Zervikale Radikulopathie^[*]

Zusammenfassung

Hintergrund Die zervikale Radikulopathie (ZR) ist ein relativ häufiges Krankheitsbild, welches in sehr vielen Bereichen der Medizin vorkommt und einen interdisziplinären Behandlungsansatz erfordert. Obwohl das Leitsymptom der Schmerz ist, weist die ZR einige Besonderheiten auf, denen die Deutsche Gesellschaft für Neurologie in einer eigenen Leitlinie Rechnung trägt. Das wesentliche Ziel dieser Leitlinie war es, den aktuellen Wissensstand zur Therapie der ZR zu vermitteln. Die vorliegende Leitlinie bezieht sich ausschließlich auf die degenerativ bedingten ZR.

Methodik Der Leitlinie liegt eine Recherche von Leitliniendatenbanken und Medline zugrunde. Unter der Moderation durch die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) erfolgte die Konsensfindung mittels eines nominalen Gruppenprozesses und des Delphi-Verfahrens. Aufgrund des interdisziplinären Behandlungsansatzes wurde das Leitliniengremium aus Experten verschiedener ärztlicher (Neurologie, Orthopädie, Unfallchirurgie, Neurochirurgie, Schmerztherapie, Physikalische und Rehabilitative Medizin und Manuelle Medizin) und therapeutischer Fachdisziplinen (Ergotherapie, Physiotherapie) und unter Beteiligung der Schmerz-Selbsthilfe (Deutsche Schmerzliga) gebildet.

Ergebnisse Hinsichtlich der Evidenzbewertung der Literatur ist festzustellen, dass die Datenlage zur Frage des optimalen Vorgehens bei ZR sehr heterogen ist. Die Anwendung von Physiotherapie in Kombination von manueller Therapie und Bewegungsübungen sowie bestimmte operative Verfahren bei ZR sind dagegen evidenzbasiert. Starker Konsens besteht bei den beteiligten Fachgesellschaften, dass das primäre Vorgehen in aller Regel konservativ ist. Hier werden Physiotherapie in Kombination von manueller Therapie, Ergotherapie zur Stärkung der Alltagskompetenz, frühzeitige Schmerztherapie, kurzzeitige intermittierende Ruhigstellung durch das Tragen einer Halskrause und eine periradikuläre Infiltrationstherapie empfohlen.

Eine Operation sollte bei therapierefraktärem Schmerzsyndrom nach Ausschöpfung der konservativen Maßnahmen spätestens 6 Monate nach Symptombeginn dem Patienten empfohlen werden. Bei lateralen und intraforaminalen Bandscheibenvorfällen können als Operationsverfahren eine ACDF („anterior cervical discectomy with fusion“) oder eine PCF („posterior cervical foraminotomy“) durchgeführt werden. Das bevorzugte Verfahren ist hier im Einzelfall zu wählen. Bei medianen und paramedianen Bandscheibenvorfällen soll der ventrale Zugang gewählt werden.

Schlussfolgerung Die Diagnose einer ZR beruht auf der Anamnese und der neurologischen Untersuchung und soll durch eine bildgebende Methode bestätigt werden. Bei Fehlen behindernder Ausfälle soll das Vorgehen primär konservativ und bei rasch progredienten Paresen primär operativ sein. Bei Einhalten der in der Leitlinie aufgeführten Empfehlungen haben die Schmerzen bei ZR eine günstige Prognose.

Abstract

Background Cervical Radiculopathy (CR) is a relatively common clinical syndrome that occurs in many areas of medicine and requires an interdisciplinary treatment approach. Although the main symptom is pain, the CR has some particularities, which the German Neurological Society takes into account in its own guideline. The main aim of this guideline was to convey the current state of knowledge for the treatment of CR. This guideline refers exclusively to the degenerative CR.

