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Guideline Summary
Guideline Title
Diagnosis and treatment of cervical radiculopathy from degenerative disorders.
Bibliographic Source(s)
North American Spine Society (NASS). Diagnosis and treatment of cervical radiculopathy from degenerative disorders. Burr Ridge (IL): North American Spine Society (NASS); 2010. 179 p. [317 references]
Guideline Status

This is the current release of the guideline.

FDA Warning/Regulatory Alert

Note from the National Guideline Clearinghouse: This guideline references a drug(s) for which important revised regulatory and/or warning information has been released.

  • April 23, 2014 – Epidural Corticosteroid Injection External Web Site Policy: The U.S. Food and Drug Administration (FDA) is warning that injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death. The injections are given to treat neck and back pain, and radiating pain in the arms and legs. The effectiveness and safety of epidural administration of corticosteroids have not been established, and FDA has not approved corticosteroids for this use. FDA is requiring the addition of a warning to the drug labels of injectable corticosteroids to describe these risks.

Scope

Disease/Condition(s)

Cervical radiculopathy from degenerative disorders

Note: Cervical radiculopathy from degenerative disorders can be defined as pain in a radicular pattern in one or both upper extremities related to compression and/or irritation of one or more cervical nerve roots. Frequent signs and symptoms include varying degrees of sensory, motor and reflex changes as well as dysesthesias and paresthesias related to nerve root(s) without evidence of spinal cord dysfunction (myelopathy).

Guideline Category
Assessment of Therapeutic Effectiveness
Diagnosis
Evaluation
Management
Treatment
Clinical Specialty
Chiropractic
Family Practice
Neurological Surgery
Orthopedic Surgery
Physical Medicine and Rehabilitation
Radiology
Intended Users
Advanced Practice Nurses
Physician Assistants
Physicians
Guideline Objective(s)
  • To provide evidence-based recommendations to address key clinical questions surrounding the diagnosis and treatment of cervical radiculopathy from degenerative disorders.
  • To provide recommendations that assist in delivering optimum, efficacious treatment and functional recovery from this spinal disorder.
Target Population

Adults (18 years or older) with a chief complaint of pain in a radicular pattern in one or both upper extremities related to compression and/or irritation of one or more cervical nerve roots

Interventions and Practices Considered

Assessment/Diagnosis

  1. Provocative tests
    • Shoulder abduction
    • Spurling's test
  2. Imaging tests
    • Magnetic resonance imaging (MRI) or myelography
    • Computed tomography (CT)
    • Electromyography (EMG)
    • CT myelography

Management/Treatment

  1. Outcome measures for medical/interventional and surgical treatment
    • Neck Disability Index (NDI)
    • 36-Item Short Form Health Survey (SF-36)
    • 12-Item Short Form Health Survey (SF-12)
    • Visual Analog Scale (VAS)
    • Modified Prolo, Patient Specific Functional Scale (PSFS)
    • Health Status Questionnaire
    • Sickness Impact Profile
    • Modified Million Index
    • McGill Pain Scores
    • Modified Oswestry Disability Index
  2. Physical therapy
  3. Transforaminal epidural steroid injections under fluoroscopic or CT guidance
  4. Ancillary treatments
    • Bracing
    • Traction
    • Electrical stimulation
    • Acupuncture
    • Transcutaneous electrical stimulation
  5. Surgery
    • Anterior cervical discectomy/decompression and fusion (ACDF)
    • Anterior cervical discectomy/decompression (ACD)
    • Anterior cervical discectomy/decompression (ACD) and reconstruction with total disc replacement
    • Posterior foraminotomy (PLF)
Major Outcomes Considered
  • Diagnostic accuracy
  • Pain scores
  • Functional outcomes scores
  • Range of motion

Methodology

Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

Identification of Search Terms and Parameters

In order to ensure a thorough literature search, North American Spine Society (NASS) has instituted a Literature Search Protocol (see Appendix D of the original guideline document) which has been followed to identify literature for evaluation in guideline development. In keeping with the Literature Search Protocol, work group members have identified appropriate search terms and parameters to direct the literature search.

