Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial

Barbara Kuijper, Jos Th J Tans, Anita Beelen, Frans Nollet, Marianne de Visser, Barbara Kuijper, Jos Th J Tans, Anita Beelen, Frans Nollet, Marianne de Visser

Abstract

Objective: To evaluate the effectiveness of treatment with collar or physiotherapy compared with a wait and see policy in recent onset cervical radiculopathy.

Design: Randomised controlled trial.

Setting: Neurology outpatient clinics in three Dutch hospitals.

Participants: 205 patients with symptoms and signs of cervical radiculopathy of less than one month's duration

Interventions: Treatment with a semi-hard collar and taking rest for three to six weeks; 12 twice weekly sessions of physiotherapy and home exercises for six weeks; or continuation of daily activities as much as possible without specific treatment (control group).

Main outcome measures: Time course of changes in pain scores for arm and neck pain on a 100 mm visual analogue scale and in the neck disability index during the first six weeks.

Results: In the wait and see group, arm pain diminished by 3 mm/week on the visual analogue scale (beta=-3.1 mm, 95% confidence interval -4.0 to -2.2 mm) and by 19 mm in total over six weeks. Patients who were treated with cervical collar or physiotherapy achieved additional pain reduction (collar: beta=-1.9 mm, -3.3 to -0.5 mm; physiotherapy: beta=-1.9, -3.3 to -0.8), resulting in an extra pain reduction compared with the control group of 12 mm after six weeks. In the wait and see group, neck pain did not decrease significantly in the first six weeks (beta=-0.9 mm, -2.0 to 0.3). Treatment with the collar resulted in a weekly reduction on the visual analogue scale of 2.8 mm (-4.2 to -1.3), amounting to 17 mm in six weeks, whereas physiotherapy gave a weekly reduction of 2.4 mm (-3.9 to -0.8) resulting in a decrease of 14 mm after six weeks. Compared with a wait and see policy, the neck disability index showed a significant change with the use of the collar and rest (beta=-0.9 mm, -1.6 to -0.1) and a non-significant effect with physiotherapy and home exercises.

Conclusion: A semi-hard cervical collar and rest for three to six weeks or physiotherapy accompanied by home exercises for six weeks reduced neck and arm pain substantially compared with a wait and see policy in the early phase of cervical radiculopathy. Trial registration Clinical trials NCT00129714.

Conflict of interest statement

Competing interests: None declared.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787506/bin/kuib640888.f1_default.jpg
Fig 1 Flow of participants. *Patients who missed one follow-up but were still participating and attended next follow-up visits
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787506/bin/kuib640888.f2_default.jpg
Fig 2 Arm pain over time. VAS=visual analogue scale
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787506/bin/kuib640888.f3_default.jpg
Fig 3 Neck pain over time. VAS=visual analogue scale

References

    1. Kuijper B, Tans JTJ, Schimsheimer RJ, van der Kallen BFW, Beelen A, Nollet F, et al. Degenerative cervical radiculopathy: diagnosis and conservative treatment: a review. Eur J Neurol 2009;16:15-20.
    1. Adams C. Cervical spondylotic radiculopathy and myelopathy. In: Vinken PJ, Bruyn GW, eds. Handbook of clinical neurology. Vol 26. Elsevier Publishing Company, 1976:97-112.
    1. Bush K, Chaudhuri R, Hillier S, Penny J. The pathomorphologic changes that accompany the resolution of cervical radiculopathy: a prospective study with repeat magnetic resonance imaging. Spine 1997;22:183-6.
    1. Spurling RG, Segerberg LH. Lateral intervertebral disk lesions in the lower cervical region. JAMA 1953;151:354-9.
    1. Vinas FC, Wilner H, Rengachary S. The spontaneous resorption of herniated cervical discs. J Clin Neurosci 2001;8:542-6.
    1. Persson LC, Carlsson CA, Carlsson JY. Long-lasting cervical radicular pain managed with surgery, physiotherapy, or a cervical collar: a prospective, randomized study. Spine 1997;22:751-8.
    1. Pain in the neck and arm: a multicentre trial of the effects of physiotherapy, arranged by the British Association of Physical Medicine. BMJ 1966;1:253-8.
    1. Twisk JW. Applied longitudinal data analysis for epidemiology: a practical guide. Cambridge University Press, 2003.
    1. Medical Research Council of the United Kingdom. Aids to the examination of the peripheral nervous system. Pedragon House, 1978. (Memorandum No 45.)
    1. Vernon H, Mior S. The neck disability index: a study of reliability and validity. J Manipulative Physiol Ther 1991;14:409-15.
    1. McCarthy MJ, Grevitt MP, Silcocks P, Hobbs G. The reliability of the Vernon and Mior neck disability index, and its validity compared with the short form-36 health survey questionnaire. Eur Spine J 2007;16:2111-7.
    1. Kelly AM. Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? Acad Emerg Med 1998;5:1086-90.
    1. Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J 2001;18:205-7.
    1. Todd KH. Clinical versus statistical significance in the assessment of pain relief. Ann Emerg Med 1996;27:439-41.
    1. Todd KH, Funk KG, Funk JP, Bonacci R. Clinical significance of reported changes in pain severity. Ann Emerg Med 1996;27:485-9.
    1. Bird SB, Dickson EW. Clinically significant changes in pain along the visual analog scale. Ann Emerg Med 2001;38:639-43.
    1. Binder AI. Cervical spondylosis and neck pain. BMJ 2007;334:527-31.
    1. Radhakrishnan K, Litchy WJ, O’Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy: a population-based study from Rochester, Minnesota, 1976 through 1990. Brain 1994;117:325-35.
    1. Persson LC, Moritz U, Brandt L, Carlsson CA. Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar: a prospective, controlled study. Eur Spine J 1997;6:256-66.
    1. Mazanec D, Reddy A. Medical management of cervical spondylosis. Neurosurgery 2007;60(1 supp1 1):S43-50.
    1. Ellenberg MR, Honet JC, Treanor WJ. Cervical radiculopathy. Arch Phys Med Rehabil 1994;75:342-52.
    1. Polston DW. Cervical radiculopathy. Neurol Clin 2007;25:373-85.
    1. Naylor JR, Mulley GP. Surgical collars: a survey of their prescription and use. Br J Rheumatol 1991;30:282-4.
    1. Rosomoff HL, Fishbain D, Rosomoff RS. Chronic cervical pain: radiculopathy or brachialgia: noninterventional treatment. Spine 1992;17(10 suppl):S362-6.
    1. Heckmann JG, Lang CJ, Zobelein I, Laumer R, Druschky A, Neundorfer B. Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients. J Spinal Disord 1999;12:396-401.
    1. Nardin RA, Patel MR, Gudas TF, Rutkove SB, Raynor EM. Electromyography and magnetic resonance imaging in the evaluation of radiculopathy. Muscle Nerve 1999;22:151-5.
    1. Sengupta DK, Kirollos R, Findlay GF, Smith ET, Pearson JC, Pigott T. The value of MR imaging in differentiating between hard and soft cervical disc disease: a comparison with intraoperative findings. Eur Spine J 1999;8:199-204.

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