Methodology The guideline is based on a search of guideline databases and medline. Under the moderation of the German Association of Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF)), the consensus was reached by means of a nominal group process and the Delphi process. Due to the interdisciplinary treatment approach, the guideline committee was formed from experts of various medical (neurology, orthopedics, trauma surgery, neurosurgery, pain therapy, physical and rehabilitative medicine and manual medicine) and therapeutic disciplines (occupational therapy, physiotherapy) and the participation of pain self-help (German pain league).

Results With regard to the evidence evaluation of the literature, it can be stated that the data on the question of the optimal procedure in CR is very heterogeneous. The use of physiotherapy in combination with manual therapy and movement exercises as well as certain surgical procedures in CR are evidence-based. There is a strong consensus among the participating medical societies that the primary approach is usually conservative. Physiotherapy in combination with manual therapy, occupational therapy to strengthen everyday life skills, early pain therapy, short-term intermittent immobilization by wearing a neck brace and periradicular infiltration therapy are recommended.

Surgery should be recommended to the patient in the case of treatment-refractory pain syndrome after the use of conservative measures no later than 6 months after onset of symptoms. For lateral and intraforaminal disc herniations, an ACDF ("anterior cervical discectomy with fusion") or a PCF ("posterior cervical foraminotomy") may be used as the surgical procedure. The preferred method should be chosen here on an individual basis. For median and paramedian disc herniations, the ventral approach should be chosen.

Conclusion The diagnosis of a CR is based on the anamnesis and the neurological examination and should be confirmed by an imaging method. In the absence of obstructive failures, the procedure should be primarily conservative and only primarily operative in rapidly progressive paresis. If the recommendations in the guideline are adhered to, the pain in ZR has a favorable prognosis.

^* Den Leitlinientext zusammen mit der Interessenkonflikterklärung finden Sie auch auf www.dgn.org sowie www.awmf.de.

