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Let's suppose that you have been diagnosed as having a pinched nerve in your neck, also known as cervical radiculopathy. If so, you probably have pain in the neck and one shoulder. The pain might radiate into your arm and you might have weakness or numbness in the arm as well. Moving your neck in certain positions probably worsens the pain.

If you're a younger adult, the pinch could be due to a herniated (slipped) disc. Discs are the soft spacers that separate each pair of stacked neck-bones (vertebrae). If you're an older adult, the pinch is more likely due to a bony spur (spondylosis). In either case, you're in good company. A survey in Sicily showed that at any one time there were 3.5 active cases of cervical radiculopathy per population of 100,000. In Rochester, Minnesota, another survey showed 85 new cases each year of cervical radiculopathy per population of 100,000.

Let's say that your doctor has evaluated you thoroughly by taking a history of your symptoms and performing a physical examination. Perhaps with the additional help of an MRI of your cervical spine (neck) and electrical tests of nerve and muscle function (nerve conduction studies and electromyography) the diagnosis of cervical radiculopathy is deemed definite. Furthermore, there is no sign that the spinal cord itself is pinched. Now what?

Now what, indeed. Choosing a treatment for this condition is far from straightforward. Out of hundreds of published medical reports concerning treatment of cervical radiculopathy, most are case reports or case series. A "case series" translates roughly as: "We gave six patients in a row the same treatment and five of them got better." What can be concluded from a study of this kind? Did the treatment make the patients better or would they have improved anyway? We don't know.

The missing ingredient here is a comparison group of untreated or differently treated individuals known as a control group. The other mark of a quality study is that the chosen treatment is randomized, meaning that the research subjects agreed in advance to be assigned to one treatment group or another based on the equivalent of a coin-toss. So out of the hundreds of published studies involving treatment of this common condition, how many were randomized controlled trials? Unfortunately, the answer is just one.

Liselott Persson, Carl-Axel Carlsson and Jane Carlsson at the University Hospital of Lund, Sweden, randomly allocated 81 patients who had symptoms of cervical radiculopathy present for at least three months to any of three treatments -- surgery, physical therapy or a cervical collar. The patients ranged from 28 to 64 years old and 54% of them were male. The surgeons used the so-called Cloward procedure, removing fragments of protruding discs and spurs through an incision in the front of the neck, and then fusing two neck-bones together by means of a bone-graft. Physical therapy involved 15 sessions over a span of three months and consisted of whatever the physical therapist considered appropriate, variously including any of the following: heat application, cold application, electrical stimulation, ultrasound, massage, manipulation, exercise and education. In the cervical collar group, patients wore rigid, shoulder-resting collars every day for three months. Additionally, some of the subjects wore soft collars overnight.

How did the study turn out? Three of the subjects who were assigned to surgery refused the procedure because they had already improved on their own. For statistical purposes their outcomes were included with those who actually received the operation. After three months the surgery and physical therapy groups reported, on average, less pain. After an additional 12 months patients in all three groups had less pain than at the beginning of the study and the outcomes of each treatment were statistically alike. Measurements of mood and overall function following treatment were likewise equal among the groups.

So, over the long haul, no treatment was better than the others. Of course, within each group some patients did better or worse than others and this spread of outcomes was not reflected in the overall averages. In fact, five patients in the collar group and one patient in the physical therapy group went on to receive surgery owing to lack of satisfactory improvement. In addition, eight patients in the surgery group underwent a second operation that in one case was due to a complication of the first operation.

With this Swedish study representing the only rigorous investigation of treatment outcomes in cervical radiculopathy, there are a number of unanswered questions. For example, what are the effects on cervical radiculopathy of painkillers, anti-inflammatory drugs, local injections, systematic traction or other forms of surgery? We don't know. What happens if there is no treatment whatsoever? We don't know the answer to that question either.

