Recent ontstane cervicale radiculopathie: minder pijn met halskraag of fysiotherapie*

Objective

To compare the effectiveness of 3 non-surgical treatment strategies in patients with recent-onset cervical radiculopathy.

Design

Randomised controlled trial.

Method

205 outpatients with less than 1 month of symptoms and signs of cervical radiculopathy were treated with a semi-hard cervical collar and as much rest as possible for 3-6 weeks, or 12 two-weekly sessions of physiotherapy and home exercises for 6 weeks, or a continuation of daily activities as much as possible without specific treatment (wait-and-see; control treatment). The primary outcome measures were changes in the scores for arm and neck pain on a 100 mm visual analogue scale (VAS) and of the Neck Disability Index (NDI) during the first 6 weeks. Differences in trends between the treatment groups were analysed using generalised estimating equations.

Results

In the control group arm pain diminished 3 mm per week on the VAS (19 mm in 6 weeks). Additional pain reduction was achieved with the cervical collar and with physiotherapy: extra reduction of 12 mm in arm pain in 6 weeks compared to the control treatment. In the control group, neck pain did not significantly decrease. Treatment with the cervical collar resulted in a reduction of 2.8 mm per week on the VAS (17 mm in 6 weeks), whereas physiotherapy gave a reduction of 2.4 mm per week (14 mm in 6 weeks). Compared to the control treatment, only treatment with the cervical collar resulted in a significant improvement to the NDI.

Conclusion

For patients with a recent onset cervical radiculopathy, both treatment with a semi-hard cervical collar and physiotherapy led to a substantial reduction in neck and arm pain in the first 6 weeks compared to a wait-and-see policy.