What Is Radiculopathy?

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What Is Radiculopathy?

Radiculopathy is a term that describes sensory and motor related symptoms relating to compressed spinal nerve roots. ("Radicular" means root and refers to the spinal nerve root.)  

Spinal nerve root compression occurs when a structure such as the intervertebral disc or a bone spur that formed as a response to wear and tear encroaches on the space where the nerve root is located.

 This encroachment usually results in the structure and the nerve root coming into contact with one another, and causing irritation.

Along with herniated disc and bone spurs, tumors, infections or vasculitis are other causes of radiculopathy (though the latter 3 are rare.)

Compressed spinal nerve roots can occur at any level from C1-2 through S4-5, but the most commonly affected areas are L4-5 and L5-S1 in the low back and C5-6 and C6-7 in the neck.  The nerve root associated with the larger number is the one that gets compressed.  For example, when the compression occurs at the C5-6 level, the spinal nerve root at C6 is compressed, but the one at C5 is not.

Radiculopathy from irritated spinal nerve roots in the neck is called cervical radiculopathy; in the low back, it's called lumbar radiculopathy.

Radiculopathy Symptoms

Depending on the cause of your compressed nerve root, along with where it's located, associated radicular symptoms may vary.

 But the most common include neck and/or shoulder pain, headache and sharp pain, weakness, numbness, tingling or other electrical type sensations going down the leg (sciatica) or arm. Other symptoms may include impaired reflexes, weakness, muscle stiffness, limited motion, and -- with cervical radiculopathy -- aching or sharp pain when you extend your neck backward.

Diagnosing Radiculopathy

According to a 2011 review published in the journal Hospital for Special Surgery, about 75% of radiculopathy cases can be diagnosed simply by the doctor taking a patient history.  You doctor will most likely recognize radiculopathy by its most common symptom which is pain down one extremity or pins and needles that coorespond to the area the affected nerve serve.  (This area is called the nerves "dermatome.)

Just the same, many doctors administer neurological exam, and/or order tests such as MRI.

During your physical exam, the doctor will test for pain, loss of feeling, reflexes and muscle strength in each of the zones. By identifying which dermatome(s) and myotome(s) are affected, she can determine which spinal nerve root(s) are damaged. The physical exam may include tests that "reproduce your pain," to help the doctor determine the nature of the nerve root damage. Diagnostic tests may help confirm findings from the physical exam, or further pinpoint the area from which your symptoms may be arising.

Conservative Radiculopathy Treatments

Treatment for cervical and lumbar radiculopathy begins non-invasively. This may include some combination of pain medications, physical therapy, avoiding activities that bring up the pain, immobilization and traction.

Physical therapy may help you stretch and strengthen your muscles; you may get traction while in PT. If you have cervical radiculopathy, wearing a collar to immobilize your neck may be part of your treatment. By limiting motion and allowing your soft tissue to rest, the collar may help relieve your symptoms. You may also be given a cervical pillow to use while you sleep. The pillow will keep an optimal degree of curve in your neck, taking pressure off the nerve roots.

Injection is another non-surgical approach that may be used, and it may help reduce swelling and pain, keeping you more comfortable.

If the non-surgical approach fails to relieve the pain after 6 to 12 weeks, you may need surgery.

The Hospital for Special Surgery review mentioned above reports that about 75-90% of people who are diagnosed with cervical radiculopathy improve without surgery.  They say that conservative therapies can be either active or passive, but that an aggressive use of an array  of active therapies (i.e. a multi-disciplinary approach consisting of things that require patient participation)  tends to get the best results.

The researchers also mention that epidural steroid injections may have associated complications, and many pain doctors are moving away from this treatment.  And they don't recommend chiropractic because studies show it's not effective for radiculopathy - and in some cases can make it worse.  They add that chiropractic may be too risky for people with spinal instability and/or mass lesions. 

Surgery for Cervical Radiculopathy

If you do need surgery to relieve the symptoms of radiculopathy, the choice of specific procedure will likely depend on the type and location of the spinal nerve root compression, your surgeon's expertise and if you've previously had spine surgery.

Based on the variables mentioned above, common surgeries for radiculopathy include:

For cervical radiculopathy, the anterior cervical discectomy and fusion is given most often. Cervical discectomy with fusion may require a bone graft. Other possible surgeries for radiculopathy in the neck include disc replacement or posterior cervical laminoforaminotomy. The posterior laminoforaminotomy may be done if you have only one herniated disc and it is coming out the side of the vertebra. Disc replacement surgery is still relatively new, but its use is on the rise.

Surgery for Lumbar and Lumbosacral Radiculopathy

For radiculopathy caused by a herniated disc in the low back area, disectomy (either open or minimally invasive) is usually the procedure of choice. Generally lumbar disectomies are not accompanied by fusion. Minimally invasive spine surgeries include percutaneous manual nucleotomy, laser discectomy, and endoscopic disectomy, to name a few.

If your pain or other symptoms persist, it may be time to consider back surgery. If that's the case, discuss your options with your doctor.

Are You at Risk for Radiculopathy?

You are at higher risk for radiculopathy if you are sedentary and/or if you drive a lot; sitting compresses your discs which may cause herniation and irritation of the nerve roots. If you have a chronic cough, this may bring on a disc herniation and radiculopathy as well. Pregnancy is another risk factor, as is heavy lifting and being male. Smoking is associated with an increased risk of radiculopathy.


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