• Literatur

• 1 Simmenroth-Nayda A. Nackenschmerzen: Die S3-Leitlinie der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin. DEGAM; 2010
• 2 Boyles R, Toy P, Mellon Jr. J. et al. Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: a systematic review. J Man Manip Ther 2011; 19: 135-142
• 3 Onks CA, Billy G. Evaluation and treatment of cervical radiculopathy. Prim Care 2013; 40: 837-848, vii-viii
• 4 Polston DW. Cervical radiculopathy. Neurol Clin 2007; 25: 373-385
• 5 Yoon SH. Cervical radiculopathy. Phys Med Rehabil Clin N Am 2011; 22: 439-446, viii
• 6 Berlit P. Erkrankungen der Nervenwurzeln und peripheren Nerven. In: Basiswissen Neurologie. Berlin, Heidelberg: Springer Berlin Heidelberg; 2014: 67-91
• 7 Neurath MF, Lohse AW. Checkliste Anamnese und klinische Untersuchung. Stuttgart: Georg Thieme Verlag; 2015
• 8 Wainner RS, Fritz JM, Irrgang JJ. et al. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine (Phila Pa 1976) 2003; 28: 52-62
• 9 Young IA, Cleland JA, Michener LA. et al. Reliability, construct validity, and responsiveness of the neck disability index, patient-specific functional scale, and numeric pain rating scale in patients with cervical radiculopathy. Am J Phys Med Rehabil 2010; 89: 831-839
• 10 Iyer S, Kim HJ. Cervical radiculopathy. Curr Rev Musculoskelet Med 2016; 9: 272-280
• 11 Wong JJ, Cote P, Quesnele JJ. et al. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J 2014; 14: 1781-1789
• 12 Matsumoto M, Fujimura Y, Suzuki N. et al. MRI of cervical intervertebral discs in asymptomatic subjects. J Bone Joint Surg Br 1998; 80: 19-24
• 13 Kuijper B, Tans JT, van der Kallen BF. et al. Root compression on MRI compared with clinical findings in patients with recent onset cervical radiculopathy. J Neurol Neurosurg Psychiatry 2011; 82: 561-563
• 14 Anonym. Bekanntmachungen: Leitlinien der Bundesärztekammer zur Qualitätssicherung der Magnet-Resonanz-Tomographie. Dtsch Arztebl International 2000; 97: 2557
• 15 Wilbourn AJ, Aminoff MJ. AAEM minimonograph 32: the electrodiagnostic examination in patients with radiculopathies. American Association of Electrodiagnostic Medicine. Muscle Nerve 1998; 21: 1612-1631
• 16 Partanen J, Partanen K, Oikarinen H. et al. Preoperative electroneuromyography and myelography in cervical root compression. Electromyogr Clin Neurophysiol 1991; 31: 21-26
• 17 Peolsson A, Soderlund A, Engquist M. et al. Physical function outcome in cervical radiculopathy patients after physiotherapy alone compared with anterior surgery followed by physiotherapy: a prospective randomized study with a 2-year follow-up. Spine (Phila Pa 1976) 2013; 38: 300-307
• 18 Engquist M, Lofgren H, Oberg B. et al. Surgery versus nonsurgical treatment of cervical radiculopathy: a prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alone with a 2-year follow-up. Spine (Phila Pa 1976) 2013; 38: 1715-1722
• 19 Peolsson A, Oberg B, Wibault J. et al. Outcome of physiotherapy after surgery for cervical disc disease: a prospective randomised multi-centre trial. BMC Musculoskelet Disord 2014; 15: 34
• 20 Engquist M, Lofgren H, Oberg B. et al. A 5- to 8-year randomized study on the treatment of cervical radiculopathy: anterior cervical decompression and fusion plus physiotherapy versus physiotherapy alone. J Neurosurg Spine 2017; 26: 19-27
• 21 Cheng CH, Tsai LC, Chung HC. et al. Exercise training for non-operative and post-operative patient with cervical radiculopathy: a literature review. J Phys Ther Sci 2015; 27: 3011-3018
• 22 Gross AR, Paquin JP, Dupont G. et al. Exercises for mechanical neck disorders: A Cochrane review update. Man Ther 2016; 24: 25-45
• 23 Fritz JM, Thackeray A, Brennan GP. et al. Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. J Orthop Sports Phys Ther 2014; 44: 45-57