Specific search strategies, including search terms, parameters and databases searched, are documented in the appendices (see Appendix E in the original guideline document).

Completion of the Literature Search

Once each work group identified search terms/parameters, the literature search was implemented by a medical/research librarian, consistent with the Literature Search Protocol (see above).

Following these protocols ensures that NASS recommendations (1) are based on a thorough review of relevant literature; (2) are truly based on a uniform, comprehensive search strategy; and (3) represent the current best research evidence available. NASS maintains a search history in Endnote, for future use or reference.

Review of Search Results/Identification of Literature to Review

Work group members reviewed all abstracts yielded from the literature search and identified the literature they will review in order to address the clinical questions, in accordance with the Literature Search Protocol. Members have identified the best research evidence available to answer the targeted clinical questions. That is, if Level I, II and/or III literature is available to answer specific questions, the work group was not required to review Level IV or V studies. Work group members reviewed the evidence on the topic of cervical radiculopathy, and studies eligible for review were required to address radiculopathy alone or include a subgroup analysis of patients with radiculopathy. Many of the studies considered for potential inclusion in this guideline included groups of patients with myelopathy, without appropriate subgroup analyses of those patients with cervical radiculopathy alone. For this reason, in the absence of subgroup analyses, a large number of studies were excluded from consideration in addressing the questions and formulating recommendations. These studies, having been reviewed, are included in the reference sections.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus (Committee)
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence

Levels of Evidence for Primary Research Question1

Types of Studies
  Therapeutic Studies —
Investigating the results of treatment
Prognostic Studies —
Investigating the effect of a patient characteristic on the outcome of disease
Diagnostic Studies —
Investigating a diagnostic test
Economic and Decision Analyses — Developing an economic or decision model
Level I
  • High quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals
  • Systematic review2 of Level I RCTs (and study results were homogenous3)
  • High quality prospective study4 (all patients were enrolled at the same point in their disease with ≥80% follow-up of enrolled patients)
  • Systematic review2 of Level I studies
  • Testing of previously developed diagnostic criteria on consecutive patients (with universally applied reference "gold" standard)
  • Systematic review2 of Level I studies
  • Sensible costs and alternatives; values obtained from many studies; with multiway sensitivity analyses
  • Systematic review2 of Level I studies
Level II
  • Lesser quality RCT (e.g., <80% follow-up, no blinding, or improper randomization)
  • Prospective4 comparative study5
  • Systematic review2 of Level II studies or Level I studies with inconsistent results
  • Retrospective6 study
  • Untreated controls from an RCT
  • Lesser quality prospective study (e.g., patients enrolled at different points in their disease or <80% follow-up)
  • Systematic review2 of Level II studies
  • Development of diagnostic criteria on consecutive patients (with universally applied reference "gold" standard
  • Systematic review2 of Level II studies
  • Sensible costs and alternatives; values obtained from limited studies; with multiway sensitivity analyses
  • Systematic review2 of Level II studies
Level III
  • Case control study7
  • Retrospective6 comparative study5
  • Systematic review2 of Level III studies
Case control study7
  • Study of nonconsecutive patients; without consistently applied reference "gold" standard
  • Systematic review2 of Level III studies
  • Analyses based on limited alternatives and costs; and poor estimates
  • Systematic review2 of Level III studies
Level IV Case Series8 Case Series
  • Case-control study
  • Poor reference standard
Analyses with no sensitivity analyses
Level V Expert Opinion Expert Opinion Expert Opinion Expert Opinion

RCT = randomized controlled trial
1 A complete assessment of quality of individual studies requires critical appraisal of all aspects of the study design.
2 A combination of results from two or more prior studies.
3 Studies provided consistent results.
4 Study was started before the first patient enrolled.
5 Patients treated one way (e.g., cemented hip arthroplasty) compared with a group of patients treated in another way (e.g., uncemented hip arthroplasty) at the same institution.
6 The study was started after the first patient enrolled.
7 Patients identified for the study based on their outcome, called "cases" (e.g., failed total arthroplasty) are compared to those who did not have outcome, called "controls" (e.g., successful total hip arthroplasty).
8 Patients treated one way with no comparison group of patients treated in another way.

