Radiculopathy arises when a nerve root is compressed or irritated, causing pain to radiate from the spine down affected limbs. Numbness or tingling may occur as well as muscle weakness or decreased reflexes. While it is considered relatively common, the prevalence varies according to age. Causal factors in radiculopathy include (among other things): a herniated disk, degenerative disk disease, spinal stenosis, spondylolisthesis and injury or trauma.
All in all, it’s not fun. In fact, it can be severe and disabling. Among the battery of therapeutic interventions that might be thrown at the condition are things like physical therapy, chiropractic care, other manual therapies, pharmacological interventions such as injections, or even surgical interventions such as nerve decompression in severe cases.
Given the common but significant-to-severe nature of the condition, much research has been thrown at the issue of radiculopathy. The current study looked specifically at cervical radiculopathy in patients with symptomatic cervical disk herniations. At the time of the report’s writing, some debate existed over best-practice conservative management of the condition. Pain medication, physical therapy, and lifestyle changes were considered par for the course. Spinal Manipulative Therapy was also a conservative treatment as were CNRI’s (cervical nerve root injections).
However, the latter came under fire due to “rare but extremely serious adverse events” in some patients. Hence, imaging-guided indirect CNRI approaches were developed. But larger trials hadn’t answered the question of which was more effective – spinal manipulative therapy or imaging-guided SNRI’s. This study took 104 participants, split them into an imaging-guided CNRI group and a spinal manipulative therapy group. They were matched according to age and sex, with the specific aim of comparing which treatment modality was more effective for cervical radiculopathy due to disk herniation.
Of course, you’re used to reading about chiropractic adjustments or chiropractic care from us. While usually, we would refer directly to this, as chiropractic-specific language is central to our focus on subluxation-based care, this particular study referred to it as spinal manipulative therapy. That said, the specific treatment used in the study was a high-velocity, low-amplitude manipulation delivered to the level of the disk herniation. They received 3-5 treatments per week for 2-4 weeks, and then 1-3 times per week after that as needed. It is noted in the paper that the goal was to produce “an audible release” and that no additional therapies were undertaken during the chiropractic sessions.
Meanwhile, the CNRI group received imaging-guided injections (one per participant) delivered under sterile conditions by musculoskeletal radiologists with experience in spinal interventions. A detailed protocol from a previously published paper was followed and injections were directed at the facet joint of the affected disk.
Interestingly, C6 and C7 were the most commonly affected spinal segments. The mean age was 44.6 (which represents a fairly typical presentation age for radiculopathy) with an age range of 24-66 years of age. Thirty-five per cent of the participants were female and the rest were male.
It’s important to note that, in this study, a result wasn’t counted as significant unless it was “Much better” or “better.”
This study returned decisive results. 86.5% of the spinal manipulative therapy (SMT) patients reported, “clinically relevant improvement at 3 months compared with 49.0% of CNRI patients.” Interestingly, there were some differences depending on whether the patient was acute or subacute/chronic. The two groups were comparable when it came to acute patients. But when evaluating the subacute/chronic patients alone, “78.3% of the SMT patients reported clinically relevant improvement at 3 months, compared with 37.5% of CNRI patients.”
While the study was matched, rather than blinded or controlled, and used a prospective cohort, it still presents a significant and convincing finding in favour of spinal manipulative therapy for cervical radiculopathy. There are certainly patient-specific considerations that need to be made, but all in all it is encouraging indeed.
Further research to look at the implications of care plans longer than 4 weeks would be beneficial, but as it stands, it’s a great finding indeed.
References:
Peterson, C., Pfirrman, C.., Hodler, J., Schmid, C., Anklin B., and Humphreys, K., (2016). Symptomatic, magnetic resonance imaging-confirmed cervical disk herniation patients: a comparative-effectiveness prospective observational study of 2 age- and sex-matched cohorts treated with either imaging-guided indirect cervical nerve root injections or spinal manipulative therapy. Journal of Manipulative and Physiological Therapeutics. Vol. 39, Iss. 3., P210-217, March 2016, DOI 10.1016/j.jmpt.2016.02.004.