• 24 Langevin P, Desmeules F, Lamothe M. et al. Comparison of 2 manual therapy and exercise protocols for cervical radiculopathy: a randomized clinical trial evaluating short-term effects. J Orthop Sports Phys Ther 2015; 45: 4-17
• 25 Thoomes EJ, Scholten-Peeters W, Koes B. et al. The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review. Clin J Pain 2013; 29: 1073-1086
• 26 Bukhari SRI, Shakil-ur-Rehman S, Ahmad S. et al. Comparison between effectiveness of mechanical and manual traction combined with mobilization and exercise therapy in patients with cervical radiculopathy. Pak J Med Sci 2016; 32: 31-34 doi:10.12669/pjms.321.8923
• 27 Diab AA, Moustafa IM. The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial. Clin Rehabil 2012; 26: 351-361
• 28 Kay TM, Gross A, Goldsmith C. et al. Exercises for mechanical neck disorders. Cochrane Database Syst Rev 2005; CD004250
• 29 Bono CM, Ghiselli G, Gilbert TJ. et al. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J 2011; 11: 64-72
• 30 Childress MA, Becker BA. Nonoperative management of cervical radiculopathy. Am Fam Physician 2016; 93: 746-754
• 31 Corey DL, Comeau D. Cervical radiculopathy. Med Clin North Am 2014; 98: 791-799, xii
• 32 Zang L, Fan N, Hai Y. et al. Using the modified Delphi method to establish a new Chinese clinical consensus of the treatments for cervical radiculopathy. Eur Spine J 2015; 24: 1116-1126
• 33 Gross A, Miller J, D'Sylva J. et al. Manipulation or mobilisation for neck pain. Cochrane Database Syst Rev 2010; CD004249
• 34 Baron R. Pharmakologisch nicht interventionelle Therapie chronisch neuropathischer Schmerzen, S1-Leitlinie der DGN. 2015 https://www.dgn.org/leitlinien/2373-ll62-2012-pharmakologisch-nicht-interventionelle-therapie-chronisch-neuropathischer-schmerzen [Zugriff 16.03.18]
• 35 George S, Klier R, Schröder H. Ergotherapie in der ambulanten Rehabilitation: eine Leistungsbeschreibung orientiert an der ICF; muskuloskeletale Erkrankungen. Dt. Verb. der Ergotherapeuten; 2010
• 36 Graubner B. ICD-10-GM 2014 Systematisches Verzeichnis: Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme 11. Revision-German Modification Version 2014: Deutscher Ärzteverlag; 2013
• 37 Cassidy JD, Boyle E, Cote P. et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine (Phila Pa 1976) 2008; 33: S176-183
• 38 Dillin W, Uppal GS. Analysis of medications used in the treatment of cervical disk degeneration. Orthop Clin North Am 1992; 23: 421-433
• 39 Dmytriv M, Rowland K, Gavagan T. et al. PT or cervical collar for cervical radiculopathy?. J Fam Pract 2010; 59: 269-272
• 40 Beltran-Alacreu H, Lopez-de-Uralde-Villanueva I, Fernandez-Carnero J. et al. Manual therapy, therapeutic patient education, and therapeutic exercise, an effective multimodal treatment of nonspecific chronic neck pain: a randomized controlled trial. Am J Phys Med Rehabil 2015; 94: 887-897
• 41 Graham N, Gross A, Goldsmith CH. et al. Mechanical traction for neck pain with or without radiculopathy. Cochrane Database Syst Rev 2008; CD006408
• 42 Leininger B, Bronfort G, Evans R. et al. Spinal manipulation or mobilization for radiculopathy: a systematic review. Phys Med Rehabil Clin N Am 2011; 22: 105-125
• 43 Miller J, Gross A, DʼSylva J. et al. Manual therapy and exercise for neck pain: a systematic review. Man Ther 2010; 15: 334-354 doi:10.1016/j.math.2010.02.007
• 44 Young IA, Michener LA, Cleland JA. et al. Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Phys Ther 2009; 89: 632-642
• 45 Zhu L, Wei X, Wang S. Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta-analysis. Clin Rehabil 2016; 30: 145-155
• 46 Cai C, Ming G, Ng LY. Development of a clinical prediction rule to identify patients with neck pain who are likely to benefit from home-based mechanical cervical traction. Eur Spine J 2011; 20: 912-922
• 47 Tseng YL, Wang WT, Chen WY. et al. Predictors for the immediate responders to cervical manipulation in patients with neck pain. Man Ther 2006; 11: 306-315
