Radiculopathy

Radiculopathy refers to a set of conditions in which one or more nerves is affected and does not work properly (a neuropathy). The emphasis is on the nerve root (radix = "root"). This can result in pain (radicular pain), weakness, numbness, or difficulty controlling specific muscles.^[1]

In a radiculopathy, the problem occurs at or near the root of the nerve, along the spine. However, the pain or other symptoms often radiate to the part of the body served by that nerve. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the foot.

The radicular pain that results from a radiculopathy should not be confused with referred pain, which is different both in mechanism and clinical features.

Polyradiculopathy refers to the condition where more than one spinal nerve root is affected.

Causes

Affected nerves may be inflamed, pinched (compressed), or working ineffectively due to a lack of blood flow. The nerve could be affected by a progressive disease that is destroying it in part or in whole. Additionally, pinched nerves can be caused by excessive pressure caused by surrounding bones, muscle, cartilage, and tendons.^[2] The "straight leg raise test" is often used to diagnose a lumbar or sacral nerve root radiculopathy.^[3]

Mechanism of Injury

Most often the radiculopathy found in the patients are located in the cervical spine, more along C6-C8.^[4] This is the reason why neck pain is a common symptom, which can cause hand tingling. C8 radiculopathy was found to cause tingling, pricking, or a tickling sensation in the hand.

C6-C7 is the most common cervical location for radiculopathy

Certain injuries can also lead to radiculopathy. These injuries include lifting heavy objects improperly or suffering from a minor trauma such as a car accident. Less common causes of radiculopathy include swelling in the spine caused by a tumor (which can compress the nerve located in that spinal column) and diabetes (which can limit normal blood flow).

Types

Forms of radiculopathy and related conditions:

• Lumbar radiculopathy: radiculopathy in the sciatica
• Cervical radiculopathy: radiculopathy in the cervical spine
• Thoracic radiculopathy; radiculopathy in the thoracic spine
• Cauda equina syndrome
• Paraplegia
• Quadriplegia
• Piriformis syndrome
• Lyme disease

Treatment

Ideally, effective treatment aims to resolve the underlying cause and restores the nerve root to normal function. Common mainstream treatment approaches include chiropractic care, physical therapy, medication, and relaxation. A comprehensive systematic review found moderate quality evidence that spinal manipulation is effective for the treatment of acute lumbar radiculopathy. Only low level evidence was found to support spinal manipulation for the treatment of chronic lumbar and cervical spine-related radiculopathies, and no evidence was found to exist for treatment of thoracic radiculopathy.^[5]

Cervical neck brace. Common modality used to stabilize the neck.

Cervical traction machine

Rehabilitation

Therapeutic exercises are frequently used in combination with many of the previously mentioned modalities and with great results. A variety of exercise regimens are available in patient treatment. An exercise regimen should be modified according to the abilities and weaknesses of the patient.^[6] Stabilization of the cervicothoracic region is paramount in limiting pain and preventing re-injury. The first part of the stabilization procedure is achieving a pain free full range of motion which can be accomplished through stretching exercises. Subsequently a strengthening exercise program should be designed to restore the deconditioned cervical, shoulder girdle, and upper trunk musculature.^[7] As reliance on the neck brace diminishes, an isometric exercise regimen should be introduced. This is a preferred method of exercise during the sub-acute phase because it resists atrophy and is least likely to exacerbate the condition. Single plane resistance exercises against cervical flexion, extension, bending, and rotation are used. While minimally invasive methods for rehabilitation are ideal, surgery is still a viable option. Patients with large cervical disk bulges are frequently recommended for surgery, however most often conservative management will help the herniation regress naturally.^[8]

Prevention

Once the nerve is compressed the best precaution to take is trying to reduce the pain. As explained before, the problem originates along the spine near the root of the nerve. Poor posture and positions could result to spinal curvatures. Loading enormous stress on the spine can worsen a person's back condition. Other behaviors such as sitting or standing for too long of a period, doing extreme workload that causes tension on the back such as yard work, or bending over multiple times can lead to too much tension for the back.^[9] The lower back is supporting the weight of the higher part of the body. The action of sitting for tremendous amount of time causes unwanted stress for the back.

Prolonged sitting results in stress especially in the cervical and lumbar areas of the spine as seen in the image above.

Epidemiology

Cervical radiculopathy is less prevalent in the United States than lumbar radiculopathy with an occurrence rate of 8 cases per 100,000. According to the AHRQ’s 2010 National Statistics for cervical radiculopathy the most affected age group is between 45 and 64 years with 51.03% of incidents. Females are affected more frequently than males and account for 53.69% of cases. Private insurance was the payer in 41.69% of the incidents followed by Medicare with 38.81%. In 71.61% of cases the patients’ income was considered not low for their zipcode. Additionally over 50% of patients lived in large metropolitans (inner city or suburb). The South is the most severely affected region in the US with 39.27% of cases. According to a study performed in Minnesota, the most common manifestation of this set of conditions is the C7 monoradiculopathy, followed by C6.^[10]

Brachial plexus. C6 and C7 nerves affected most frequently

See also

• Peripheral neuropathy

References

External links

• Radiculopathy at the US National Library of Medicine Medical Subject Headings (MeSH)
• Symptoms
• Pinched nerve solution
• More on Radiculopathy
• Youtube video: Spine & Nerve Health with Dr. Aaron Filler (comparing Sciatica and Piriformis Syndrome)
• Neck and Arm Pain Infographic, Cervical Radiculopathy from the Mount Sinai Hospital, New York