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Cervical Radiculopathy

What is a Cervical Radiculopathy?

A is pain felt from an irritated . Even though the nerve is pinched in the neck, most of the pain is often felt in the arm.

This if often confusing to patients who believe the problem must be in the arm itself.

What causes a Cervical Radiculopathy?

In younger patients, the nerve is often pinched by a Disc Herniation.

In older patients, the reasons are often more diverse: At times, it is the fact that the disc height has been lost. When this occurs, there is less room for the spinal nerves to leave the spine through an opening called a ‘which is a nerve channel. In other patients, the foramen is narrowed because of bone spurring from Arthritis of the neck joints (facet joints). A narrowed cervical foramen (nerve channel) is called “Cervical Foraminal Stenosis”.

What symptoms does a Cervical Radiculopathy cause?

While patients may have some neck and shoulder pain with this condition, the pain is often worse in the arm and even the hand. The pain often follows the exact path of the nerve from the neck down into the arm and hand. Some patients only experience the arm or hand pain without any neck symptoms.

Here are some of the typical symptoms:

  1. Pain shooting into the arm from the neck
  2. Pain is often felt as a sharp, burning sensation
  3. Pain is present most of the time
  4. Numbness or tingling in the arm
  5. Weakness in the arm
  6. Symptoms improved when placing the hand over the head

How do Spine Specialists diagnosis a Cervical Radiculopathy?

The diagnosis of a cervical radiculopathy depends on a complete history, physical examination, and spinal images.

  1. History

The symptoms reported by the patients are often the first key in the diagnosis. Pain in the neck which travels to the arm and is relieved by placing the hand over one’s head are all very classic symptoms. Numbness or tingling in the arm and the feeling of weakness can also occur and help confirm the diagnosis.

      2. Physical Examination

Here are some of the common physical examination techniques used:

  1. Mobility of the neck (range of motion testing)
  2. Palpation (touch and pressure) of the neck, shoulders and arms (spine palpation)
  3. Testing of the sensation, strength and reflexes in the arms (spine neurological testing)
  4. Spurling’s test
  5. Gait testing
  6. Neck compression test
  7. Neck distraction test
  8. Valsalva test
  9. Ankle Clonus test
  10. Hoffman’s test
  11. Lhermitte’s sign

 

     3. Spine Images

In order to obtain more information about the problem, special spine images are often ordered. Here are some of these imaging studies:

a. X-Rays                                                             

A plain X-Ray can be helpful in diagnosing a cervical radiculopathy. In older patients the narrowing of a foramen (nerve channel) may be seen if it is due to a bone spur or loss of the height of a disc. However, the spinal nerve or disc itself cannot be seen.

b. CT Scans

A CT scan can show the bone anatomy of the neck in much more detail than plain X-Rays. Bone spurring which causes the foramen (nerve channel) to narrow can be seen very clearly. However, the and can be difficult to visualize. Also, CT scans involved significant radiation.

3. MRI Scans

An MRI scan is often the preferred test since it can show the most detail about the important softer structures such as discs, spinal cord and spine nerves. Since a cervical radiculopathy results from an irritated spinal nerve, visualizing this nerve is important. The MRI allows the spine specialist to see the critical structures and be able to evaluate if the spinal cord itself is at risk or involved. The bone anatomy of the neck is not seen as clearly as it is on a CT scan but typically well enough to know if a bone spur is the cause or a contributor to the nerve irritation.                       

4. EMG/NCS

Electromyograms (EMG) and Nerve Conduction Studies (NCS) can help verify which nerve is involved in the Cervical Radiculopathy. These studies can also tell how severe the nerve compression is and whether the nerve appears to be recovering.       

 

How do Spine Specialistis treat a Cervical Radiculopathy?

Here are some of the Non-Surgical and Surgical treatments available:

  1. Non-Surgical Care

Non-surgical treatments are usually recommended prior to surgery, unless a patient has significant neurological problems related to the nerve compression, such as significant arm weakness or loss of muscle mass (atrophy). The majority of patients respond to conservative care and will not need surgery. Some of the conservative, less invasive ways to treat a cervical radiculopathy are:

a. Alternative Health Care

b. PT, Massage Therapy and Meditation exercises can help with the pain from a Cervical Radiculopathy.

c. Chiropractic Care: Chiropractic care offers specific techniques to relieve nerve compression and offer help with pain and dysfunction.

d. Spine Exercises: Spine exercisescan help prevent the loss of muscle mass from a pinched nerve in the neck. They often focus on shoulder and arm strength and mobility.

e. Physical Therapy (PT): PT offers specific treatments for pinched nerves in the neck. They include and muscle treatments for pain relief. PT also can maintain and even regain muscle mass and tone. Traction can be used to stretch the neck, thereby increasing the room available for the nerve in the foramen (nerve channel). Home traction can also be prescribed and a device provided by the Physical Therapist. Electrical muscle stimulation can calm muscle spasms. Certain exercises can help maintaining the best possible neck position and keep muscles from losing strength. Soft spine collars can help keeping the neck from moving too much which could exacerbate the pain.

f. Self Help Devices: Certain Self Help Devices such as andcan be very helpful for pinched nerves in the neck. There are also and heating pads which can offer some relief. Ergonomic devices such as special and can help with the pain at work.

g. Medications: Here are some of the commonly prescribed medications for this condition:

 1. Non-Steroidal Anti-inflammatory Drugs (NSAIDS) are often used and may be helpful in reducing the inflammation and subsequent swelling of a spinal nerve.

2. Steroids are more potent than non-steroid anti-inflammatory medications and can be very helpful in controlling severe pain, especially when the pain first starts. They are usually given by mouth for the short term only. However, they are often more difficult to tolerate due to side effects.

3. Pain Killers can also help, but unlike the anti-inflammatory medications do not treat the problem itself, but rather the symptoms of the problem. Pain killers can be non-narcotic or narcotic in nature.

4. Nerve Pain Medications. These medications belong to different groups of medications such as antidepressants or anti-seizure medications which have nerve pain relieving properties.

5. Antidepressants: Some antidepressant medications can have nerve pain relieving properties.

h. Epidural Steroid Injections

Sometimes injections are used to relieve pain. They can be very helpful, especially for severe pain. Epiduralsteroid injections are done to deliver an injectable steroid medication directly to the nerve. Compared to taking steroids by mouth, this can deliver a larger amount of steroid to the nerve and bypass some of the side effects from oral steroids.

Here are some different types of injections which can help:

Cervical Interlaminar Epidural Steroid Injection

Cervical Interlaminar Epidural Steroid Injection

Cervical Nerve Root Block

 

      2. Surgical Care

Surgery is usually reserved for patients who do not improve with more conservative (less invasive) care or have very severe symptoms which require surgery to improve the patient’s quality of life.

Here are some of the surgeries done for Cervical Radiculopathies:

A. Minimally Invasive Surgery

1. Cervical Endoscopic Laminotomy/Discectomy

2. Percutaneous Cervical Discectomy

3. Anterior Cervical Endoscopic Microdiscectomy

 

B. Open Surgery

1. Cervical Fusion Surgery (ACDF)

2. Cervical Artificial Disc Replacement

3. Cervical Laminotomy/Foraminotomy

4. Cervical Laminotomy/Discectomy