Radiculopathy

Radiculopathy is characterized by pain that radiates from the spine and causes symptoms along the nerve pathway. The disease is often caused by direct pressure on the nerve roots that show up in a dermatome (an area of the skin that is controlled by the specific sensory fibers of a single nerve root).

Overview

Radiculitis (radicular pain) may occur when a spinal disc presses against nerves that connect to the spinal cord. Because the spinal nerves branch out to other areas of the body, the symptoms of this nerve pressure can be felt in other places besides the location of the affected disc and nerve root. Sciatica is the most common form of radiculopathy that is caused by a pinched nerve in the lumbar spine.

Anatomy

The spinal cord acts as a highway that passes sensory information between the body and the brain. Located inside the spinal canal, it comes off the base of the brain and runs through the cervical spine and stops at the lower part of the thoracic spine, forming the central nervous system. The nerve roots come off the bottom of the cord and form a bundle called the cauda equine (horse’s tail).

The spinal cord is protected by the vertebrae that make up the spinal column. Intervertebral discs separate and cushion each vertebra and keep them from rubbing together. On the back of each vertebra are bony projections that make up the vertebral arch and spinal canal. The arch consists of two supporting pedicles and two laminae. The spinal canal contains the spinal cord, ligaments, fat, and blood vessels. A pair of spinal nerves exit the spinal cord and branch out through the body.

 

What is Radiculopathy?

Radiculopathy is caused by compression of one or more of the nerve roots as they exit the spinal column. It can occur at any part of the spine, however, it is most commonly found in the lower back and the neck. It occurs less often in the thoracic spine.

Types of Radiculopathy

There are distinct types of radiculopathy associated with each of the three main sections of your spinal column, listed below.

Cervical Radiculopathy

The second most common type of radiculopathy, cervical radiculopathy is the clinical description of pain and/or neurological symptoms resulting from any type of condition that irritates a nerve in the cervical spine (neck). When a nerve root in the cervical spine is irritated through compression or inflammation, symptoms of pain, tingling, numbness, and/or weakness can radiate anywhere along that nerve’s pathway into the shoulder, arm, and/or hand.

Lumbar Radiculopathy

The most common type of radiculopathy, lumbar radiculopathy is caused by inflammation, compression, and/or injury to a spinal nerve root, or sciatic nerve in the low back. Causes of this type of pain, in the order of prevalence, include:

• Herniated disc with nerve compression
• Foraminal stenosis (narrowing of the spinal canal due to bone spurs or arthritis)
• Diabetes
• Nerve root injuries
• Scar tissue from previous spinal surgery that is affecting the nerve root

Sciatica refers to the type of pain and where it is felt. The clinical diagnosis is usually arrived at through a combination of the patient’s history (including a description of the pain) and a physical exam. Imaging studies such as MRIs and CT myelograms are used to confirm the diagnosis and will typically show the site of impingement on the nerve root.

Thoracic Radiculopathy

Compared to lumbar and cervical radiculopathy, thoracic radiculopathy is very rare. Since the thoracic spine anchors the ribs it has much less mobility and therefore, is less prone to stress as the body ages. However, patients feeling back pain shouldn’t rule out thoracic radiculopathy as the source of their pain without a diagnosis. Diagnostic tests such as an MRI, CT scan, EMG, and x-ray can pinpoint the location of the compressed nerve root.

Causes of Radiculopathy

Radiculopathy is caused by irritation or compression of the nerves as they exit the spine. The cause of the nerve compression can be mechanical, such as a herniated disc, osteophytes or a thickening of the surrounding ligaments. Less common causes include tumor or infection, scoliosis causing nerves on one side of the spine to be compressed, and inflammation from trauma or degeneration.

Symptoms of Radiculopathy

Radiculopathy symptoms can range from acute to chronic and from mild to severe. The symptoms will vary, depending on the location of the compressed nerve root. There are some symptoms common to all types of radiculopathy. The affected nerves can cause hypersensitivity where the slightest touch can cause excruciating pain. If nerve damage occurs, the muscles may become weak.

Lumbar:

• Lower back pain that radiates from the hips and into the legs
• Neuropathy (numbness) in the legs and feet, incontinence in severe cases

Cervical:

• Neck pain
• Weakness
• Tingling
• Neuropathy (numbness) in the neck, shoulder, and arm on one side of the body

Thoracic:

• Pain in the chest and torso (these symptoms are sometimes mistaken for shingles)

RADICULOPATHY SYMPTOMS

Diagnosing Radiculopathy

The diagnosis of radiculopathy begins with a complete medical history and physical examination by a physician. The doctor will inquire about the type and location of symptoms, how long they have been present, what makes them get better and worse, and what other medical problems the patient has. Knowing the exact location of the symptoms helps the doctor pinpoint the compressed nerve.

Risk Factors

Understanding the controllable risk factors for radiculopathy can help patients slow the onset of symptoms, even if they cannot prevent them completely. Although radiculopathy can be brought on by overuse, injury or trauma, poor body mechanics, poor ergonomics, and genetic factors, the most common cause is aging.

Certain risk factors can accelerate the development and progression of radiculopathy. Some risk factors include:

• Osteoarthritis and rheumatoid arthritis
• Obesity
• Poor posture
• Spinal abnormalities such as scoliosis
• Repetitive movements

Exams & Tests

Imaging tests may be ordered to help find the compressed or irritated nerve. An x-ray is often ordered first to rule out trauma, osteoarthritis, tumor, or infections as the cause of radiculopathy. Then an MRI scan may be ordered to get a look at the soft tissues around the spine including the discs, nerves, and ligaments. If the patient cannot obtain an MRI, a CT scan can be used instead. In some cases, the doctor may order an electromyogram (EMG) to determine if there is damage to the nerve.

Treatment for Radiculopathy

Conservative, non-surgical treatments can be effective for some patients. When conservative treatment is not successful, the symptoms are not resolved and quality of life is still affected, surgical intervention may be necessary.

Non-Surgical Treatment

Non-surgical treatment for the symptoms of radiculopathy may include:

• Anti-inflammatory medications
• Physical therapy
• Chiropractic care
• Epidural steroid injections

Surgical Treatment

Nerve decompression surgeries such as foraminotomy/foraminectomy, facetectomy, laminotomy/laminectomy, or discectomy may be performed to relieve the nerve pressure causing the symptoms of radiculopathy.

Prevention & Self-Care

Radiculopathy cannot be prevented, but the chances of developing it can be reduced. Maintaining good posture and a healthy weight, staying physically active, using safe techniques when lifting heavy objects, quitting smoking, and avoiding excess strain on the neck and backbone can reduce the chances of developing radiculopathy.

The Bonati Spine Institute encourages patients suffering from radiculopathy to contact us to request an MRI review or discuss your symptoms and conditions with our medical professional specialists. Find out why The Bonati Spine Institute is the world leader in advanced spine surgery.

We encourage you to contact us to request an MRI review or discussion with one of our medical professionals. Find out why The Bonati Spine Procedures are considered to be among the world’s best solutions for spine problems.