Radiculopathy

What is Radiculopathy?

Radiculopathy, also known as a pinched nerve, refers to a set of neuropathic conditions caused by one or more compressed nerves in the spine at or near the level of the nerve root. Radiculopathy oftens causes uncomfortable symptoms like radicular pain, numbness, tingling, and weakness in the muscles ¹.

Radiculopathy has three distinct types according depending on their exact location of origins. These include Cervical Radiculopathy, Radiculopathy Thoracic , and Lumber Radiculopathy. Cervical Radiculopathy refers to a pinch nerve at the top of the spine or neck area. Thoracic Radiculopathy refers to Radiculopathy in the middle or chest area of the Spine or Back Area. Lumber Radiculopathy refers to Radiculopathy in the lower part of the back and hip area.

What are the main causes and risk-factors associated with Radiculopathy?

Radiculopathy can be induced by many factors such as disc herniation, bone spurs, trauma, osteoarthritis, spinal stenosis, inflammation, and tumors; in extremely rare cases, diabetes as well ^1–3.

Physicians caution patients to recognize the risk factors associated with Radiculopathy. These important risk factors include-

• Aging, race and hereditary factors;
• Poor posture, repetitive motions, and spinal abnormalities;
• People involved in heavy labor, sports, or military service.

Symptoms of Radiculopathy

Symptoms of radiculopathy vary according to their location of origin, whether recognized as cervical, thoracic, or lumbar radiculopathy.

Cervical radiculopathy

Cervical radiculopathy occurs for the compression of cervical nerve roots. It results because of the involvement of the sixth (60%) and seventh (25%) cervical nerves. The prevalence of cervical radiculopathy reported about 0.4% in the population ^4,5.

The associated symptoms may include:

• Pain in the arm, neck, chest, upper back, and shoulders.
• Lack of coordination in hand.
• Weakness in muscle and numbness or tingling in fingers or hands.

Thoracic radiculopathy

Thoracic radiculopathy represents an uncommon spinal disorder because of rare causes. This thoracic radiculopathy often not discovered for months or years, even after symptoms arise ³.

The common symptoms associated with this radiculopathy may include:

• Band like thoracic or abdominal pain.
• Numbness and tingling.

Lumbar radiculopathy

Lumbar radiculopathy refers to a condition involving the compression of the lumbar spinal nerve root. The estimated prevalence of lumbar radiculopathy is about 3% to 5% in the population ².

The associated symptoms may include:

• Pain in the low back, hips, and buttock.
• Numbness or weakness in the leg.
• Sharp or burning pain while sitting or extending the foot.

How do neurosurgeons diagnose Radiculopathy?

The initial diagnosis includes a complete history and physical examination of the patients. Doctors may further confirm by:

• Manual muscle testing,
• Sensory testing,
• Lasegue’s sign (for lumbar radiculopathy),
• X-ray,
• Electromyography (EMG),
• Computed tomography (CT) scan,
• Magnetic resonance imaging (MRI), etc.

What are the most effective treatments for Radiculopathy?

Most patients with radiculopathy respond well to non-surgical, conservative treatment. These treatments may include:

• Physical therapy (cervical traction and mobilization exercises) to strengthen the muscles in the back and around the spine;
• Medication, such as pain relievers, muscle relaxants, anti-depressants and non-steroidal anti-inflammatory drugs to reduce pain and inflammation;
• Chiropractic treatment to prevent worsening of the pain;
• Spinal manipulation;
• Corticosteroid injections or oral steroids to reduce swelling and inflammation around the nerve root.

About 75% to 90% of the patient’s symptoms diminish after non-operative treatment ⁶. In case of persistent pain of patients, surgery may be necessary to relieve the pressure. Surgical treatments for radiculopathy include anterior and posterior decompression, anterior cervical discectomy, laminectomy, foraminotomy, and laminotomy. Surgeons may choose a suitable procedure that fits the patient’s condition by taking the overall health and other individual factors as consideration^1–3,5.

What are the best methods to prevent Radiculopathy?

Though we can’t prevent all cases of radiculopathy but some strategies can reduce the risk of radiculopathy. These include:

• Maintaining healthy body weight,
• Playing sports, doing cycling,
• Regular lifting of weight,
• Staying fit and doing regular exercise, etc.

References:

1. Zhang X, Zhang Z, Wen J, Lu J, Sun Y, Sang D. The effectiveness of therapeutic strategies for patients with radiculopathy: A network meta-analysis. Molecular Pain. 2018;14(10). doi:10.1177/1744806918768972
2. Berry JA, Elia C, Saini HS, Miulli DE. A Review of Lumbar Radiculopathy, Diagnosis, and Treatment. Cureus. 2019;11(10). doi:10.7759/cureus.5934
3. Choi HE, Shin MH, Jo GY, Kim JY. Thoracic radiculopathy due to rare causes. Annals of Rehabilitation Medicine. 2016;40(3):534–539. doi:10.5535/arm.2016.40.3.534
4. Rodine RJ, Vernon H. Cervical radiculopathy: a systematic review on treatment by spinal manipulation and measurement with the Neck Disability Index. The Journal of the Canadian Chiropractic Association. 2012;56(1):18–28. http://www.ncbi.nlm.nih.gov/pubmed/22457538%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC3280115
5. Iyer S, Kim HJ. Cervical radiculopathy. Current Reviews in Musculoskeletal Medicine. 2016;9(3):272–280. doi:10.1007/s12178-016-9349-4
6. Thoomes EJ, Scholten-Peeters W, Koes B, Falla D, Verhagen AP. The effectiveness of conservative treatment for patients with cervical radiculopathy: A systematic review. Clinical Journal of Pain. 2013;29(12):1073–1086. doi:10.1097/AJP.0b013e31828441fb