title: The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature.
abstract: BACKGROUND
  Cervical spine disc herniation is a disabling source of cervical radiculopathy. However, little is known about its course and prognosis. Understanding the course and prognosis of symptomatic cervical disc herniation is necessary to guide patients' expectations and assist clinicians in managing patients.
  
  
  OBJECTIVE
  To describe the natural history, clinical course, and prognostic factors of symptomatic cervical disc herniations with radiculopathy.
  
  
  METHODS
  Systematic review of the literature and best evidence synthesis.
  
  
  METHODS
  A systematic search of MEDLINE, EMBASE, CINAHL, SportsDiscus, and the Cochrane Central Register of Controlled Trials from inception to 2013 was conducted to retrieve eligible articles. Eligible articles were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. The results from articles with low risk of bias were analyzed using best evidence synthesis principles.
  
  
  RESULTS
  We identified 1,221 articles. Of those, eight articles were eligible and three were accepted as having a low risk of bias. Two studies pertained to course and one study pertained to prognosis. Most patients with symptomatic cervical disc herniations with radiculopathy initially present with intense pain and moderate levels of disability. However, substantial improvements tend to occur within the first 4 to 6 months post-onset. Time to complete recovery ranged from 24 to 36 months in, approximately, 83% of patients. Patients with a workers' compensation claim appeared to have a poorer prognosis.
  
  
  CONCLUSIONS
  Our best evidence synthesis describes the best available evidence on the course and prognosis of cervical disc herniations with radiculopathy. Most patients with symptomatic cervical spine disc herniation with radiculopathy recover. Possible recurrences and time to complete recovery need to be further studied. More studies are also needed to understand the prognostic factors for this condition.
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, 6100 Leslie Street, Toronto, Ontario, Canada; Division of Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, Canada. Electronic address: jwong@cmcc.ca.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Wong
authors.affiliation: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, 6100 Leslie Street, Toronto, Ontario, Canada; Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, 2000 Simcoe Street North, Oshawa, Ontario, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street North, Oshawa, Ontario, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.affiliation: Division of Undergraduate Education, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, Canada.
authors.forename: Jairus J
authors.initials: JJ
authors.lastname: Quesnele
authors.affiliation: Department of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, Canada.
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Stern
authors.affiliation: Department of Graduate Studies, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, Canada.
authors.forename: Silvano A
authors.initials: SA
authors.lastname: Mior
mesh_terms: D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D011379:Prognosis; D011843:Radiculopathy / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D020127:Recovery of Function; D013997:Time Factors; D014942:Workers' Compensation
keywords: Cervical disc herniation; Cervical radiculopathy; Course; Epidemiology; Prognosis; Systematic review