Radiculopathy, commonly known as a "pinched nerve," is a condition resulting from compression of the nerve roots of the spinal cord. Radiculopathy can occur in the cervical, thoracic, or lumbar spine. In the following, we provide more information about this condition and how it can be treated.
The spine is structured by a series of vertebrae that form a channel housing the spinal cord. Nerve roots extend out from the spinal cord and passing through the foramina, which are small lateral holes that form between two spinal vertebrae. When these nerve roots are pinched or compressed, it usually causes pain and other symptoms of radiculopathy.
Types of radiculopathy
Symptoms of radiculopathy can vary depending on the location of the pinched nerve, and often include pain, weakness, numbness, and tingling.
- Lumbar radiculopathy The lower back is the area most susceptible to radiculopathy. It is more commonly known as sciatica, because the nerve roots that make up the sciatic nerve are often involved.
- Cervical radiculopathy occurs when a nerve root in the cervical spine is compressed or irritated. Since the nerve roots in this area primarily control sensations in the arms and hands, these are the parts of the body that are most likely to experience the symptoms. Most often, these symptoms include shoulder pain, muscle weakness, and numbness.
- Thoracic radiculopathy. This refers to a compressed nerve root in the thoracic area of the spine, that is, in the upper back. This is least the common location for radiculopathy, and its primary symptoms are tingling, pain, and numbness that can spread to the front of the body.
Back pain is an increasingly common condition among people of any age. This is due to our current lifestyle, with a tendency to sedentary habits and lack of physical activity. Instituto Clavel is dedicated to helping people resolve their issues with spinal health, so we are always happy to share recommendations on how to prevent and relieve back pain.
Advice on how to prevent or relieve back pain
What causes radiculopathy?
The most common cause of radiculopathy is a change in the tissues surrounding the nerve roots. These tissues include the bony material of the vertebrae, the intervertebral discs, and ligaments. When any of these tissues change in size or consistency, it can cause the foramina (small exit holes) through which the nerve roots pass to narrow. This is known as foraminal stenosis (it is similar to canal stenosis that affects the spinal cord, but more lateral, near where the roots begin).
In most cases, foraminal stenosis is caused by the gradual degenerative process of the spine as we age, but it can also be the result of a spinal injury. As the body begins to age, the discs in the spine degenerate and begin to bulge, and also become drier and harder. The body responds by growing more bone (bone spurs) to strengthen the discs, which can narrow the foramen as a result, pinching the nerve root.
Most common causes of radiculopathy:
- Disc herniation. A herniated disc, or large disc bulge, is one of the most common reasons for foraminal stenosis and radiculopathy. The intervertebral discs act like cushions between the vertebrae, but sometimes, they move out of place or become damaged and can press on nerves. This tends to occur most often in the lower back, but can also affect the neck area.
- Bone spurs. Bone spurs (also called osteophytes), are an additional growth of bone, which can narrow the foramina and ultimately lead to radiculopathy. Bone spurs can form in the spine as a result of an injury, or due to an inflammatory disease like osteoarthritis, or other degenerative conditions.
- Other causes. Thickening of spinal ligaments, especially the yellow ligament, can also lead to narrowing of the space around nerve roots and, as a consequence, cause compression of the nerves. Less common causes of radiculopathy are other spinal conditions or benign or malignant tumors that can press against the spinal nerve roots.
How is radiculopathy diagnosed?
In most cases, radiculopathy can be diagnosed with a physical examination including tests to check muscle strength, reflexes, numbness or loss of sensation, and posture. If you find making certain movements painful or difficult, this will help your doctor identify the affected nerve root. The examination will focus on your neck, shoulders, arms, and hands, depending on where your symptoms are.
Other diagnostic tests that your doctor may recommend:
- X-rays to check the alignment of the bones of the spine and to determine any vertebral displacement that could cause foraminal compression.
- Magnetic resonance imaging (MRI) to assess soft tissues of the spine, detect hernias, ligament growth, articular capsules, and other less frequent causes of radiculopathy such as nerve sheath tumors.
- CT scan to assess the bone, loss of disc height, check for presence of spurs or osteophytes, and possible excessive growth of the facet joints.
- Electromyogram to pinpoint the exact nerve root that is affected. This test is rarely needed, and used only when the diagnosis is unclear.
Treatment for radiculopathy
The appropriate treatment for radiculopathy will depend on the affected area and the cause of the condition, as well as a number of other factors. Nonsurgical treatment is always the first option and may include: medications, such as nonsteroidal anti-inflammatory drugs, opioids, or muscle relaxants that control symptoms; weight loss plans to reduce pressure on the problem area; physical therapy to strengthen muscles and prevent further damage; or steroid injections to reduce inflammation and relieve the symptoms.
Some more advanced cases, with acute pain, and with less favorable prognoses, will need surgery. Depending on the underlying pathology, this surgery will involve widening the canal or the foramen, removal of a hernia, or decompression of the elements that are placing pressure on the nerve root. Sometimes, spinal decompression surgery also involves stabilization of the vertebral segment by instrumentation, using elements like rods and screws, cages, implants, etc.
If you need a personalized evaluation of your case, or if you have any more questions about radiculopathy and how it is treated, Instituto Clavel is here to answer you.
Categories: Spine treatments, Spine pathologies, Cervical pain