The pathomorphologic changes that accompany the resolution of cervical radiculopathy. A prospective study with repeat magnetic resonance imaging.

Abstract

A prospective study with independent clinical and radiologic review. To assess whether regression of cervical intervertebral disc herniations accompanied and correlated with clinical improvement in patients recovering from cervical radiculopathy without undergoing surgical intervention. The study subjects were 13 consecutive patients, nine men (69%) and four women (31%), presenting with cervical radiculopathy. All patients but one had objective neurologic signs. All patients had large posterolateral cervical intervertebral disc herniations demonstrated by magnetic resonance imaging. Pain was controlled by serial periradicular and epidural corticosteroid injections. Patients were finally examined and discharged from care because of sustained pain control at an average of 6 months (range, 2-12 months). They were interviewed subsequently over the telephone by an independent clinician and rescanned at an average of 12 months (range, 4-31 months). The scans were reviewed by an independent radiologist masked to the sequence of the scans. Regression of cervical disc herniations was demonstrated in 12 of the 13 patients. All patients had made a satisfactory clinical recovery, but the one with the herniation that had not regressed suffered from persistent minor symptoms. Most cervical disc herniations regress with time and without the need for surgical resection. Thus, surgical intervention can be avoided with adequate pain control, allowing the herniation time to regress.