Cervical decompression

Cervical spinal decompression in Paris 6

Cervical pain of discogenic origin is a common reason for consultation. When a cervical intervertebral disc deteriorates or protrudes, it can compress a nerve root and cause pain radiating into the arm, shoulder or hand: this is cervicobrachial neuralgia.

Cervical decompression is a variant of neurovertebral spinal decompression specifically adapted to the neck region. It aims to reduce the mechanical stresses exerted on the cervical discs and associated nerve structures.

Consultations take place at the practice located at 9 Rue du Regard, 75006 Paris, in the 6th arrondissement.

Indications for cervical decompression

Cervical decompression may be considered in the following situations:

• cervical disc herniation: protrusion or extrusion at the C4-C5, C5-C6 or C6-C7 level
• cervicobrachial neuralgia: pain radiating from the neck to the arm, related to nerve root compression
• cervical degenerative disc disease: disc wear with reduced disc height and associated pain
• chronic cervical pain of discogenic origin: persistent neck pain with documented disc involvement

Differences from lumbar decompression

Cervical decompression differs from lumbar decompression in several ways:

• traction forces: significantly lower (10 to 20 kg compared with 30 to 60 kg for the lumbar spine), adapted to the size and fragility of the cervical structures
• positioning: the patient lies supine, with a specific support system for the head and neck
• traction angle: adjusted according to the targeted disc level (slight flexion for upper levels, neutral position for lower levels)
• session duration: generally shorter (15 to 20 minutes of effective traction)
• precautions: increased vigilance due to the proximity of the spinal cord and vertebral arteries

Cervicobrachial neuralgia and decompression

Cervicobrachial neuralgia (CBN) presents as pain that originates in the neck and radiates into the arm, sometimes reaching the fingers. It is often caused by a cervical disc herniation compressing a nerve root.

The path of the pain depends on the level of compression:

• C5-C6: pain in the shoulder, outer aspect of the arm and thumb
• C6-C7: pain in the posterior aspect of the arm, forearm and middle fingers
• C7-T1: pain in the inner aspect of the arm and last two fingers

Cervical decompression can help relieve this compression by targeting the affected disc level.

Cervical decompression protocol

1. Initial assessment: comprehensive cervical clinical examination, neurological testing of the upper limbs, imaging analysis (cervical MRI)
2. Screening for contraindications: vascular tests (vertebral arteries), assessment of cervical stability
3. Individualised protocol: generally 10 to 15 sessions, at a rate of 2 per week during the initial phase
4. Continuous reassessment: adjustment of parameters (force, angle, duration) at each session
5. Comprehensive approach: combination with osteopathic treatment addressing cervical tension, the shoulders and thoracic spine

Contraindications specific to the cervical spine

In addition to the general contraindications of decompression (fracture, tumour, infection, instability), the cervical spine requires additional precautions:

• vertebrobasilar insufficiency (vascular risk during traction)
• advanced cervical myelopathy (spinal cord compromise requiring neurosurgical assessment)
• rheumatoid arthritis with cervical involvement (risk of C1-C2 instability)
• recent cervical surgery (fusion, arthroplasty)
• ossification of the posterior longitudinal ligament (OPLL)

Clinical studies

Fritz JM et al. (2014)

Title: Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial.

Publication: Journal of Orthopaedic & Sports Physical Therapy, 2014; 44(2): 45-57

Results: 86 patients with neck pain and signs of radiculopathy were randomised for four weeks to exercise alone, exercise plus mechanical traction, or exercise plus over-door home traction. At 6 months, disability (Neck Disability Index) was significantly lower with mechanical traction than with exercise alone (−13.3 points) and with home traction (−8.1); the advantage over exercise alone persisted at 12 months. The subgrouping rule under test was supported on the NDI at 6 months only.

Reference: PubMed

Young IA et al. (2009)

Title: Manual therapy, exercise, and traction for patients with cervical radiculopathy.

Results: The combination of cervical traction with manual therapy and exercises showed significant improvement in pain and function in patients with cervical radiculopathy, compared with exercises alone.

Reference: PubMed