Thus, in the care of individual patients there is a yin-yang balancing act between the medical edict of "Above all, do no harm" and the practical dictum of "Do what you have to do." This balancing act usually means starting with less intrusive treatments like drugs and physical therapy. If symptoms fail to improve or become unbearable, an operation may be helpful.

(C) 2006 by Gary Cordingley

Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and researcher who works in Athens, Ohio. For more health-related articles see his website at: http://www.cordingleyneurology.com.

Most Head Restraints Fail to Stop Neck Injury

Of 87 models evaluated, 21 received the highest rating, according to results released Tuesday by the Insurance Institute for Highway Safety (IIHS). Fifty-four vehicles, or 62 percent, flunked the test, which gauges how well the head and neck restraints prevent whiplash when the vehicle is hit from behind.

The Institute evaluated current vehicle models based on the geometric measurements of the head restraints and their performance in a crash simulation sled. Fifty-four of the vehicles were rated marginal or poor, the two lowest rankings, while a dozen received the second-highest score of acceptable. Twenty-one received the best rating of good.

“Any given day, you’re more likely to need a good head restraint to protect you from a neck injury than you are an air bag to protect you in a head-on crash,” said David S. Zuby, the senior vice president of the Institute’s Vehicle Research Center. “People don’t think too much about the fender benders that can result in neck pain for weeks or even months after the crash.”

Head restraints in several passenger vehicles provided marginal or poor protection against neck injuries, the Institute reported Thursday. Only 22 of 75 vehicles tested in a simulated rear crash at 20 mph received the top score of good from the Institute.

Overall, reported The Early Show consumer correspondent Susan Koeppen, 60 percent of cars tested fall short of giving you the protection you need. Almost two out of three models were rated marginal or poor. Neck injuries are the most common injuries reported in car crashes, she added.

"People think of head restraints as head rests, but they're not. They're important safety features," said Adrian Lund, the Institute's president. "You're more likely to need the protection of a good head restraint than the other safety devices in your vehicle because rear-end crashes are so common."

Bill Kwong, a Toyota Motor Corp. spokesman, said that the test does not take into account other aspects of a vehicle's response to a crash under normal driving conditions, such as the vehicle's structure, rear crumple zones and bumpers. "We feel our in-house procedures are good predictors of how it will perform in the real world," Kwong said. "We feel our test procedures are good predictors of how well our seat or head restraints will protect occupants from neck injuries in the event of a rear impact.”

The Institute said that the simulated rear crashes at 20 miles per hour showed that many large vehicles fall short in protecting against neck injuries, which lead to two million insurance claims a year costing at least $8.5 billion. "It's not a major feat of engineering to design seats and head restraints that afford good protection in these common crashes," said Zuby.

"We're seeing some improvement, but it's not across the board," Lund said. "We still have a lot of vehicles out there that we rate as marginal poor. In fact, 59 percent of the SUVs and pickups and minivans that we evaluated we gave marginal or poor rating for their whiplash protection."

Several automakers defended their methods of testing for rear crash protection. DaimlerChrysler noted that many of the vehicles were designed before the Institute began conducting the tests. General Motors Corp. said that it designs head restraints "to meet a variety of driver sizes rather than focusing on a single set of metrics in all GM vehicles." The company added it is ensuring the quality of head restraints the way they secure the reliability of Saturn bug shield and other auto parts accessories.

Now the key to better protection is making sure head restraint is in the proper position, Lund noted.

About the Author

Anthony Fontanelle is a 35-year-old automotive buff who grew up in the Windy City. He does freelance work for an automotive magazine when he is not busy customizing cars in his shop.

Does Lund make good truck products?

Such as bug shields and window vents?

well i have a Lund bugshield on my truck and i've always liked it and glad i bought it, but mine also is metal so i can't say anything for a plastic one, mine is polished stainless steel

Westford Academy girls tennis moves on to state final
It wasn’t easy, but in the end they got it done.

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