Cervical Radiculopathy

Description

The spinal cord runs through a central bony canal composed of vertebrae. Nerves extend from the spinal cord between the vertebrae to innervate the entire body. The compression or irritation of these nerves results in radiculopathy. Cervical radiculopathy results from compression of spinal nerves in the neck. The effects are felt in the arms and hands.

Causes

Causes of cervical radiculopathy overlap with those of lumbar radiculopathy. These include disk herniation and osteophyte formation. A herniated disk can cause symptoms by both mechanical compression and chemical irritation from the contents of the nucleus pulposus. Cervical spondylosis is a degenerative process in the cervical spine that progresses with age. It is marked by disk degeneration and narrowing of the foramina and bone hypertrophy. It is a major cause of cervical radiculopathy.

Risk factors associated with cervical radiculopathy are cigarette smoking, heavy lifting, operating/driving heavy machinery that vibrates and repetitive motions associated with various sports. Trauma can also result in cervical radiculopathy.

Symptoms

Common symptoms of cervical radiculopathy include pain that can be dull, sharp or burning in nature. Other symptoms include weakness and numbness. Symptoms also correlate with the level at which the pathology occurs.

C5 Radiculopathy: Results in upper arm and shoulder pain but tingling and numbness are absent

C6 Radiculopathy: Pain and weakness extend from the neck to the biceps, wrist, thumb and index finger

C7 Radiculopathy: Pain and weakness extend from the neck to the triceps, hand and middle finger

C8 Radiculopathy: Pain extends from the neck to the hand; it is characterized by a weak hand grip and pain on the inside of the arm extending to the ring and little finger

Diagnosis

The first step in diagnosing cervical radiculopathy is an accurate history and physical exam. Your physician will ask you to describe your pain pattern. She or he will identify the specific areas where your pain occurs to determine which spinal nerve root(s) is/are compressed and/or irritated. Diagnostic imaging may include a CT scan, CT myelography or an MRI.

Management

Non-surgical treatment is effective in most cases of cervical radiculopathy. Immobilization with a soft collar can help minimize motion and reduce nerve root irritation. Long term immobilization should be avoided as it can lead to deconditioning and atrophy of neck muscles.

Physical therapy helps through improving the range of motion and strength training of neck muscles. It should be started after the initial symptoms improve. Physical therapy can also help with posture and ergonomic training.

Cervical traction can be applied manually by the physical therapist or with a set of increasing weights.

Cervical epidural steroid injections are an option when the more conservative therapies discussed above do not result in a significant improvement of symptoms. These should be performed by an appropriately trained physician such as an interventional pain management specialist. These injections are usually done under radiographic guidance.

Potential indications for surgery include worsening neurologic deficits, compression of the spinal cord (myelopathy), cervical instability due to fractures, ligamentous injury and bony lesions.