Radiculopathy

Overview

Radiculopathy refers to symptoms that develop when there is compression of a spinal nerve root. Most commonly, the nerve compression is related to a disc herniation or spondylosis (degenerative changes in the spine) and may occur with or without trauma. It is important to note that not all disc herniations cause nerve compression or pain. While any nerve root can be affected, the lower cervical (neck) and lower lumbar (low back) levels are the most common. Because the fibers of one spinal nerve root provide sensation and strength in a specific region of the body, arm, or leg, a compressed nerve will cause symptoms in the region where the nerve provides strength and sensation. Nerves in your neck provide sensation and strength in your arms, while nerves in your low back provide sensation and strength in your legs.

Radiculopathy is characterized by:

  • Pain. For cervical radiculopathies, the pain often radiates from the neck and down the arm (sometimes to the shoulder/scapula). For lumbar and lumbosacral radiculopathies, the pain radiates from the low back down the buttock and leg.
  • Numbness or tingling. These sensory changes may be present in the arm/hand or leg/foot.
  • Weakness. For a cervical radiculopathy, you may have weakness in your arm/hand and notice that you drop things or have difficulty lifting things. For a lumbar radiculopathy, you may have weakness in your leg/foot and notice that you have trouble walking and catch your toe on things.
  • Bladder or bowel changes. Less commonly, the nerves affecting the bladder and bowel can become compressed and contribute to loss of control and incontinence of bladder or bowel function.

The symptoms associated with radiculopathy are typically unilateral (affecting one side of the body). The pain can worsen with certain movements of the neck or low back, with prolonged sitting or walking, and sometimes with coughing or sneezing.

  • If you have severe pain that isn’t relieved with over-the-counter pain relievers
  • If you have weakness in your arm or leg
  • If you have any signs or symptoms of infection (e.g., fever)
  • If you have difficulty controlling your bladder or bowel function
  • If you have significant unintentional weight loss

Radiculopathy is caused by impingement of a spinal nerve root. The most common cause of compression is a disc herniation and/or degenerative changes in the spine. Spondylolisthesis (when a vertebra is out of alignment relative to the adjacent vertebra) may also contribute. Less common causes of nerve compression include cyst, fracture, infection, and tumor.

Risk factors for radiculopathy include aging, improper lifting techniques, repetitive motions, being overweight, poor posture, and a family history of degenerative arthritis. Radiculopathy may be more common in those who participate in contact sports, when compared to the non-contact sports.

The diagnosis of radiculopathy is based on your medical history and a physical examination, including evaluation of nerve function (testing reflexes, strength, and sensation). The provider may move the neck, arms, back, and legs in certain ways.

An X-ray is often performed and can show if there is arthritis and degenerative changes in the spine or if the vertebra is out of alignment. An X-ray may show a fracture of the spine as well.

Sometimes more advanced imaging of the spine is recommended (such as a CT scan or MRI) to evaluate for a disc herniation and nerve compression and to rule out other causes of radiculopathy.

An EMG (electromyogram) is a needle test that can be done to assess the health of muscles and nerves and can show evidence of a nerve problem such as radiculopathy.

Typically, radiculopathy can be treated successfully without surgery. Treatment recommendations will depend on the severity of the radiculopathy and associated symptoms. Once the symptoms are gone, it is important to return to normal activities gradually.

Over-the-counter pain relievers can provide relief, such as non-steroidal anti-inflammatory drugs like ibuprofen (Aleve), naproxen (Advil and Motrin), or acetaminophen (Tylenol). A brief burst of oral steroid is sometimes considered to reduce pain and inflammation. Gabapentin or pregabalin are medications that are sometimes prescribed to treat nerve pain.

  • Activity modification. Avoid positions and activities that make the symptoms worse.
  • Ice and heat application
  • Physical therapy. Your provider might refer you to physical therapy for exercises. The last part of therapy may include sport-specific rehabilitation for athletes.   

Injections

Steroid injections (epidural steroid injection) may be considered for severe pain or pain that does not respond well to more conservative treatments.

In some cases, surgery may be necessary to remove the compression on the nerve, particularly if you have progressive weakness or your symptoms don’t improve with more conservative treatments.

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