• 48 Thoomes EJ. Effectiveness of manual therapy for cervical radiculopathy, a review. Chiropr Man Therap 2016; 24: 45
• 49 Dziewas R, Konrad C, Drager B. et al. Cervical artery dissection – clinical features, risk factors, therapy and outcome in 126 patients. J Neurol 2003; 250: 1179-1184
• 50 Hufnagel A, Hammers A, Schonle PW. et al. Stroke following chiropractic manipulation of the cervical spine. J Neurol 1999; 246: 683-688
• 51 Miller RG, Burton R. Stroke following chiropractic manipulation of the spine. JAMA 1974; 229: 189-190
• 52 Preul C, Joachimski F, Witte OW. et al. Bilateral vertebral artery dissection after chiropractic maneuver. Clin Neuroradiol 2010; 20: 255-259
• 53 Rothwell DM, Bondy SJ, Williams JI. Chiropractic manipulation and stroke: a population-based case-control study. Stroke 2001; 32: 1054-1060
• 54 Gouveia LO, Castanho P, Ferreira JJ. Safety of chiropractic interventions: a systematic review. Spine (Phila Pa 1976) 2009; 34: E405-413
• 55 Joghataei MT, Arab AM, Khaksar H. The effect of cervical traction combined with conventional therapy on grip strength on patients with cervical radiculopathy. Clin Rehabil 2004; 18: 879-887
• 56 Kosloff TM, Elton D, Tao J. et al. Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations. Chiropr Man Therap 2015; 23: 19
• 57 Frisoni GB, Anzola GP. Vertebrobasilar ischemia after neck motion. Stroke 1991; 22: 1452-1460
• 58 Jeret JS, Bluth M. Stroke following chiropractic manipulation. Report of 3 cases and review of the literature. Cerebrovasc Dis 2002; 13: 210-213
• 59 Bauer J, Böhle E, Bork H. et al. Leitlinie zur konservativen und rehabilitativen Versorgung bei Bandscheibenvorfällen mit radikulärer Symptomatik. http://www.awmf.org/uploads/tx_szleitlinien/033-048l_S2k_Bandscheibenvorfall_konservativ_rehabilitative_Versorgung_2014-07.pdf [Zugriff 16.03.18]
• 60 Horst R, Maicki T, Trabka R. et al. Activity- vs. structural-oriented treatment approach for frozen shoulder: a randomized controlled trial. Clin Rehabil 2017; 31: 686-695
• 61 Bundesausschuss G. Richtlinie des Gemeinsamen Bundesausschusses über die Verordnung von Hilfsmitteln in der vertragsärztlichen Versorgung (Hilfsmittel-Richtlinie, HilfsM-RL). https://www.g-ba.de/informationen/richtlinien/12/ [Zugriff 16.03.18]
• 62 Patel KC, Gross A, Graham N. et al. Massage for mechanical neck disorders. Cochrane Database Syst Rev 2012; CD004871
• 63 Wei X, Wang S, Li L. et al. Clinical evidence of Chinese massage therapy (Tui Na) for cervical radiculopathy: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2017; 2017: 9519285
• 64 Kroeling P, Gross A, Graham N. et al. Electrotherapy for neck pain. Cochrane Database Syst Rev 2013; CD004251
• 65 Gross A, Forget M, St GeorgeK. et al. Patient education for neck pain. Cochrane Database Syst Rev 2012; CD005106
• 66 Gross AR, Kaplan F, Huang S. et al. Psychological care, patient education, orthotics, ergonomics and prevention strategies for neck pain: an systematic overview update as part of the ICON Project. Open Orthop J 2013; 7: 530-561
• 67 Haines T, Gross A, Burnie SJ. et al. Patient education for neck pain with or without radiculopathy. Cochrane Database Syst Rev 2009; CD005106
• 68 Yu H, Cote P, Southerst D. et al. Does structured patient education improve the recovery and clinical outcomes of patients with neck pain? A systematic review from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine J 2016; 16: 1524-1540
• 69 Carlesso LC, Gross AR, MacDermid JC. et al. Pharmacological, psychological, and patient education interventions for patients with neck pain: results of an international survey. J Back Musculoskelet Rehabil 2015; 28: 561-573
• 70 Kjaer P, Kongsted A, Hartvigsen J. et al. National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. Eur Spine J 2017;
• 71 Attal N, Cruccu G, Baron R. et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 2010; 17: 1113-e1188
