylotic cervical myelopathy : a prospective randomised study. Eur Spine J 9 : 538-544, 2000 https://doi.org/10.1007/s005860000132
  27. Kaiser JA, Holland BA : Imaging of the cervical spine. Spine (Phila Pa 1976) 23 : 2701-2712, 1998 https://doi.org/10.1097/00007632-199812150-00009
  28. Kim HK, Kim MH, Cho DS, Kim SH : Surgical outcome of cervical arthroplasty using bryan(r). J Korean Neurosurg Soc 46 : 532-537, 2009 https://doi.org/10.3340/jkns.2009.46.6.532
  29. Kim KT, Kim YB : Comparison between open procedure and tubular retractor assisted procedure for cervical radiculopathy : results of a randomized controlled study. J Korean Med Sci 24 : 649-653, 2009 https://doi.org/10.3346/jkms.2009.24.4.649
  30. Korinth MC, Kruger A, Oertel MF, Gilsbach JM : Posterior foraminotomy or anterior discectomy with polymethyl methacrylate interbody stabilization for cervical soft disc disease : Results in 292 patients with monoradiculopathy. Spine (Phila Pa 1976) 31 : 1207-1214; discussion 1215-1216, 2006 https://doi.org/10.1097/01.brs.0000217604.02663.59
  31. Kozak JA, Hanson GW, Rose JR, Trettin DM, Tullos HS : Anterior discectomy, microscopic decompression, and fusion : a treatment for cervical spondylotic radiculopathy. J Spinal Disord 2 : 43-46, 1989
  32. Krupp W, Schattke H, Muke R : Clinical results of the foraminotomy as described by frykholm for the treatment of lateral cervical disc herniation. Acta Neurochir (Wien) 107 : 22-29, 1990 https://doi.org/10.1007/BF01402608
  33. Kumar N, Gowda V : Cervical foraminal selective nerve root block : a 'two-needle technique' with results. Eur Spine J 17 : 576-584, 2008 https://doi.org/10.1007/s00586-008-0600-6
  34. Lees F, Turner JW : Natural history and prognosis of cervical spondylosis. Br Med J 2 : 1607-1610, 1963 https://doi.org/10.1136/bmj.2.5373.1607
  35. Lestini WF, Wiesel SW : The pathogenesis of cervical spondylosis. Clin Orthop Relat Res : 69-93, 1989
  36. Mazziotti G, Angeli A, Bilezikian JP, Canalis E, Giustina A : Glucocorticoid- induced osteoporosis: An update. Trends Endocrinol Metab 17 : 144-149, 2006 https://doi.org/10.1016/j.tem.2006.03.009
  37. Mehren C, Suchomel P, Grochulla F, Barsa P, Sourkova P, Hradil J, et al. : Heterotopic ossification in total cervical artificial disc replacement. Spine (Phila Pa 1976) 31 : 2802-2806, 2006 https://doi.org/10.1097/01.brs.0000245852.70594.d5
  38. Modic MT, Masaryk TJ, Ross JS, Mulopulos GP, Bundschuh CV, Bohlman H : Cervical radiculopathy: Value of oblique MR imaging. Radiology 163 : 227-231, 1987 https://doi.org/10.1148/radiology.163.1.3823440
  39. Nandoe Tewarie RD, Bartels RH, Peul WC : Long-term outcome after anterior cervical discectomy without fusion. Eur Spine J 16 : 1411-1416, 2007 https://doi.org/10.1007/s00586-007-0309-y
  40. Naroji S HA, Harrop J : Cervical radiculopathy in : Shen FH (ed) : Arthritis and arthroplasty, the spine. Philadelphia : Saunders, 2010, pp43-48
  41. Park JH, Roh KH, Cho JY, Ra YS, Rhim SC, Noh SW : Comparative analysis of cervical arthroplasty using mobi-c(r) and anterior cervical discectomy and fusion using the solis(r)-cage. J Korean Neurosurg Soc 44 : 217-221, 2008 https://doi.org/10.3340/jkns.2008.44.4.217
  42. Pickett GE, Sekhon LH, Sears WR, Duggal N : Complications with cervical arthroplasty. J Neurosurg Spine 4 : 98-105, 2006 https://doi.org/10.3171/spi.2006.4.2.98
  43. Prestone DC SB : Chapter 29 radiculopathy, ed 2. Philadelphia : Elsevier, 2005
  44. Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT : Epidemiology of cervical radiculopathy. A population-based study from rochester, minnesota, 1976 through 1990. Brain 117 ( Pt 2) : 325-335, 1994 https://doi.org/10.1093/brain/117.2.325
