Cervical Radiculopathy Management

Initial Treatment Approach

The American College of Physicians recommends starting treatment within 72 hours of symptom onset for maximum benefit, with oral prednisolone 50 mg daily for 5 days, followed by a 5-day taper, which provides highly effective pain reduction in approximately 75% of patients 1
Treatment should be initiated after confirming true radiculopathy by documenting dermatomal pain distribution, sensory changes along a specific dermatome, or motor weakness in the corresponding myotome 1

The American Academy of Neurology suggests that in the acute phase, nonoperative management is the mainstay, with success rates averaging 90%, and all patients without myelopathy or significant muscle weakness should receive at least 6 weeks of conservative treatment before considering surgical intervention 2, 3, 4
Cervical radiculopathy is typically self-limiting, with 75-90% of patients achieving symptomatic improvement with conservative care 2, 3, 4

The American College of Rheumatology recommends not continuing corticosteroids beyond 6 weeks, as prolonged exposure provides no additional benefit while substantially increasing risks of hypertension, hyperglycemia, sleep and mood disturbances, gastric ulceration, glaucoma, myopathy, and osteoporosis 5
For severe cases or when oral therapy is insufficient, consider IV dexamethasone with an initial 10 mg bolus followed by 4 mg four times daily (16 mg/day total) for 3-7 days, with total treatment duration not exceeding 14 days 6

In elderly patients with comorbidities, the moderate-dose approach is particularly appropriate, balancing efficacy with safety, and single daily dosing is preferred over divided doses for systemic corticosteroids 1, 6

If symptoms persist despite 6 weeks of conservative management including oral corticosteroids, or if significant functional deficits develop, surgical consultation is warranted, and anterior cervical decompression provides rapid relief (within 3-4 months) of arm and neck pain compared to physical therapy or cervical collar immobilization 2, 3, 7