Methods Used to Analyze the Evidence
Systematic Review with Evidence Tables
Description of the Methods Used to Analyze the Evidence

Evidence Analysis

Members have independently developed evidentiary tables summarizing study conclusions, identifying strengths and weaknesses and assigning levels of evidence. In order to systematically control for potential biases, at least two work group members have reviewed each article selected and independently assigned levels of evidence to the literature using the North American Spine Society (NASS) levels of evidence. Any discrepancies in scoring have been addressed by two or more reviewers. The consensus level (the level upon which two-thirds of reviewers were in agreement) was then assigned to the article.

As a final step in the evidence analysis process, members have identified and documented gaps in the evidence to educate guideline readers about where evidence is lacking and help guide further needed research by NASS and other societies.

Methods Used to Formulate the Recommendations
Expert Consensus (Nominal Group Technique)
Description of Methods Used to Formulate the Recommendations

Identification of Clinical Questions

Trained guideline participants were asked to submit a list of clinical questions that the guideline should address. The lists were compiled into a master list, which was then circulated to each member with a request that they independently rank the questions in order of importance for consideration in the guideline. The most highly ranked questions, as determined by the participants, served to focus the guideline.

Identification of Work Groups

Multidisciplinary teams were assigned to work groups and assigned specific clinical questions to address. Because North American Spine Society (NASS) is comprised of surgical, medical and interventional specialists, it is imperative to the guideline development process that a cross-section of NASS membership is represented on each group. This also helps to ensure that the potential for inadvertent biases in evaluating the literature and formulating recommendations is minimized.

Formulation of Evidence-Based Recommendations and Incorporation of Expert Consensus

Work groups held webcasts to discuss the evidence-based answers to the clinical questions, the grades of recommendations and the incorporation of expert consensus. Expert consensus has been incorporated only where Level I-IV evidence is insufficient and the work group has deemed that a recommendation is warranted. Transparency in the incorporation of consensus is crucial, and all consensus-based recommendations made in this guideline very clearly indicate that Level I-IV evidence is insufficient to support a recommendation and that the recommendation is based only on expert consensus.

Consensus Development Process

Voting on guideline recommendations was conducted using a modification of the nominal group technique in which each work group member independently and anonymously ranked a recommendation on a scale ranging from 1 ("extremely inappropriate") to 9 ("extremely appropriate"). Consensus was obtained when at least 80% of work group members ranked the recommendation as 7, 8 or 9. When the 80% threshold was not attained, up to three rounds of discussion and voting were held to resolve disagreements. If disagreements were not resolved after these rounds, no recommendation was adopted.

After the recommendations were established, work group members developed the guideline content, addressing the literature which supports the recommendations.

Rating Scheme for the Strength of the Recommendations

Grades of Recommendation

A. Good evidence (Level I studies with consistent findings) for or against recommending intervention.

B. Fair evidence (Level II or III studies with consistent findings) for or against recommending intervention.

C. Poor quality evidence (Level IV or V studies) for or against recommending intervention.

I. Insufficient or conflicting evidence not allowing a recommendation for or against intervention.

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation
External Peer Review
Internal Peer Review
Description of Method of Guideline Validation

Submission of the Draft Guidelines for Review/Comment

Guidelines were submitted to the full Evidence-Based Guideline Development Committee and the Research Council Director for review and comment. Revisions to recommendations were considered for incorporation only when substantiated by a preponderance of appropriate level evidence.

