Radiculopathy (Cervical, Lumbar)

The vertebrae, or bony building blocks of the spine, are cushioned by gel-like discs in between the vertebrae.

Radiculopathy is a condition due to a compressed nerve in the spine that can cause pain, numbness, tingling, or weakness along the course of the nerve. Radiculopathy can occur in any part of the spine, but it is most common in the lower back (lumbar radiculopathy) and in the neck (cervical radiculopathy). It is less commonly found in the middle portion of the spine (thoracic radiculopathy).

Radiculopathy is caused by compression or irritation of the nerves as they exit the spine. This can be due to mechanical compression of the nerve by a disc herniation, a bone spur (osteophytes) from osteoarthritis, or the thickening of surrounding ligaments.

Other less common causes of mechanical compression of the nerves are a tumor or infections. Either of these can reduce the amount of space in the spinal canal and compress the exiting nerve.

Scoliosis can cause the nerves on one side of the spine to become compressed by the abnormal curve of the spine.

Inflammation from trauma or degeneration can lead to radiculopathy from direct irritation of the nerves.

Risk factors for radiculopathy are activities that place an excessive or repetitive load on the spine. Patients involved in heavy labor or contact sports are more prone to develop radiculopathy than those with a more sedentary lifestyle. A family history of radiculopathy or other spine disorders also increases the risk of developing radiculopathy.

Low back pain usually resolves on its own and is commonly the result of a strain injury. There are many treatments for low back pain.

The symptoms of radiculopathy depend on which nerves are affected. The nerves exiting from the neck (cervical spine) control the muscles of the neck and arms and supply sensation there. The nerves from the middle portion of the back (thoracic spine) control the muscles of the chest and abdomen and supply sensation there. The nerves from the lower back (lumbar spine) control the muscles of the buttocks and legs and supply sensation there.

The most common symptoms of radiculopathy are pain, numbness, and tingling in the arms or legs. It is common for patients to also have localized neck or back pain as well. Lumbar radiculopathy that causes pain that radiates down a lower extremity is commonly referred to as sciatica. Thoracic radiculopathy causes pain from the middle back that travels around to the chest. It is often mistaken for shingles.

Some patients develop a hypersensitivity to light touch that feels pain in the area involved. Less commonly, patients can develop weakness in the muscles controlled by the affected nerves. This can indicate nerve damage.

The diagnosis of radiculopathy begins with a medical history and physical examination by the physician. During the medical history, the doctor will ask questions about the type and location of symptoms, how long they have been present, what makes them better and worse, and what other medical problems are present. By knowing the exact location of the patient's symptoms, the doctor can help localize the responsible nerve. The physical examination will focus on the extremity involved. The doctor will check the patient's muscle strength, sensation, and reflexes to see if there are any abnormalities.

The patient may then be asked to obtain imaging studies to look for a source of radiculopathy. Plain X-rays are often obtained first. These can often identify the presence of trauma or osteoarthritis and early signs of tumor or infection. An MRI scan may then be obtained. This study provides the best look at the soft tissues around the spine including the nerves, the disc, and the ligaments. If the patient is unable to obtain an MRI, they may obtain a CT scan instead to explore possible compression of the nerves.

In some cases, the doctor may order a nerve conduction study or electromyogram (EMG). These studies look at the electrical activity along the nerve and can show if there is damage to the nerve.

Fortunately, most people can obtain good relief from their symptoms of radiculopathy with conservative treatment. This may include anti-inflammatory medications, physical therapy or chiropractic treatment, and avoiding activity that strains the neck or back. The majority of radiculopathy patients respond well to this conservative treatment, and symptoms often improve within 6 weeks to 3 months.

If patients do not improve with the treatments listed above they may benefit from an epidural steroid injection. With the help of an X-ray machine, a physician injects steroid medication between the bones of the spine adjacent to the involved nerves. This can help to rapidly reduce the inflammation and irritation of the nerve and help reduce the symptoms of radiculopathy.

In some cases, the symptoms continue despite all of the above treatment options. If this occurs and the symptoms are severe, surgery may be an option. The goal of the surgery is to remove the compression from the affected nerve. Depending on the cause of the radiculopathy, this can be done by a laminectomy or a discectomy. A laminectomy removes a small portion of the bone covering the nerve to allow it to have additional space. A discectomy removes the portion of the disc that has herniated out and is compressing a nerve.

The outlook for radiculopathy is good. The majority of patients respond well to conservative treatment options. Those patients that need surgical procedures typically obtain good results as well with no long-term restrictions.

• Radiculopathy is caused by compression or irritation of a nerve as it exits the spinal column.
• Symptoms of radiculopathy include pain, numbness, tingling, or weakness in the arms or legs.
• Most patients with radiculopathy respond well to conservative treatment including medications, physical therapy, or chiropractic treatment.
• Radiculopathy may resolve within 6 weeks to 3 months.

There is no specific prevention for radiculopathy. Maintaining a reasonable weight, good muscle conditioning, and avoiding excessive strain on the neck and back can reduce the chances of developing radiculopathy.