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RADICULOPATHY

Doctors use the term radiculopathy to specifically describe pain, and other symptoms like numbness, tingling, and weakness in your arms or legs that are caused by a problem with your nerve roots. The nerve roots are branches of the spinal cord that carry signals out the rest of the body at each level along the spine. This term comes from a combination of the Latin word radix, which means the roots of a tree, and the Latin word pathos, which means a disease. This disease is often caused by direct pressure from a herniated disc or degenerative changes in the cervical spine that cause irritation and inflammation of the nerve roots. Radiculopathy usually creates a pattern of pain and numbness that is felt in your arms or your legs in the area of skin supplied the by sensory fibers of the nerve root, and weakness in the muscles that are also supplied by the same nerve root. The number of roots that are involved can vary, from one to several, and it can also affect both sides of the body at the same time.

Symptoms

The most common symptom of cervical radiculopathy is pain that radiates down into your arms from your neck. Sensory symptoms are more common than motor symptoms, and muscle weakness is usually a sign that the nerve compression is more severe. The quality and type of pain can vary, from dull, aching, and difficult to localize, to sharp, burning, and easy to pinpoint. Radiculopathy can create hypersensitivity to touch as well as numbness in the area of skin that is supplied by the nerve root. Pain in your arms as well as in your neck is usually the first sign that your nerve roots are irritated by a problem in your neck. Symptoms such as numbness and tingling, and especially weakness in the muscles of your arms are warning signs that your problem may be more serious. Weakness in your arms is a definite sign that you should see a doctor about your neck pain.

Diagnosis

There are several different causes of radiculopathy, but the correct diagnosis of the cause of your symptoms begins with a complete physical examination of the neck, arms and lower extremities. Your doctor will examine your neck for flexibility, range of motion, and the presence of certain signs that suggest that a particular nerve root is being affected. This often involves testing the strength of your muscles and checking your reflexes to make sure that they are still working normally. You will often be asked to fill out a diagram that asks you where your symptoms of pain, numbness, tingling and weakness are occurring.

A routine set of x-rays is also usually ordered when a patient with neck pain goes to see a doctor. An MRI scan or a CT scan can also be part of the evaluation for the causes of radiculopathy. An MRI scan is very useful for determining where the nerve roots are being compressed because this type of a scan is designed to show the details of soft-tissue structures, like nerves and discs. A CT scan is often used to evaluate the bony anatomy in the cervical spine, which can show how much space is available for the nerve roots and spinal cord within the spinal canal. The nerve roots exit the spinal canal through a bony tunnel called the neuroforamen, and it is at this point that the nerve roots are especially vulnerable to compression.

In many instances, A CT scan or an MRI is often not ordered until a decision has been made to proceed with surgery. This is because scientific studies show many people with “normal” necks have evidence of significant cervical disc herniations on MRI scans that could be held responsible for nerve root compression, and yet these people do not have any symptoms of neck pain. Therefore, MRI’s are usually ordered only when the diagnosis is unclear, or after it becomes apparent that the patient is not going to get better with non-surgical options and the surgeon needs to determine what type of surgery is best to relieve the symptoms.

Surgery for radiculopathy is offered as an early option for people who have evidence of muscle weakness that is being caused by nerve root or spinal cord compression. This is because muscle weakness is a definite sign that the nerves are being injured (more seriously than when pain is the only symptom) and relieving the pressure on the nerves is more of an urgent priority. In other situations, surgery is offered after physical therapy, rest, and medications have failed to adequately relieve the symptoms of pain, numbness and weakness.

For more information about the surgery for foraminal stenosis, please see ACDF, Artificial Disc Replacement and Cervical Foraminotomy