Submission for Board Approval

Once any evidence-based revisions were incorporated, the drafts were prepared for North American Spine Society (NASS) Board review and approval. Edits and revisions to recommendations and any other content were considered for incorporation only when substantiated by a preponderance of appropriate level evidence.

Recommendations

Major Recommendations

The grades of recommendations (A-C, I) and levels of evidence (I-V) are defined at the end of the "Major Recommendations" field.

Recommendations for Diagnosis and Treatment of Cervical Radiculopathy from Degenerative Disorders

Diagnosis and Imaging

What history and physical examination findings best support a diagnosis of cervical radiculopathy from degenerative disorders?

It is suggested that the diagnosis of cervical radiculopathy be considered in patients with arm pain, neck pain, scapular or periscapular pain, and paresthesias, numbness and sensory changes, weakness, or abnormal deep tendon reflexes in the arm. These are the most common clinical findings seen in patients with cervical radiculopathy.

Grade of Recommendation: B

It is suggested that the diagnosis of cervical radiculopathy be considered in patients with atypical findings such as deltoid weakness, scapular winging, weakness of the intrinsic muscles of the hand, chest or deep breast pain, and headaches. Atypical symptoms and signs are often present in patients with cervical radiculopathy, and can improve with treatment.

Grade of Recommendation: B

Provocative tests including the shoulder abduction and Spurling's tests may be considered in evaluating patients with clinical signs and symptoms consistent with the diagnosis of cervical radiculopathy.

Grade of Recommendation: C

Because dermatomal arm pain alone is not specific in identifying the pathologic level in patients with cervical radiculopathy, further evaluation including computed tomography (CT), CT myelography (CTM), or magnetic resonance imaging (MRI) is suggested prior to surgical decompression.

Grade of Recommendation: B

What are the most appropriate diagnostic tests (including imaging and electrodiagnostics), and when are these tests indicated in the evaluation and treatment of cervical radiculopathy from degenerative disorders?

MRI is suggested for the confirmation of correlative compressive lesions (disc herniation and spondylosis) in cervical spine patients who have failed a course of conservative therapy and who may be candidates for interventional or surgical treatment.

Grade of Recommendation: B

In the absence of reliable evidence, it is the work group's opinion that CT may be considered as the initial study to confirm a correlative compressive lesion (disc herniation or spondylosis) in cervical spine patients who have failed a course of conservative therapy, who may be candidates for interventional or surgical treatment and who have a contraindication to MRI.

Work Group Consensus Statement

CT myelography is suggested for the evaluation of patients with clinical symptoms or signs that are discordant with MRI findings (e.g., foraminal compression that may not be identified on MRI). CT myelography is also suggested in patients who have a contraindication to MRI.

Grade of Recommendation: B

The evidence is insufficient to make a recommendation for or against the use of electromyography (EMG) for patients in whom the diagnosis of cervical radiculopathy is unclear after clinical exam and MRI.

Grade of Recommendation: I (Insufficient Evidence)

Selective nerve root block with specific dosing and technique protocols may be considered in the evaluation of patients with cervical radiculopathy and compressive lesions identified at multiple levels on MRI or CT myelography to discern the symptomatic level(s). Selective nerve root block may also be considered to confirm a symptomatic level in patients with discordant clinical symptoms and MRI or CT myelography findings.

Grade of Recommendation: C

Outcome Measures for Medical/Interventional and Surgical Treatment

What are the most appropriate outcome measures to evaluate the treatment of cervical radiculopathy from degenerative disorders?

The Neck Disability Index (NDI), 36-Item Short Form Health Survey (SF-36), 12-Item Short Form Health Survey (SF-12) and Visual Analog Scale (VAS) are recommended outcome measures for assessing treatment of cervical radiculopathy from degenerative disorders.

Grade of Recommendation: A

The Modified Prolo, Patient Specific Functional Scale (PSFS), Health Status Questionnaire, Sickness Impact Profile, Modified Million Index, McGill Pain Scores and Modified Oswestry Disability Index are suggested outcome measures for assessing treatment of cervical radiculopathy from degenerative disorders.

