Therapy of cervicobrachialgia

For the symptomatic treatment of cervical brachialgia, a variety of different therapeutic approaches are suitable. Symptomatic therapy is understood to be a therapy oriented towards signs of disease (symptoms). A truly causal therapy, such as the removal of a herniated disc of the cervical spine, does not take place initially.

A cervical collar can provide relief for the cervical spine in the acute phase of the disease. The aim of physiotherapy in acute cervicobrachialgia is to calm the mechanically irritated nerve root. Special physiotherapeutic exercise treatments are carried out for this purpose. During traction, a targeted body traction leads to an expansion of the intervertebral holes (exit of the nerve roots) and to a relaxation of the muscles and vertebral joints. The traction can be done by hand or by using special apparatus such as the sling table (lumbar spine) and the glisson sling (cervical spine).

Other forms of therapy for cervicobrachialgia

The application of therapeutically effective forms of current (electrotherapy, electrostimulation) belongs to the field of physical therapy and is issued with the Ordinance on Therapeutic Products for Physiotherapy. Various types of current have anti-inflammatory and pain-relieving effects. Classical drugs used to inhibit inflammation and pain are non-steroidal anti-inflammatory drugs (NSAIDs) and cortisone.

The application in tablet form or as a drug for injection is possible. The main aim is to reduce pain by inhibiting inflammation at the nerve root. Pregabalin (Lyrika ®) can also be used as an adjunctive therapy to chronic cervical brachialgia.

Lyrica ® has an analgesic effect in neuropathic pain (nerve pain) of various types. The most effective therapy for the treatment of cervical brachialgia are targeted infiltrations to the affected nerve roots. This form of injection therapy is also known as periradicular therapy (PRT).

In order to apply infiltrations precisely to the nerve roots, an imaging procedure is necessary. Especially suitable for this is the imaging support of computer tomography (CT). A mixture of a local anaesthetic and cortisone is usually used as the injection content.

Epidural infiltrations are also used with great success. In contrast to epidural infiltrations of the lumbar spine, no local anaesthetic is injected, but a mixture of physiological saline solution and cortisone. The effect is very good.

Operation for cervicobrachialgia

If cervical brachialgia cannot be treated sufficiently conservatively due to the severity of the underlying disease, e.g. due to a very large herniated disc, surgical therapy measures are applied by removing the herniated disc (disc prosthesis, spondylodesis, endoscopic discectomy) and/or by widening the nerve exit holes (decompression, foraminotomy). Before a surgical measure to treat cervicobrachialgia can be considered, conservative measures should be exhausted. Surgery is performed if there is a severe loss of nerve supply and if the symptoms have not disappeared within a few months.

In terms of freedom from pain, surgery is sometimes disappointing for patients, as it is often only temporary. The operation is performed by a neurosurgeon. During the operation, the surgeon removes the nerve from the tissue that causes the complaints.

Due to the different possibilities for the development of a cervicobrachial ligament, this can be different types of tissue, such as the part of a prolapsed intervertebral disc or bone outgrowths. Three different techniques are used in the operation of a cervicobrachialgia In most patients, a reduction in strength and sensory disturbance caused by cervicobrachialgia recedes after the operation, as does pain, which, however, often reoccurs later. – In the latest method, an artificial disc is inserted.

Compared to the other two methods, this method offers the advantage that the mobility of the cervical spine is not restricted. – Another surgical procedure, the so-called microdiscectomy, can be used if a part of the disc is damaged and needs to be removed. However, this is only possible if the intervertebral disc is not already degenerated/pre-damaged.

If the operation can cause instability between two vertebral bodies, a

  • Operative connection of these. For this purpose, the surgeon removes a bone graft from the iliac crest of the patient, which is inserted between the two cervical vertebrae. After two to three months, the bone is then firmly integrated into its new environment and the headrest that was previously worn can be removed. Through this technique, the cervical spine loses some of its mobility.