Treatment of patients with degenerative cervical radiculopathy using a multimodal conservative approach in a geriatric population: a case series.

STUDY DESIGN Retrospective clinical case series. OBJECTIVE To describe the management of 10 patients with advanced cervical spondyloarthrosis with radiculopathy, using manual therapy, intermittent mechanical cervical traction, and home exercises. BACKGROUND Predictors and short-term outcomes of cervical radiculopathy have been published. These predictors have not been developed for, or applied to, geriatric patients with spondylitic radiculopathy. CASE DESCRIPTION A series of 10 patients (aged 67 to 82 years) were referred to a physical therapist for medically prediagnosed cervical spondyloarthrosis and radiculopathy, as determined by magnetic resonance imaging. Neck Disability Index (NDI), numeric pain rating scale (NPRS), upper limb tension testing, Spurling's test, and the cervical distraction test were all completed on each patient at initial examination and at discharge. NDI and NPRS data were also collected at 6 months posttreatment. Intervention included manual therapy (including high-velocity low-amplitude thrust manipulation) of the upper thoracic and cervical spine, intermittent mechanical cervical traction, and a home program (including deep cervical flexor strengthening) for 6 to 12 sessions over a period of 3 to 6 weeks. OUTCOMES All 10 patients had substantial improvement in NPRS and NDI scores. The mean NPRS score was less than 1/10, and the mean NDI score was 6/50 at discharge, compared to the original mean NPRS and NDI scores of 5.7 and 27.4, respectively. All patients reported maintaining those gains for 6 months. DISCUSSION A multimodal approach for patients diagnosed with cervical spondyloarthrosis with radicular symptoms was useful in this geriatric population to reduce pain, minimize radicular symptoms, and improve functional outcomes. LEVEL OF EVIDENCE Therapy, level 4.