Professor Martin Underwood, MD
Does treatment with a cervical collar or physiotherapy reduce pain and improve function faster than a wait-and-see policy in cervical radiculopathy?
Randomized controlled trial. ClinicalTrials.gov NCT00129714.
Neurology outpatient clinics in 3 Dutch hospitals.
205 patients 18 to 75 years of age (mean age 47 y, 51% men) who had cervical radiculopathy with symptoms for ≤ 1 month, arm pain radiating distal to the elbow and rated ≥ 40 mm on a visual analogue scale (VAS), and ≥ 1 of the following: arm pain provoked by neck movements, sensory changes in ≥ 1 adjacent dermatome, muscle weakness in ≥ 1 adjacent myotome, and reduced deep tendon reflexes in the affected arm. Exclusion criteria included spinal cord compression and past treatment with physiotherapy or a cervical collar.
69 patients were allocated to wear semi-hard cervical collars during the day for 3 weeks and to rest as much as possible; patients were weaned off collar use over the following 3 weeks. 70 patients were allocated to twice-weekly physiotherapy and daily home exercises for 6 weeks. Physiotherapy focused on mobilizing and stabilizing the cervical spine using graded-activity exercises. 66 patients were allocated to a wait group.
Included neck and arm pain (100 mm VAS, 0 = no pain, 100 = worst pain ever) and disability (100-point neck disability index, higher scores = poorer function).
At 6 weeks, semi-hard cervical collars and physiotherapy each reduced arm pain and neck pain more than a wait approach, and semi-hard cervical collars reduced neck disability more than a wait approach (Table). Groups did not differ for arm pain (P = 0.93), neck pain (P = 0.68), or neck disability (P = 0.67) at 6 months.
In patients with cervical radiculopathy, a semi-hard cervical collar or physiotherapy reduced pain more than a wait-and-see approach at 6 weeks but not at 6 months.
Semi-hard cervical collar (CC) or physiotherapy (PT) vs wait-and-see approach (WS) for cervical radiculopathy‡
‡NDI = neck disability index; other abbreviations defined in Glossary.
§Visual analogue scale; range 0 mm = no pain to 100 mm = worst pain ever.
||100-point scale (confirmed by author); higher scores = poorer functional status.
Underwood PM. A cervical collar or physiotherapy was better than a wait-and-see policy for early pain relief in cervical radiculopathy. Ann Intern Med. ;152:JC2–9. doi: 10.7326/0003-4819-152-4-201002160-02009
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Published: Ann Intern Med. 2010;152(4):JC2-9.
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