  45. Reitman CA, Hipp JA, Nguyen L, Esses SI : Changes in segmental intervertebral motion adjacent to cervical arthrodesis : a prospective study. Spine (Phila Pa 1976) 29 : E221-E226, 2004 https://doi.org/10.1097/00007632-200406010-00022
  46. Ritter MA, Vaughan RB : Ectopic ossification after total hip arthroplasty. Predisposing factors, frequency, and effect on results. J Bone Joint Surg Am 59 : 345-351, 1977 https://doi.org/10.2106/00004623-197759030-00009
  47. Ross JS, Ruggieri PM, Glicklich M, Obuchowski N, Dillinger J, Masaryk TJ, et al. : 3D MRI of the cervical spine : Low flip angle fisp vs. Gd-dtpa turboflash in degenerative disk disease. J Comput Assist Tomogr 17 : 26-33, 1993 https://doi.org/10.1097/00004728-199301000-00004
  48. Russell SM, Benjamin V : Posterior surgical approach to the cervical neural foramen for intervertebral disc disease. Neurosurgery 54 : 662- 665; discussion 665-666, 2004 https://doi.org/10.1227/01.NEU.0000108781.07294.13
  49. Saal JS, Saal JA, Yurth EF : Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine (Phila Pa 1976) 21 : 1877-1883, 1996 https://doi.org/10.1097/00007632-199608150-00008
  50. Shim JH, Park CK, Lee JH, Choi JW, Lee DC, Kim DH, et al. : A comparison of angled sagittal mri and conventional mri in the diagnosis of herniated disc and stenosis in the cervical foramen. Eur Spine J 18 : 1109-1116, 2009 https://doi.org/10.1007/s00586-009-0932-x
  51. Stabler A, Eck J, Penning R, Milz SP, Bartl R, Resnick D, et al. : Cervical spine : Postmortem assessment of accident injuries--comparison of radiographic, mr imaging, anatomic, and pathologic findings. Radiology 221 : 340-346, 2001 https://doi.org/10.1148/radiol.2212010336
  52. Storm PB, Chou D, Tamargo RJ : Surgical management of cervical and lumbosacral radiculopathies: Indications and outcomes. Phys Med Rehabil Clin N Am 13 : 735-759, 2002 https://doi.org/10.1016/S1047-9651(02)00014-1
  53. Su CS, Lan MY, Chang YY, Lin WC, Liu KT : Clinical features, neuroimaging and treatment of spontaneous intracranial hypotension and magnetic resonance imaging evidence of blind epidural blood patch. Eur Neurol 61 : 301-307, 2009 https://doi.org/10.1159/000206856
  54. van Akkerveeken PF : The diagnostic value of nerve root sheath infiltration. Acta Orthop Scand Suppl 251 : 61-63, 1993
  55. Van de Kelft E, van Vyve M : Diagnostic imaging algorithm for cervical soft disc herniation. J Neurol Neurosurg Psychiatry 57 : 724-728, 1994 https://doi.org/10.1136/jnnp.57.6.724
  56. van der Heijden GJ, Beurskens AJ, Koes BW, Assendelft WJ, de Vet HC, Bouter LM : The efficacy of traction for back and neck pain : a systematic, blinded review of randomized clinical trial methods. Phys Ther 75 : 93-104, 1995 https://doi.org/10.1093/ptj/75.2.93
  57. Van Zundert J, Huntoon MA, van Kleef M : Complications of transforaminal cervical epidural steroid injections. Spine (Phila Pa 1976) 34 : 2477; author reply 2478, 2009 https://doi.org/10.1097/BRS.0b013e3181b96f08
  58. White BD BN, Fitzgerald JJ : Anterior cervical foraminotomy for cervical radiculopathy. Br J Neurosurg 21 : 370-374, 2007 https://doi.org/10.1080/02688690701441340
  59. Yi S, Lee DY, Ahn PG, Kim KN, Yoon do H, Shin HC : Radiologi-cally documented adjacent-segment degeneration after cervical arthroplasty : Characteristics and review of cases. Surg Neurol 72 : 325-329; discussion 329, 2009 https://doi.org/10.1016/j.surneu.2009.02.013
  60. Yi S, Lim JH, Choi KS, Sheen YC, Park HK, Jang IT, et al. : Comparison of anterior cervical foraminotomy vs arthroplasty for unilateral cervical radiculopathy. Surg Neurol 71 : 677-680, discussion 680, 2009 https://doi.org/10.1016/j.surneu.2008.06.017
  61. Yoon DH, Yi S, Shin HC, Kim KN, Kim SH : Clinical and radiological results following cervical arthroplasty. Acta Neurochir (Wien) 148 : 943-950, 2006 https://doi.org/10.1007/s00701-006-0805-6

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