• 72 KBV KB, Fachgesellschaften AdWM. Nationale VersorgungsLeitlinie: Nicht-spezifischer Kreuzschmerz – Langfassung. 2. Aufl. Version 1, 2017
• 73 Dworkin RH, O'Connor AB, Audette J. et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc 2010; 85: S3-S14
• 74 Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain 2010; 150: 573-581
• 75 Moore A, Costello J, Wieczorek P. et al. Gabapentin improves postcesarean delivery pain management: a randomized, placebo-controlled trial. Anesth Analg 2011; 112: 167-173
• 76 Vedula SS, Bero L, Scherer RW. et al. Outcome reporting in industry-sponsored trials of gabapentin for off-label use. N Engl J Med 2009; 361: 1963-1971
• 77 Vedula SS, Li T, Dickersin K. Differences in reporting of analyses in internal company documents versus published trial reports: comparisons in industry-sponsored trials in off-label uses of gabapentin. PLoS Med 2013; 10: e1001378
• 78 Wiffen P, Collins S, McQuay H. et al. Anticonvulsant drugs for acute and chronic pain. Cochrane Database Syst Rev 2005; CD001133
• 79 Wiffen PJ, Derry S, Moore RA. et al. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2014; CD005451
• 80 Freynhagen R, Strojek K, Griesing T. et al. Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible- and fixed-dose regimens. Pain 2005; 115: 254-263
• 81 Sabatowski R, Galvez R, Cherry DA. et al. Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomised, placebo-controlled clinical trial. Pain 2004; 109: 26-35
• 82 Siddall PJ, Cousins MJ, Otte A. et al. Pregabalin in central neuropathic pain associated with spinal cord injury: a placebo-controlled trial. Neurology 2006; 67: 1792-1800
• 83 Mathieson S, Maher CG, McLachlan AJ. et al. Trial of pregabalin for acute and chronic sciatica. N Engl J Med 2017; 376: 1111-1120
• 84 Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database Syst Rev 2007; CD005454
• 85 Moore RA, Derry S, Aldington D. et al. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev 2015; CD008242
• 86 Derry S, Wiffen PJ, Aldington D. et al. Nortriptyline for neuropathic pain in adults. Cochrane Database Syst Rev 2015; 1: CD011209
• 87 Hearn L, Derry S, Phillips T. et al. Imipramine for neuropathic pain in adults. Cochrane Database Syst Rev 2014; CD010769
• 88 Hearn L, Moore RA, Derry S. et al. Desipramine for neuropathic pain in adults. Cochrane Database Syst Rev 2014; CD011003
• 89 Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev 2014; CD007115
• 90 Ch B. Degenerative Erkrankungen der Wirbelsäule-klinische Befunde, Operationsindikationen und konservative Therapiemöglichkeiten. Journal für Neurologie, Neurochirurgie und Psychiatrie 2005; 6: 6-10
• 91 Wiffen PJ, Derry S, Moore RA. Lamotrigine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2013; CD006044
• 92 Bensler S, Sutter R, Pfirrmann CW. et al. Long term outcomes from CT-guided indirect cervical nerve root blocks and their relationship to the MRI findings – a prospective study. Eur Radiol 2015; 25: 3405-3413
• 93 Bush K, Hillier S. Outcome of cervical radiculopathy treated with periradicular/epidural corticosteroid injections: a prospective study with independent clinical review. Eur Spine J 1996; 5: 319-325
• 94 Cyteval C, Thomas E, Decoux E. et al. Cervical radiculopathy: open study on percutaneous periradicular foraminal steroid infiltration performed under CT control in 30 patients. AJNR Am J Neuroradiol 2004; 25: 441-445
• 95 Desai A, Saha S, Sharma N. et al. The short- and medium-term effectiveness of CT-guided selective cervical nerve root injection for pain and disability. Skeletal Radiol 2014; 43: 973-978
• 96 Kelekis A, Filippiadis DK, Velonakis G. et al. Fluoroscopically guided infiltration of the cervical nerve root: an indirect approach through the ipsilateral facet joint. Pain Physician 2014; 17: 291-296
