What Is Radiculopathy?

Woman with backache, massaging her back.
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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 such cases 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.

Risk Factors 

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.

Other factors that increase your risk for radiculopathy include:

  • Being male
  • Chronic cough
  • Pregnancy
  • Heavy lifting (routine)
  • Smoking

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.

Diagnosis 

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

Just the same, many doctors administer a 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.

Non-Surgical Treatment

Treatment for cervical and lumbar radiculopathy begins non-invasively.

In fact, the Hospital for Special Surgery review mentioned above reports that about 75 percent to 90 percent 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.

This may include pain medication and a combination of other approaches including:

Physical Therapy: Physical therapy may help you stretch and strengthen your muscles; you may get traction while in PT.

Immobilization: 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.

Positioning: 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.

Injections: Injection may help reduce swelling and pain, keeping you more comfortable. However, epidural steroid injections may have associated complications, and many pain doctors are moving away from this treatment.

Note: Chiropractic is not recommended because studies show it's not effective for radiculopathy—and in some cases can make it worse. It may be too risky for people with spinal instability and/or mass lesions. 

Surgery

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

Your doctor may consider:

  • Discectomy (most common)—This is the surgical removal of the disc.
  • Disectomy with fusion—This may require a bone graft
  • Disc replacement— Though still relatively new, its use for this issue is on the rise.
  • Posterior cervical laminoforaminotomy—This may be done if you have only one herniated disc and it is coming out the side of the vertebra.

Minimally invasive procedures such as percutaneous manual nucleotomy, laser discectomy, and endoscopic disectomy may also be considered, depending on your case.

Sources:

AAOS. Cervical Radiculopathy (Pinched Nerve). AAOS website. Last Updated Feb 2010. http://orthoinfo.aaos.org/topic.cfm?topic=A00332.

AAOS. Cervical Radiculopathy: Surgical Treatment Options. AAOS website. Last Updated Feb 2010. http://orthoinfo.aaos.org/topic.cfm?topic=A00540.

Canale, Beaty. Cervical Disc Disease. Canale and Beaty: Campbell's Operative Orthopaedics. 11th ed. MDConsult. http://www.mdconsult.com/das/book/body/100188922-3/0/1584/316.html

Caridi, J., et. al.Cervical Radiculopathy: A Review HSS J. Oct. 2011. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192889/

Neuroscience Resource Pages. Radiculopathies. http://www.neuroanatomy.wisc.edu/SClinic/Radiculo/Radiculopathy.htm

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