Grade of Recommendation: B

Medical and Interventional Treatment

What is the role of physical therapy/exercise in the treatment of cervical radiculopathy from degenerative disorders?

Emotional and cognitive factors (e.g., job dissatisfaction) should be considered when addressing surgical or medical/interventional treatment for patients with cervical radiculopathy from degenerative disorders.

Grade of Recommendation: I (Insufficient Evidence)

What is the role of manipulation/chiropractics in the treatment of cervical radiculopathy from degenerative disorders?

As the efficacy of manipulation in the treatment of cervical radiculopathy from degenerative disorders is unknown, careful consideration should be given to evidence suggesting that manipulation may lead to worsened symptoms or significant complications when considering this therapy. Premanipulation imaging may reduce the risk of complications.

Work Group Consensus Statement

What is the role of epidural steroid injections for the treatment of cervical radiculopathy from degenerative disorders?

Transforaminal epidural steroid injections using fluoroscopic or CT guidance may be considered when developing a medical/interventional treatment plan for patients with cervical radiculopathy from degenerative disorders. Due consideration should be given to the potential complications.

Grade of Recommendation: C

What is the role of ancillary treatments such as bracing, traction, electrical stimulation, acupuncture and transcutaneous electrical stimulation in the treatment of cervical radiculopathy from degenerative disorders?

Ozone injections, cervical halter traction and combinations of medications, physical therapy, injections and traction have been associated with improvements in patient reported pain in uncontrolled case series. Such modalities may be considered recognizing that no improvement relative to the natural history of cervical radiculopathy has been demonstrated.

Work Group Consensus Statement

Emotional and cognitive factors (e.g., job dissatisfaction) should be considered when addressing surgical or medical/interventional treatment for patients with cervical radiculopathy from degenerative disorders.

Grade of Recommendation: I (Insufficient Evidence)

Surgical Treatment

Does surgical treatment (with or without preoperative medical/interventional treatment) result in better outcomes than medical/interventional treatment for cervical radiculopathy from degenerative disorders?

Surgical intervention is suggested for the rapid relief of symptoms of cervical radiculopathy from degenerative disorders when compared to medical/interventional treatment.

Grade of Recommendation: B

Emotional and cognitive factors (e.g., job dissatisfaction) should be considered when addressing surgical or medical/interventional treatment for patients with cervical radiculopathy from degenerative disorders.

Grade of Recommendation: I (Insufficient Evidence)

Does anterior cervical discectomy/decompression and fusion (ACDF) result in better outcomes (clinical or radiographic) than anterior cervical discectomy/decompression (ACD) alone?

Both ACD and ACDF are suggested as comparable treatment strategies, producing similar clinical outcomes, in the treatment of single level cervical radiculopathy from degenerative disorders.

Grade of Recommendation: B

The addition of an interbody graft for fusion is suggested to improve sagittal alignment following ACD.

Grade of Recommendation: B

Does ACDF with instrumentation result in better outcomes (clinical or radiographic) than ACDF without instrumentation?

Both ACDF with and without a plate are suggested as comparable treatment strategies, producing similar clinical outcomes and fusion rates, in the treatment of single level cervical radiculopathy from degenerative disorders.

Grade of Recommendation: B

The addition of a cervical plate is suggested to improve sagittal alignment following ACDF.

Grade of Recommendation: B

While plate stabilization may be indicated in some patients undergoing multilevel ACDF, there is insufficient evidence that this practice results in significant improvement in clinical outcomes for degenerative cervical radiculopathy.

Work Group Consensus Statement

Does anterior surgery result in better outcomes (clinical or radiographic) than posterior surgery in the treatment of cervical radiculopathy from degenerative disorders?

Either ACDF or posterior laminoforaminotomy (PLF) are suggested for the treatment of single level degenerative cervical radiculopathy secondary to foraminal soft disc herniation to achieve comparably successful clinical outcomes.

