North American Spine Society Develops Clinical Guidelines for Cervical Radiculopathy (Pinched Neck Nerves), Notes Cleveland-area Spine Surgeon Robert Berkowitz, MD

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Spine pain is the most common form of chronic pain. When a spinal disc becomes herniated, it can irritate sensitive nerves in the neck and back—a condition known as radiculopathy. The North American Spine Society has just released evidence-based recommendations on the diagnosis and treatment of pinched nerves in the neck, or cervical radiculopathy.

Robert J. Berkowitz, MD

Spinal discs are essentially shock absorbers between the vertebrae in the neck and back. When a disc’s filling impinges on sensitive nerves in the neck, it can cause pain, weakness or numbness that can radiate down the arms.

Each year, 13 million Americans go to the doctor for chronic back pain. “Statistics show that about one in four people with back pain is suffering from a herniated disc,” says Robert Berkowitz, MD, a board-certified spine surgeon at the Center for Orthopedics in Sheffield Village, Ohio.

The North American Spine Society has just published Cervical Radiculopathy from Degenerative Disorders, the latest in its series of Evidence-based Clinical Guidelines for Multidisciplinary Spine Care. “These guidelines reflect contemporary treatment concepts of the highest-quality clinical literature,” says Dr. Berkowitz.

“The purpose of the guidelines is to put science behind recommendations on how to diagnose and treat pinched nerves in the neck,” he explains. “Each guideline is graded with a standardized level of evidence, from Level I for high-quality randomized trials, to Level V for expert opinion,” Dr. Berkowitz explains.

“Then the guideline is given a recommendation grade, from A for good evidence to I for insufficient or conflicting evidence,” he adds. The NASS guidelines evaluate both non-surgical and surgical methods used to treat pinched nerves in the neck.

“Without treatment, a significant portion of herniated discs get better over the course of two years,” says Dr. Berkowitz. “What we're trying to do with pain medication, chiropractic care, acupuncture, injections or physical therapy is to try to buy time, which might help the body fix the problem without surgery,” he explains. “These conservative treatments can help the patient feel comfortable while the body is healing itself.”

“Surgery offers rapid relief of symptoms compared to medical or interventional treatments,” says Dr. Berkowitz. “We operate on herniated discs when patients are in excruciating pain and can't wait two years for the body to heal itself,” he explains. “They have terrible, searing pain down their arm or leg and are not willing to wait, so we operate and take the pain away immediately.”

This was the case with 49-year-old James Morris, who recently traveled from Kentucky to northeast Ohio for relief of unremitting shoulder and arm pain. “It was the worst pain I’ve ever felt in my life,” Morris recalls. “I’m a 6’4”, 300-pound man and I was in tears.

“For months, I’d gone back and forth to the doctors in Kentucky,” Morris explains. “I went to my internal medicine doctor, an orthopedist and a neurologist and begged them for relief. They were talking about putting me on methadone, which is very addictive.”

Then Morris’s sister, a nurse in Oberlin, Ohio, advised him to see Dr. Berkowitz. When Dr. Berkowitz examined Morris, he explained that the pain radiating down his arm and hand was caused by a herniated disc in his neck.

“Spinal discs are essentially shock absorbers between the vertebrae in the neck and back,” Dr. Berkowitz explains. “When a disc’s filling impinges on sensitive nerves in the neck, it can cause pain, weakness or numbness that can radiate down the arms. When a disc in the lower back irritates the sciatic nerve that runs down the back of the leg, the condition is known as sciatica.”

In Morris’s case, an x-ray and MRI confirmed Dr. Berkowitz’s diagnosis: a herniated C5-C6 neck disc. Dr. Berkowitz performed an anterior cervical discectomy and fusion on Morris. “This procedure removes the disc, puts a new piece of bone where the disc used to be and fuses that level of the spine,” he explains.

Dr. Berkowitz was the first physician in Lorain County and Western Cuyahoga County, Ohio, to perform cervical disc replacement surgery, a new alternative that can help preserve motion in the neck. He also offers microdiscectomy, a minimally invasive surgical technique to treat a herniated disc.

“When I woke up from surgery, the pain was totally gone and I was able to lift my arms!” says Morris. “Now I have a new appreciation for living. I feel like I could try out for the Lakers and make the last cut.”

For information on treatment for herniated discs, visit For details on neck disc replacement, visit To schedule a consultation with Dr. Berkowitz, call Northeast Ohio’s Center for Orthopedics at 440.329.2800.

Northeast Ohio’s Center for Orthopedics, with offices in Sheffield Village, Oberlin and Westlake, Ohio, offers complete bone and joint care by five advance-trained, board-certified orthopedic surgeons. Call 440-329-2800 or visit for more information.


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