Herniated cervical intervertebral discs with radiculopathy: An outcome study of conservatively or surgically treated patients

To study the functional outcomes of patients with cervical herniated interv ertebral discs with radiculopathy but without signs of cervical myelopathy using a retrospective cohort study design. The patients were retrospectivel y identified by chart reviews. Inclusion criteria were (a) cervical radicul opathy with defined neurological disturbances (sensory disorder, reflex abn ormalities, and motor weakness); (b) a spinal computed tomograph scan or ma gnetic resonance image demonstrating neuroradiologic abnormalities (soft or hard disc); and (c) completion of conservative physical and pharmacologica l treatment. Of 119 consecutive patients who were treated at the Department s of Neurology and Neurosurgery, University of Erlangen-Nuremberg, between January 1, 1985, and December 31, 1995, 60 patients met the inclusion crite ria and were prospectively assessed, with an average: follow-up time of 5.5 years. The patients were interviewed with regard to their daily activities , ability to work, and the surgical treatment they had undergone. A complet e neurological examination also was performed. In 88.3%, the onset of disea se was acute and in 11.7% subacute or chronic. The most common signs and sy mptoms were brachialgia (98.3%), neck pain (93.3%), sensory disorders (88.3 %), reflex abnormalities (61.7%), and motor weakness (51.7%). The neuroimag ing procedures demonstrated a disc prolapse (soft disc) in approximately 90 % and spondylotic osteophytes Chard disc) in approximately 10%. During an a verage follow-up time of 5.5 years (range, 4.6 months-10.6 years) 39 (65%) patients had been treated using only conservative methods (COG = conservati vely treated group), and 21 (35%) patients had undergone surgery (ventral d iscectomy) (SUG = surgically treated group). Brachialgia was completely or essentially improved in 100% of the COG and 95.1% of the SUG. Sensory disor ders remitted completely or markedly in 97% of the COG and 75% of the SUG. The reflex abnormalities normalized or improved in 59.2% of the COG and in 53.3% of the SUG. Motor weakness improved in 94.1% of the COG and in 50% of the SUG. Neck pain was difficult to treat. It improved in only 36.1% of th e COG and in 20% of the SUG. Occupational capacity was lost in 10% of the C OG and in 38.9% of the SUG. In a self-rating scale, 89.7% of patients in th e COG did not feel disabled in their everyday activities, compared with 66. 7% of the patients in the SUG. Patients with a herniated cervical intervert ebral disc with radiculopathy can be treated conservatively with good resul ts, although a residual intermittent neck pain syndrome often persists. The patients in the SUG, who initially showed more severe and long-lasting neu rological disturbances, were improved at the time of examination, although with more marked residual disorders. Surgery is indicated only when appropr iate conservative treatment for a reasonable time has failed.