While cervical disc pathology can unquestionably produce radiculopathy, many patients presenting with arm pain, paresthesia or perceived weakness do not exhibit the clinical behavior of true nerve-root compromise. In these cases, failure to differentiate the primary pain generator may lead to unnecessary spinal injections, nerve ablation procedures or surgical consultation despite limited likelihood of benefit.
Less Medicine, More Surgery
The conventional paradigm for treating neck and back problems is medical treatment (usually drugs), and/or surgery. A recent study found a sharp decrease in medical treatment, but an alarming increase in surgery:
Hospital Admissions (per 100,000 adults) for Medically Treated and Surgically Treated Neck and Back Problems
| Medical Treatment | 1982 | 1987 | 1992 |
| Ontario | 242.8 | 180.2 | 117.1 |
| U.S. | 586.3 | 383.6 | 143.7 |
Surgically Treated
| Ontario | 72.1 | 72.4 | 82.3 |
| U.S. | 160.5 | 194.1 | 217.2 |
The researchers suggest that "higher admission rates for surgery in the U.S. may reflect a larger supply of surgical specialists and imaging units."
------------------ SOURCE: Lavis JN, Anderson GM, Taylor VM, Deyo RA, Bombardier C, Axcell T, Kreuter W. Trends in hospital use for mechanical neck and back problems in Ontario and the United States: discretionary care in different health care systems. Can Med Assoc J 1998;158:29-36.