Radiculopathy is a term that describes damage to spinal nerve roots. Radiculopathy may occur at any level along the spine. If the damage is to one or more nerve root(s) in your neck, it's called cervical radiculopathy. If the damage is to nerve root(s) in the low back, it's called lumbar radiculopathy.
Causes of Radiculopathy
Radiculopathy is usually a result of nerve root compression, which occurs when something puts pressure on the nerve root. Most of the time the pressure comes from a herniated disc. Bone spurs are another common cause of nerve root compression. Tumors, infections or vasculitis can also damage the nerve root, although this is rare.
Common symptoms of radiculopathy include neck and/or shoulder pain, headache and sharp pain, weakness, numbness, tingling or other nerve symptoms going down the leg (sciatica) or arm. Other symptoms may include impaired reflexes, weakness, muscle stiffness, limited motion, and -- with cervical radiculopathy -- aching or sharp pain when you extend your neck backward.
Are You at Risk for Radiculopathy?
You are at higher risk for radiculopathy if you are sedentary and/or if you drive a lot; sitting compresses your discs which may cause herniation and irritation of the nerve roots. If you have a chronic cough, this may bring on a disc herniation and radiculopathy as well. Pregnancy is another risk factor, as is heavy lifting and being male. Smoking is associated with an increased risk of radiculopathy.
Each nerve root supplies nerve function (feeling and movement impulse) to specific zones in the body through which their respective nerves travel. In the skin, the zones are called dermatomes. When referring to muscles, the zones are called myotomes.
During your physical exam, the doctor will test for pain, loss of feeling, reflexes and muscle strength in each of the zones. By identifying which dermatome(s) and myotome(s) are affected, she can determine which spinal nerve root(s) are damaged. The physical exam may include tests that "reproduce your pain," to help the doctor determine the nature of the nerve root damage. Diagnostic tests may help confirm findings from the physical exam, or further pinpoint the area from which your symptoms may be arising.
Conservative Treatment for Radiculopathy
Treatment for cervical and lumbar radiculopathy begins non-invasively. This may include some combination of pain medications, physical therapy, avoiding activities that bring up the pain, immobilization and traction.
Physical therapy will help you stretch and strengthen your muscles; you may get traction while in PT. If you have cervical radiculopathy, wearing a collar to immobilize your neck may be part of your treatment. By limiting motion and allowing your soft tissue to rest, the collar may help relieve your symptoms. You may also be given a cervical pillow to use while you sleep. The pillow will keep an optimal degree of curve in your neck, taking pressure off the nerve roots.
Injection is another non-surgical approach that may be used, and it may help reduce swelling and pain, keeping you more comfortable. If the non-surgical approach fails to relieve the pain after 6 to 12 weeks, you may need surgery.
Surgery for Radiculopathy
If you do need surgery to relieve the symptoms of radiculopathy, the choice of specific procedure will likely depend on the location of the damage, your surgeon's expertise, if you've previously had spine surgery and the type of problem causing the radiculopathy.
Based on the variables mentioned above, common surgeries for radiculopathy include:
For cervical radiculopathy, the anterior cervical discectomy and fusion is given most often. Cervical discectomy with fusion may require a bone graft. Other common surgeries for radiculopathy in the neck include disc replacement or posterior cervical laminoforaminotomy. The posterior laminoforaminotomy may be done if you have only one herniated disc and it is coming out the side of the vertebra. Disc replacement surgery is still relatively new, but its use is on the rise.Surgery for Lumbar and Lumbosacral Radiculopathy
For radiculopathy caused by a herniated disc in the low back area, disectomy (either open or minimally invasive) is usually the preferred procedure. Generally lumbar disectomies are not accompanied by fusion. Minimally invasive spine surgeries include percutaneous manual nucleotomy, laser discectomy, and endoscopic disectomy, to name a few.
If your pain or other symptoms persist, it may be time to consider back surgery. If that's the case, discuss your options with your doctor.
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