Radiculopathy

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There are two kinds of radiculopathy: cervical (myelopathy) and lumbar radiculopathy.

Cervical radiculopathy

The spine, also called the backbone, is designed to give us stability, smooth movement, as well as provide a corridor of protection for the delicate spinal cord. It is made up of bony segments called vertebrae and fibrous tissue called intervertebral discs. Disc protrusion, also called herniated disc, is a condition caused by a tear in an intervertebral disc allowing the disc contents to bulge out.

Disc protrusions in the cervical or neck area places pressure on nerve roots (nerve root compression) or the spinal cord causing radiculopathy. Radiculopathy is a medical term used to describe the neurological deficits that can occur from pressure on the nerves and spinal cord, such as arm or finger weakness, numbness or pain.

Cervical radiculopathy refers to a dysfunction of a nerve root caused by injury or compression of a spinal nerve root in the neck. On the other hand cervical radiculopathy refers to compression of the spinal cord within the neck.

Conditions that can cause radiculopathy include:

  • Degenerative Disc Disease: A condition caused by wear and tear on the discs between the vertebrae causing them to lose their cushioning ability.
  • Spinal Stenosis: Narrowing of the spinal canal as we age, most commonly due to degenerative arthritis.
  • Degenerative Spondylolisthesis: This condition is degeneration (wear and tear) of the vertebral components, usually occurring after age 50, causing slippage of a vertebra onto another, leading to spinal stenosis, a narrowing of the spinal canal.

Lumbar radiculopathy

Back pain is a common condition affecting approximately 80% of the population at some point in their lives. The area usually affected is the lower back (lumbar region) as it bears most of the upper body’s weight. Pain in the lower back may sometimes radiate to the legs. This is referred to as lumbar radiculopathy. Lumbar radiculopathy can be extremely debilitating and interfere with your daily activities.

To understand lumbar radiculopathy, you need to know a little about spinal anatomy. The spine consists of 33 vertebral bones stacked one on top of the other with cushioning discs lying between each vertebra. The lumbar region of the spine (below the rib cage) consists of 5 vertebrae. Nerves of the spinal cord in this region communicate with the lower body through spaces between the vertebrae. Trauma to the spine, age and overuse can result in deterioration of the vertebral bones and joints or bulging of the discs. The resultant loss of space can lead to compression of the spinal nerve roots. Depending on the area being supplied by the nerve, symptoms are experienced in the lower extremities.

Symptoms

Cervical radiculopathy symptoms

Cervical radiculopathy can result in pain, numbness, or weakness in the shoulder, arm, wrist or hand. Patients with radiculopathy present with weakness, problems manipulating small objects, and difficulty with normal gait.

Lumbar radiculopathy symptoms

Common symptoms include a sharp or burning pain that travels down one leg. Other symptoms include numbness, tingling and muscle weakness. Occasionally, leg pain occurs without the back pain. A thorough evaluation is necessary to identify your spine as the actual source of your pain.

Diagnosis

Cervical radiculopathy 

Your doctor will perform a physical examination to diagnose cervical radiculopathy. A magnetic resonance imaging (MRI) scan of your spine may be ordered to confirm the diagnosis and to rule out the other conditions causing similar symptoms.

In addition to a complete history and physical examination, your doctor can use several diagnostic tests such as spine X-ray, spine MRI or spine CT scans and electromyography and nerve conduction studies to diagnose cervical radiculopathy.

Lumbar radiculopathy

Your symptoms and history are reviewed and a detailed physical examination is performed. If the pain originates in the spine, it usually follows a specific pattern of distribution that your doctor identifies and correlates with a particular spinal level or nerve root. Imaging studies are performed to confirm the diagnosis.

Treatment

Cervical radiculopathy

When conservative treatment measures such as rest, medication, physical therapy, and pain blocking injections are ineffective, your surgeon may recommend spine surgery.

The most common spine surgery to relieve symptoms of nerve root compression involves removing the disc and fusing the two vertebrae above and below it with a bone graft. A newer treatment option is now available to replace the herniated disc with an artificial disc. Artificial discs are used in place of a bone fusion to preserve neck movement and flexibility.

A decompressive laminectomy and fusion is a common surgery for treating patients with cervical radiculopathy. It is a surgical procedure in which a portion of the bone or lamina causing pressure on the nerves is removed. In spinal fusion, a piece of bone, taken from elsewhere in the body is transplanted between the adjacent spinal bones (vertebrae). As the healing occurs, the bone fuses with the spine.

Lumbar radiculopathy

Most cases of lumbar radiculopathy are transient and can be treated by conservative methods such as rest, activity limitation, anti-inflammatory medications, spinal manipulation, spinal injections, physical therapy, specific home exercises and other modalities. A specific treatment plan is formulated to effectively relieve your symptoms and ensure a quick return to your regular activities. If symptoms are severe or persistent surgery may be recommended.

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