Radiculopathy Overview: Symptoms, Causes, Treatment

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Radiculopathy is a term that refers to diseases of the spinal nerve roots . Root is a medical term that means "root" and refers to the root of the spinal nerve.

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A common cause of radiculopathy is compression of the spinal nerve root.

Spinal nerve root compression occurs when a structure such as an intervertebral disc or bone spur, formed as a result of prolonged wear and tear, invades the space where the nerve root is located. This invasion usually causes the structure and the nerve root to touch each other, causing irritation and other symptoms, sometimes including pain .

Other causes of radiculopathy include herniated discs , bone spurs, infections, vasculitis , and, in rare cases, tumors.

Compressed spinal nerve roots can occur at any level from C1-2, which is the region corresponding to the upper neck, to S4-5, which corresponds to the very base of the spine. However, the most commonly affected areas are L4-5 and L5-S1 in the lower back and C5-6 and C6-7 in the neck.

Radiculopathy due to irritation of the spinal nerve roots in the neck is called cervical radiculopathy; in the lower back it is called lumbar radiculopathy.

Risk factor's

You are at higher risk of developing radiculopathy if you are sedentary and / or drive a lot. While sitting, it squeezes the discs, which can lead to herniation and subsequent irritation of the nerve roots.

Other factors that can increase your risk of radiculopathy include :

  • Male
  • Chronic cough
  • The pregnancy
  • Normal weight lifting
  • Of smoking

Symptoms

Depending on the cause of the nerve root compression and its location, root symptoms can vary.

The most common symptoms include neck and shoulder pain, headache and sharp pain, weakness, numbness, tingling, or other electrical sensations radiating down the leg ( sciatica ) or arm. Other symptoms may include impaired reflexes, weakness, muscle stiffness, limited movement, and, in cervical radiculopathy disease, sharp or painful pain when stretching the neck back .

Diagnostics

According to a 2011 review published in the journal Hospital for Special Surgery, approximately 75% of radiculopathy cases can be diagnosed by a physician simply by looking at the patient's history. Your healthcare provider will most likely recognize radiculopathy by its most common symptom: pain in a limb and / or numbness or electrical sensation, also in a limb, which corresponds to the muscle group that serves the affected nerve. This area is called a nerve dermatome .

Another symptom that may indicate radiculopathy is the weakness of certain muscles in a limb. In this case, the area served by a particular spinal nerve is called a myotome . Myotomes are associated with muscle function, while dermatomes are associated with sensation.

Many healthcare providers perform a neurological exam and may request an exam in addition to the physical exam. Diagnostic tests, such as an MRI , can help confirm the results of the physical exam or better identify the area where your symptoms may be occurring.

During your physical exam, your doctor will likely check for pain, loss of sensation, reflexes, and muscle strength in each of your dermatomes and myotomes.

By identifying which dermatomes and myotomes are affected, you can determine which spinal nerve roots are damaged. A physical exam may include tests that simulate your pain to help the doctor determine the nature of the nerve root injury.

Non-surgical treatment

Treatment of cervical and lumbar radiculopathy begins non-invasively . In fact, the review from the Hospital for Special Surgery mentioned above reports that between 75% and 90% of people diagnosed with cervical radiculopathy improve without surgery. While conservative therapies can be active or passive, aggressive use of a variety of active therapies, generally consisting of a multidisciplinary approach that requires patient participation, generally produces the best results .

This may include pain relievers in combination with one or more of the following:

  1. Physical therapy can help you stretch and strengthen your muscles and develop core stabilization. You may also have cravings during physical therapy .
  2. Immobilization the cervical spine with the help of the collar helps the soft tissues heal properly.
  3. Positioning aids, such as a cervical cushion for radiculopathy of the neck, can help you get a good night's sleep.
  4. Steroid injections can help reduce swelling and pain and make you feel more comfortable.

Surgery

If a nonsurgical approach does not help relieve pain after 6 to 12 weeks, you may need surgery. The choice of procedure will likely depend on the type and location of the spinal nerve root compression, the experience of your surgeon, and whether you have had prior spinal surgery.

Surgeries that your healthcare provider may consider include:

  • Discectomy , the most common procedure for radiculopathy caused by a herniated disc, involves surgical removal of the disc.
  • Fusion discectomy adds fusion to discectomy. Fusion can help stabilize the spine. A bone graft may be required for this procedure.
  • Disc replacement is a relatively new and little used surgical technique. Advocates say its advantage over fusion discectomy is that it keeps the spine moving.
  • Posterior cervical laminophoraminotomy is sometimes performed when surgery is required on a single herniated disc and the disc material extends beyond the vertebra.

A 2018 study published in the journal Molecular Pain that compared various treatments for radiculopathy found that surgery, traction, and steroid injections showed better changes in pain status.

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