In addition to practising full time in Toronto, Dr. Shawn Thistle is founder and president of Research Review Service inc., an online, subscriptionbased service designed to help busy practitioners integrate current, relevant scientific evidence into their practice (www.researchreviewservice. com). Shawn also recently launched The Epicurean Scholar, which offers continuing education seminars combined with gourmet food and wine events (www.Epicureanscholar.com). Dr. Thistle graduated from CMCC (where he lectures in the Orthopedics Department) and holds an Honours Degree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medical Acupuncture from McMaster University, and is a Certified Active Release Techniques (ART®) Provider and Functional Range Release®/Functional Anatomical Palpation® instructor and provider. Study Title: cervical radiculopathy: a systematic review on treatment by spinal manipulation and measurement with the Neck disability Index Author(s): Rodine, R. and Vernon, h. Publication Information: Journal of the canadian chiropractic association 2012; 56(1): 18–28. This review was prepared by Michael Haneline, DC, MPH, of Research Review Service. BACKGROUND INFORMATION Cervical radiculopathy (CR) is reported to affect about 3.5 persons per 1,000. The condition mostly affects those who are in their 50s and 60s and it does not seem to be gender specific. CR is not typically the result of trauma; rather, it is most commonly caused by a cervical disc herniation or a combination of discogenic and spondylotic changes that have become aggravated. Common symptoms of CR include neck and radicular pain as well as paresthesia. Scapular pain is also common and was present in 51.6 per cent of cases in one study.1 Physical examination findings typically include painful cervical spine range of motion (ROM) and decreased deep tendon reflexes. Other findings include muscle weakness in 15 per cent of cases, decreased sensation in one-third of cases, and muscle atrophy, which is present in less than two per cent of cases. The C7 nerve root is the most commonly involved level, with findings present in 39. 3-46.3 per cent of patients in one study; followed by C6 in 17.6-42.6 per cent of cases.2 An extensive review of the literature did not find insufficient evidence to draw firm conclusions about which treatments are appropriate for CR, nor could researchers identify therapies that are contraindicated.3 Another review reported that the evidence for manipulative therapy in CR is minimal, is low in quality and has a high risk of bias.4 Nonetheless, 93 per cent of chiropractors reported that they would use spinal manipulative therapy (SMT) in a patient with suspected or confirmed cervical disc herniation.4 Other manual medicine professionals employ this treatment as well. This paper had two objectives, as follows: • The primary objective was to review the use of SMT for CR, reflecting on chiropractic treatment practices. • The secondary objective was to review the use of the neck disability index (NDI) in the management of patients with neck and arm pain. CONCLUSIONS AND PRACTICAL APPLICATIONS The evidence for or against SMT for patients with CR is limited. Moreover, a review by the Task Force on Neck Pain and Its Associated Disorders did not find enough evidence on any type of treatment to draw firm conclusions or to make appropriate recommendations for the management of patients with CR. Therefore, the authors’ conclusion that “…the cautious application of high velocity-low amplitude procedures in cases of confirmed or suspected CR” is sound. To read this review in full, including systematic review results, study methods critique and references, please visit the Current Issue page at www.canadianchiropractor.ca.