Causes of Radiculopathy and How It Is Treated

Radiculopathy, also referred to as a "pinched nerve," is the compression of one or more nerves at their spinal roots. This disrupts how the nerve normally works, leading to nerve pain, weakness, and paresthesias (altered sensations).

Radiculopathy can be diagnosed based on symptoms and imaging tests like a CT scan. The treatment may involve medications, physical therapy, and spinal surgery.

This article looks at the causes and symptoms of radiculopathy and what can be done to diagnose and fix pinched nerves in the spine.

What Causes Radiculopathy?

Spinal nerve root compression occurs when changes in the spinal cord "pinches" a nerve either suddenly (due to an injury) or progressively (due to wear and tear of the spine). The compression alters the transmission of nerve signals, causing pain, weakness, and abnormal sensations.

Causes of a pinched nerve include:

• Herniated disc
• Degenerative disc disease
• Osteoarthritis ("wear-and-tear arthritis")
• Facet joint deterioration
• Bone spurs
• Spinal stenosis
• Spinal injury
• Tumors. both cancerous and non-cancerous
• Certain infections like shingles or Lyme's disease
• Diabetic neuropathy
• Injury following a spinal epidural

Compressed spinal nerve roots can occur anywhere from the cervical spine in the neck area to the lumbar spine in the lower back. In between is the thoracic spine of the upper and middle back.

Certain lifestyle factors place you at increased risk of radiculopathy, including:

• Obesity
• Sedentary lifestyle
• Routine long-distant driving
• Pregnancy
• Routine heavy lifting
• Smoking

What Radiculopathy Feels Like

The main symptoms of radiculopathy are radicular pain (nerve pain that can radiate to other parts of the body), muscle weakness, and paresthesia (numbness, burning, tingling, or pins-and-needles sensations).

Symptoms of radiculopathy vary based on which part of the spine is affected:

• Cervical radiculopathy can cause pain, weakness, and/or paresthesia in the shoulder or arm.
• Thoracic radiculopathy can cause pain starting in the middle back that travels around to the chest. This type of radiculopathy is rare.
• Lumbar radiculopathy can cause pain, weakness, and/or paresthesia that starts in the lower back and radiates through the buttock and down the back of the leg. This type of radiculopathy is known as sciatica.
  

How Is Radiculopathy Diagnosed?

The diagnosis of radiculopathy involves a review of your medical history, a neurological exam, and imaging tests to help locate the area of compression.

A neurological exam is a series of in-office tests that, for the purpose of radiculopathy, aims to identify abnormal sensations and reflexes and to check for a loss of mobility or motor skills.

Imaging tests commonly used for radiculopathy include:

• Spinal X-ray
• Computed tomography (CT): A technology that composites multiple X-rays for a more detailed, three-dimensional image
• Magnetic resonance imaging (MRI): A non-radioactive imaging study that is especially good at detecting soft tissue injuries like a herniated disc

In addition, a nerve conduction study with electromyography (NCS/EMG) can determine if the cause of your symptoms is neurological or muscular.

Can Radiculopathy Be Treated?

Typically, radiculopathy is treated with conservative therapies such as over-the-counter (OTC) painkillers and rest. It is only when these options fail that more aggressive treatments are considered.

Non-Surgical Options

Some cases of radiculopathy respond well to OTC nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen). Severe cases may require a short course of a prescription corticosteroid (steroid) drug like prednisone.

These drug treatments may be combined with:

• Immobilization of the spine with a neck brace or back brace
• Ice applications performed for 10 to 15 minutes several times a day to reduce pain
• Cortisone injections to provide longer-lasting relief from severe back pain
• Physical therapy to strengthen and stabilize your core muscle

Surgical Options

If conservative therapies fail to relieve pain after six to 12 weeks, you may need surgery. The choice of procedure will largely depend on the type and location of the spinal nerve root compression.

Examples include:

• Discectomy: The most common treatment for a herniated disc involves the surgical removal of the herniated (bulging) disc.
• Discectomy with fusion: The fusion of adjacent spinal bones may help stabilize the spinal column after a discectomy. This procedure may require a bone graft.
• Disc replacement: This relatively new surgical technique replaces a damaged disc with an artificial one.
• Posterior cervical laminoforaminotomy: This operation is done from the back of the neck to relieve pressure on one or more cervical spinal nerves.

Summary

Radiculopathy is a pinched spinal root nerve. Symptoms include pain, weakness, and abnormal sensations like burning or numbness. The location of the symptoms can vary based on which part of the spine is affected.

A herniated disc, osteoarthritis, and bone spurs are just a few of the possible causes of radiculopathy. Treatment options include rest, spinal immobilization, OTC or prescription painkillers, physical therapy, cortisone shots, and possibly surgery.