What is radiculopathy?
Lower back pain, including radiculopathy, is one of the most common musculoskeletal medical complaints and the leading cause of disability in the developed world. The spine, also known as the vertebral column, is made up of individual vertebrae, as well as the sacrum and coccyx bones.
The spinal cord is housed inside this vertebral column and each of the spinal nerves are connected to the spinal cord by a root. These nerve roots then split away from the spinal cord and travel between the vertebrae into various areas of the body.
Radiculopathy refers to the various symptoms produced when one of the nerve roots in the spinal column becomes pinched. One of the hallmarks of radiculopathy is not necessarily back pain but pain in other parts of the body. The pinched nerve can occur at any area along the spine, including the cervical, lumbar and thoracic sections:
- Cervical radiculopathy occurs due to sustained damage at the root of the spinal nerves in the neck and cause pain and numbness in the neck that radiates down the shoulder and into the arm.
- Lumbar radiculopathy, commonly known as sciatica, is pain in the lower extremities that radiates from the lumbar spine, caused by compression at the roots of the spinal nerves, and generally causes discomfort in the lower back, hips and thighs, and travels down the legs.
- Thoracic radiculopathy, in the upper back, is the least common type of radiculopathy. The symptoms can cause pain and numbness that wraps all the way around to the front of the body.
Causes and Risk Factors
Radiculopathy is typically caused by changes in the vertebrae, intervertebral discs and tendons surrounding the nerve roots. These tissues shift or change in size due to various conditions or trauma.
The result can be narrowing of the foramina, which are the spaces where the nerve roots extend inside and outside the spine. This process is known as foraminal stenosis. Most cases of foraminal stenosis are caused by aging, which involves a gradual degeneration of the spine. However, a spinal injury may also cause foraminal stenosis.
Other causes of radiculopathy include:
- Herniated disc
- Bone spurs in the spine, which are areas of extra bone growth due to inflammation from degenerative conditions or trauma
- Ossification (thickening) of the spinal ligaments causing nerve root compression
More rare causes of radiculopathy include:
- Spinal infections
- Benign or malignant growths in the spine
Symptoms
Specific radiculopathy symptoms depend on the section of the spine where the nerve root is compressed. Some patients don’t experience any symptoms or may go through periods of flare-ups of symptoms.
When a nerve root is compressed, it becomes inflamed. The inflammation is what causes the painful and unpleasant symptoms of radiculopathy, including:
- Sharp pain in the back, arms, legs or shoulders that may worsen with various activity
- Weakness in the arms or legs
- Loss of reflexes in the arms or legs
- Paresthesia (abnormal sensations) in the arms or legs
- Numbness of the skin
- Prickly or “pins and needles” feeling in the arms or legs
Myelopathy. Some patients also have myelopathy in conjunction with radiculopathy, which is compression of the spinal cord, often by herniated or bulging discs. The inflamed discs can press on the spinal cord and on the nerve roots, making the radiculopathy symptoms more severe, including trouble walking, poor coordination and even paralysis.
Radiculopathy versus neuropathy. Radiculopathy symptoms may be similar or the same as those of peripheral neuropathy, making a correct diagnosis harder to find. Peripheral neuropathy occurs when the peripheral nervous system is damaged.
Carpal tunnel syndrome, which involves trapped nerves in the wrist, is an example of peripheral neuropathy. Radiculopathy from pinched nerves in the neck can also produce the same pain, weakness and numbness in the wrist and hand. A spine specialist may be needed for an accurate diagnosis.
Diagnosis
A physical exam may be used to check muscle strength and reflexes. If pain with certain movements is experienced, the affected nerve root is easier to identify. Imaging tests are also often ordered, such as X-rays, computed tomography (CT) scans or magnetic resonance imaging (MRI) scans.
These tests are used to see the structures in the affected area. Nerve conduction studies, along with electromyography (for checking the function of muscles), may also be ordered to help differentiate whether the problem is neurological or muscular.
Treatment
Radiculopathy treatment methods depend on the location of pain, the cause of the condition and other patient specific factors. The vast majority of radiculopathy cases are benign and resolve spontaneously on their own anywhere from within 2 to 12 weeks. Due to this fact, nonsurgical treatment is typically tried first and may include one or more of the following:
- Medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), opioids (with strict monitoring) and muscle relaxants to help manage symptoms
- Weight loss to reduce pressure on the affected area
- Physical therapy to strengthen muscles and prevent future damage
- Steroid injections to reduce inflammation and also relieve pain
When nonsurgical methods fail to control symptoms, surgery may become an option. Surgery is used to reduce pressure on the nerve root by widening the space where the nerve roots leave the spine. This type of surgery may involve removing all or parts of a disc and/or vertebrae. Cervical posterior foraminotomy is one of these minimally invasive spine surgical options.
If you are experiencing symptoms of radiculopathy, please call us today to schedule an appointment with one of our specialists.