• 97 Kolstad F, Leivseth G, Nygaard OP. Transforaminal steroid injections in the treatment of cervical radiculopathy. A prospective outcome study. Acta Neurochir (Wien) 2005; 147: 1065-1070 ; discussion 1070
• 98 Strobel K, Pfirrmann CW, Schmid M. et al. Cervical nerve root blocks: indications and role of MR imaging. Radiology 2004; 233: 87-92
• 99 Manchikanti L, Cash KA, Pampati V. et al. Two-year follow-up results of fluoroscopic cervical epidural injections in chronic axial or discogenic neck pain: a randomized, double-blind, controlled trial. Int J Med Sci 2014; 11: 309-320
• 100 Anderberg L, Annertz M, Persson L. et al. Transforaminal steroid injections for the treatment of cervical radiculopathy: a prospective and randomised study. Eur Spine J 2007; 16: 321-328
• 101 Pobiel RS, Schellhas KP, Eklund JA. et al. Selective cervical nerve root blockade: prospective study of immediate and longer term complications. AJNR Am J Neuroradiol 2009; 30: 507-511
• 102 Rathmell JP, Benzon HT, Dreyfuss P. et al. Safeguards to prevent neurologic complications after epidural steroid injections: consensus opinions from a multidisciplinary working group and national organizations. Anesthesiology 2015; 122: 974-984
• 103 Persson LC, Moritz U, Brandt L. et al. 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: 256-266
• 104 Sampath P, Bendebba M, Davis JD. et al. Outcome in patients with cervical radiculopathy. Prospective, multicenter study with independent clinical review. Spine (Phila Pa 1976) 1999; 24: 591-597
• 105 Engquist M, Lofgren H, Oberg B. et al. Factors affecting the outcome of surgical versus nonsurgical treatment of cervical radiculopathy: a randomized, controlled study. Spine (Phila Pa 1976) 2015; 40: 1553-1563
• 106 Burneikiene S, Nelson EL, Mason A. et al. The duration of symptoms and clinical outcomes in patients undergoing anterior cervical discectomy and fusion for degenerative disc disease and radiculopathy. Spine J 2015; 15: 427-432
• 107 Fouyas IP, Sandercock PA, Statham PF. et al. How beneficial is surgery for cervical radiculopathy and myelopathy?. BMJ 2010; 341: c3108
• 108 de Rooij JD, Gadjradj PS, Huygen FJ. et al. Management of symptomatic cervical disk herniation: a survey among Dutch neurosurgeons. Spine (Phila Pa 1976) 2017; 42: 311-317
• 109 Rhee JM. Anterior cervical discectomy and fusion surgery for cervical radiculopathy: is time of essence?. Spine J 2015; 15: 433-434
• 110 Hu Y, Lv G, Ren S. et al. Mid- to long-term outcomes of cervical disc arthroplasty versus anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease: a systematic review and meta-analysis of eight prospective randomized controlled trials. PLoS One 2016; 11: e0149312
• 111 Kim HJ, Nemani VM, Piyaskulkaew C. et al. Cervical radiculopathy: incidence and treatment of 1,420 consecutive cases. Asian Spine J 2016; 10: 231-237
• 112 Jacobs WC, Anderson PG, Limbeek J. et al. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev 2004; CD004958
• 113 Jacobs W, Willems PC, van Limbeek J. et al. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev 2011; CD004958
• 114 Matz PG, Holly LT, Groff MW. et al. Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy. J Neurosurg Spine 2009; 11: 174-182
• 115 Matz PG, Ryken TC, Groff MW. et al. Techniques for anterior cervical decompression for radiculopathy. J Neurosurg Spine 2009; 11: 183-197
• 116 Traynelis VC. Cervical arthroplasty. Clin Neurosurg 2006; 53: 203-207
• 117 Boselie TF, Willems PC, van Mameren H. et al. Arthroplasty versus fusion in single-level cervical degenerative disc disease. Cochrane Database Syst Rev 2012; CD009173
• 118 Gao F, Mao T, Sun W. et al. An updated meta-analysis comparing artificial cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease (CDDD). Spine (Phila Pa 1976) 2015; 40: 1816-1823