Grade of Recommendation: B

Compared to PLF, ACDF is suggested for the treatment of single level degenerative cervical radiculopathy from central and paracentral nerve root compression and spondylotic disease.

Work Group Consensus Statement

Does ACD and reconstruction with total disc replacement result in better outcomes (clinical or radiographic) than ACDF in the treatment of cervical radiculopathy from degenerative disorders?

ACDF and total disc arthroplasty (TDA) are suggested as comparable treatments, resulting in similarly successful short term outcomes, for single level degenerative cervical radiculopathy.

Grade of Recommendation: B

What is the long-term result (four+ years) of surgical management of cervical radiculopathy from degenerative disorders?

Surgery is an option for the treatment of single level degenerative radiculopathy to produce and maintain favorable long term (greater than four year) outcomes.

Grade of Recommendation: C

Definitions:

Grades of Recommendation

A. Good evidence (Level I studies with consistent findings) for or against recommending intervention.

B. Fair evidence (Level II or III studies with consistent findings) for or against recommending intervention.

C. Poor quality evidence (Level IV or V studies) for or against recommending intervention.

I. Insufficient or conflicting evidence not allowing a recommendation for or against intervention.

Levels of Evidence for Primary Research Question1

Types of Studies
  Therapeutic Studies —
Investigating the results of treatment
Prognostic Studies —
Investigating the effect of a patient characteristic on the outcome of disease
Diagnostic Studies —
Investigating a diagnostic test
Economic and Decision Analyses — Developing an economic or decision model
Level I
  • High quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals
  • Systematic review2 of Level I RCTs (and study results were homogenous3)
  • High quality prospective study4 (all patients were enrolled at the same point in their disease with ≥80% follow-up of enrolled patients)
  • Systematic review2 of Level I studies
  • Testing of previously developed diagnostic criteria on consecutive patients (with universally applied reference "gold" standard)
  • Systematic review2 of Level I studies
  • Sensible costs and alternatives; values obtained from many studies; with multiway sensitivity analyses
  • Systematic review2 of Level I studies
Level II
  • Lesser quality RCT (e.g., <80% follow-up, no blinding, or improper randomization)
  • Prospective4 comparative study5
  • Systematic review2 of Level II studies or Level I studies with inconsistent results
  • Retrospective6 study
  • Untreated controls from an RCT
  • Lesser quality prospective study (e.g., patients enrolled at different points in their disease or <80% follow-up)
  • Systematic review2 of Level II studies
  • Development of diagnostic criteria on consecutive patients (with universally applied reference "gold" standard
  • Systematic review2 of Level II studies
  • Sensible costs and alternatives; values obtained from limited studies; with multiway sensitivity analyses
  • Systematic review2 of Level II studies
Level III
  • Case control study7
  • Retrospective6 comparative study5
  • Systematic review2 of Level III studies
Case control study7
  • Study of nonconsecutive patients; without consistently applied reference "gold" standard
  • Systematic review2 of Level III studies
  • Analyses based on limited alternatives and costs; and poor estimates
  • Systematic review2 of Level III studies
Level IV Case Series8 Case Series
  • Case-control study
  • Poor reference standard
Analyses with no sensitivity analyses
Level V Expert Opinion Expert Opinion Expert Opinion Expert Opinion

RCT = randomized controlled trial
1 A complete assessment of quality of individual studies requires critical appraisal of all aspects of the study design.
2 A combination of results from two or more prior studies.
3 Studies provided consistent results.
4 Study was started before the first patient enrolled.
5 Patients treated one way (e.g., cemented hip arthroplasty) compared with a group of patients treated in another way (e.g., uncemented hip arthroplasty) at the same institution.
6 The study was started after the first patient enrolled.
7 Patients identified for the study based on their outcome, called "cases" (e.g., failed total arthroplasty) are compared to those who did not have outcome, called "controls" (e.g., successful total hip arthroplasty).
8 Patients treated one way with no comparison group of patients treated in another way.

Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for the recommendations (see the "Major Recommendations" field).

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

Improvements in the quality and efficiency of care delivered to patients with cervical radiculopathy from degenerative disorders

Potential Harms

Due consideration should be given to the potential complications of transforaminal epidural steroid injections using fluoroscopic or computed tomography (CT), including spinal cord injury and death.

Qualifying Statements

Qualifying Statements
  • This guideline does not represent a "standard of care," nor is it intended as a fixed treatment protocol. It is anticipated that there will be patients who will require less or more treatment than the average. It is also acknowledged that in atypical cases, treatment falling outside this guideline will sometimes be necessary. This guideline should not be seen as prescribing the type, frequency or duration of intervention. Treatment should be based on the individual patient's need and physician's professional judgment. This document is designed to function as a guideline and should not be used as the sole reason for denial of treatment and services. This guideline is not intended to expand or restrict a health care provider's scope of practice or to supersede applicable ethical standards or provisions of law.
  • This clinical guideline should not be construed as including all proper methods of care or excluding other acceptable methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding any specific procedure or treatment is to be made by the physician and patient in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution.

Implementation of the Guideline

Description of Implementation Strategy

The recommendations will be reviewed by a group experienced in performance measure development (e.g., the American Medical Association [AMA] Physician's Consortium for Performance Improvement) to identify those recommendations rigorous enough for measure development.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Getting Better
Living with Illness
IOM Domain
Effectiveness
Patient-centeredness
Safety

Identifying Information and Availability

Bibliographic Source(s)
North American Spine Society (NASS). Diagnosis and treatment of cervical radiculopathy from degenerative disorders. Burr Ridge (IL): North American Spine Society (NASS); 2010. 179 p. [317 references]
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
2010
Guideline Developer(s)
North American Spine Society - Medical Specialty Society
Source(s) of Funding

North American Spine Society (NASS)

Guideline Committee

North American Spine Society (NASS) Evidence-based Guideline Development Committee

Composition of Group That Authored the Guideline

Committee Members: Christopher M. Bono, MD, Committee Chair; Gary Ghiselli, MD, Outcome Measures Chair; Thomas J. Gilbert, MD, Diagnosis/Imaging Chair; D. Scott Kreiner, MD, Medical/Interventional Chair; Charles Reitman, MD, Surgical Treatment Chair; Jeffrey Summers, MD, Natural History Chair; Jamie Baisden, MD; John Easa, MD; Robert Fernand, MD; Tim Lamer, MD; Paul Matz, MD; Dan Mazanec, MD; Daniel K. Resnick, MD; William O. Shaffer, MD; Anil Sharma, MD; Reuben Timmons, MD; John Toton, MD

Financial Disclosures/Conflicts of Interest

All participating authors have submitted a disclosure form relative to potential conflicts of interest which is kept on file at North American Spine Society (NASS).

Guideline Status

This is the current release of the guideline.

Guideline Availability

Electronic copies: Available in Portable Document Format (PDF) from the North American Spine Society (NASS) Web site External Web Site Policy.

Print copies: Available from the North American Spine Society (NASS), 7075 Veterans Boulevard, Burr Ridge, IL 60527; Toll-free: (866) 960-6277. An order form is available from the North American Spine Society Web site External Web Site Policy.

Availability of Companion Documents

None available

Patient Resources

None available

NGC Status

This NGC summary was completed by ECRI Institute on January 13, 2011. This summary was updated by ECRI Institute on July 3, 2014 following the U.S. Food and Drug Administration advisory on Epidural Corticosteroid Injection.

Copyright Statement

Full-text guidelines can only be acquired through the North American Spine Society (NASS). Questions regarding use and reproduction should be directed to NASS, attention Belinda Duszynski, Research Manager.

Disclaimer

NGC Disclaimer

The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

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