• 119 Davis RJ, Nunley PD, Kim KD. et al. Two-level total disc replacement with Mobi-C cervical artificial disc versus anterior discectomy and fusion: a prospective, randomized, controlled multicenter clinical trial with 4-year follow-up results. J Neurosurg Spine 2015; 22: 15-25
• 120 Demetriades AK, Ringel F, Meyer B. Cervical disc arthroplasty: a critical review and appraisal of the latest available evidence. Adv Tech Stand Neurosurg 2014; 41: 107-129
• 121 Xie JC, Hurlbert RJ. Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study. Neurosurgery 2007; 61: 107-116 ; discussion 116–107
• 122 Wright IP, Eisenstein SM. Anterior cervical discectomy and fusion without instrumentation. Spine (Phila Pa 1976) 2007; 32: 772-774 ; discussion 775
• 123 Barlocher CB, Barth A, Krauss JK. et al. Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interposition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients. Neurosurg Focus 2002; 12: E4
• 124 Sasso RC, Smucker JD, Hacker RJ. et al. Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine (Phila Pa 1976) 2007; 32: 2933-2940 ; discussion 2941–2932
• 125 Korinth MC, Kruger A, Oertel MF. et al. Posterior foraminotomy or anterior discectomy with polymethyl methacrylate interbody stabilization for cervical soft disc disease: results in 292 patients with monoradiculopathy. Spine (Phila Pa 1976) 2006; 31: 1207-1214 ; discussion 1215–1206
• 126 Bydon M, Mathios D, Macki M. et al. Long-term patient outcomes after posterior cervical foraminotomy: an analysis of 151 cases. J Neurosurg Spine 2014; 21: 727-731
• 127 Church EW, Halpern CH, Faught RW. et al. Cervical laminoforaminotomy for radiculopathy: symptomatic and functional outcomes in a large cohort with long-term follow-up. Surg Neurol Int 2014; 5: S536-S543
• 128 Faught RW, Church EW, Halpern CH. et al. Long-term quality of life after posterior cervical foraminotomy for radiculopathy. Clin Neurol Neurosurg 2016; 142: 22-25
• 129 Kwon YJ. Long-term clinical and radiologic outcomes of minimally invasive posterior cervical foraminotomy. J Korean Neurosurg Soc 2014; 56: 224-229
• 130 Mansfield HE, Canar WJ, Gerard CS. et al. Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis. Neurosurg Focus 2014; 37: E9
• 131 Skovrlj B, Gologorsky Y, Haque R. et al. Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy. Spine J 2014; 14: 2405-2411
• 132 Jagannathan J, Sherman JH, Szabo T. et al. The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 yearsʼ clinical and radiographic follow-up. J Neurosurg Spine 2009; 10: 347-356
• 133 Krupp W, Schattke H, Muke R. Clinical results of the foraminotomy as described by Frykholm for the treatment of lateral cervical disc herniation. Acta Neurochir (Wien) 1990; 107: 22-29
• 134 Wang TY, Lubelski D, Abdullah KG. et al. Rates of anterior cervical discectomy and fusion after initial posterior cervical foraminotomy. Spine J 2015; 15: 971-976
• 135 Liu WJ, Hu L, Chou PH. et al. Comparison of anterior cervical discectomy and fusion versus posterior cervical foraminotomy in the treatment of cervical radiculopathy: a systematic review. Orthop Surg 2016; 8: 425-431
• 136 Ahn Y. Percutaneous endoscopic cervical discectomy using working channel endoscopes. Expert Rev Med Devices 2016; 13: 601-610
• 137 Burkhardt BW, Muller S, Oertel JM. Influence of prior cervical surgery on surgical outcome of endoscopic posterior cervical foraminotomy for osseous foraminal stenosis. World Neurosurg 2016; 95: 14-21
• 138 Madhavan K, Chieng LO, McGrath L. et al. Early experience with endoscopic foraminotomy in patients with moderate degenerative deformity. Neurosurg Focus 2016; 40: E6
• 139 Oertel JM, Philipps M, Burkhardt BW. Endoscopic posterior cervical foraminotomy as a treatment for osseous foraminal stenosis. World Neurosurg 2016; 91: 50-57
• 140 Telfeian AE, Jasper GP, Oyelese AA. et al. Technical considerations in transforaminal endoscopic spine surgery at the thoracolumbar junction: report of 3 cases. Neurosurg Focus 2016; 40: E9