Cervical Radiculopathy

INTRODUCTION

Cervical radiculopathy occurs when a nerve in the neck is irritated as it leaves the spinal canal. Commonly thought of as a “pinched nerve,” cervical radiculopathy is generally a result from a herniated disc or bone spur that is pressing against an inflamed nerve root. Most often these are a result of degenerative changes in the neck.

Learn about cervical radiculopathy including:

• How the cervical spine is affected
• What symptoms accompany the condition
• How the condition is diagnosed
• What treatment options are available

ANATOMY

In order to understand your symptoms and treatment choices, it is helpful to start with a basic understanding of the anatomy of the neck. This includes becoming familiar with the various parts that make up the cervical spine and how they work together.

CAUSES

CERVICAL RADICULOPATHY (“PINCHED NERVE”)

Nerve roots that go from the spinal cord in the cervical spine travel into the arm. Along the way, these nerves supply sensation (feeling) to areas of the skin from the shoulder to the fingers. They also carry electrical signals to muscles that move the arm, hand and fingers. Problems occur when one of these nerves become inflamed due to a pinched herniated disc, or a bone spur. This may show up as weakness, numbness and pain where the nerve travels. The pain may feel deep, dull and achy. You may also have sharp, shooting pain along the path of the nerve. Muscles controlled by the affected nerve root may also weaken. In the neck, this condition is called cervical radiculopathy.

DISC HERNIATION

The neck is subject to tension and pressure when the neck moves. The disc between each vertebra responds by acting as a shock absorber. Bending the neck forward compresses the discs between the vertebrae and tends to bulge the discs backward toward the spinal canal and nerve roots.

Problems may occur when the center part of the disc, the nucleus pulposus, squeezes out of the disc and puts pressure on nerves in the neck. This condition, called disc herniation, can happen when a tear in the outer ring of the disc (the annulus) allows the nucleus to squeeze through. The annulus can tear or rupture anywhere around the disc. If it tears next to the spinal canal, the nucleus can squeeze out and put pressure on the spinal cord or spinal nerves. Pressure against the nerve root from a herniated disc can cause numbness and weakness along the nerve. When the nerve root is inflamed, the added pressure from the disc may also cause vague, deep pain in the neck, shoulder and upper arm. It can also cause sharp, shooting pain to radiate along the pathway of the nerve.

This condition may occur when too much force is exerted on an otherwise healthy intervertebral disc. Heavy forces on the neck may simply be too much for even a healthy disc to absorb.

Herniated discs are more common in middle-aged adults. This is because the natural process of aging causes the discs to become weakened from degeneration. Less force is needed to cause the degenerated disc to herniate. Not everyone with a herniated disc has degenerative problems. Likewise, not everyone with degeneration will suffer a herniated disc.

BONE SPURS

In older people, degenerative disc disease can cause bone spurs to form near the nerve roots. If these bone spurs get big enough, they may begin to rub on the nerve root and irritate it. This usually occurs inside the foraminae, which are small openings on each side of the spinal column where the nerve roots leave the spine. An irritated nerve root that is squeezed by a bone spur can cause the same symptoms as a herniated disc in the neck, including pain, numbness and weakness in the arm.

SYMPTOMS

Cervical radiculopathy causes symptoms that radiate away from the neck. Although the problem is in the neck, the symptoms will be felt wherever the nerve travels, including the shoulder, arm, or hand. By locating the symptoms, your doctor can usually tell which nerve in the neck is having problems. Symptoms generally include:

• Pain
• Numbness and weakness
• Reflexes in the upper arm may also be affected

In addition, neck pain and headaches near the back of the head are common with cervical radiculopathy. The back of the head is called the occiput, which is why headaches in this area are called occipital headaches.

DIAGNOSIS

Finding the cause of your neck problem begins with a complete history and physical exam. Your doctor may order several diagnostic tests to find the exact cause of your neck pain as well as your symptoms. These include:

• Standard X-rays are usually a first step in looking into any neck problem. These include an oblique (angled) view, along with X-rays taken as you bend forward (flexion) and backward (extension)
• Your doctor will also determine whether other tests, such as an MRI, are needed

TREATMENT OPTIONS

CONSERVATIVE TREATMENT

• Medication
  Medications are commonly used to control pain, inflammation, muscle spasm and sleep disturbance.
• Cervical Collar
  A cervical collar is often used to provide support and limit motion while an injured neck is healing. It also helps keep the proper alignment. Cervical collars can be soft (made of foam) or hard (plastic). Because these collars can restrict head movement, you may need help with eating or other activities. The skin under the collar needs to be checked every day to prevent blisters or sores.
• Cervical Pillow
  A special pillow may help ease your pain at night and allow you to sleep better. Cervical pillows are specially designed to place the right amount of curvature in the neck while you sleep and to decrease the amount of irritation on the nerve roots. These pillows can be purchased from drug stores or from a physical therapist.
• Physical Therapy
  Your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, as well as improving your mobility and strength and helping you do your daily activities with greater ease and ability.

Therapists use cervical traction to gently stretch the neck and to relieve pressure on the irritated nerve root. Electrical stimulation eases muscle spasm and pain. Exercises focus on improving strength and coordination of the neck, shoulders and upper back. Therapy sessions may be scheduled two to three times each week for up to six weeks.

The goals of physical therapy are to help you:

• Learn correct posture and body movements to reduce neck strain
• Maintain appropriate activity levels
• Maximize your neck range of motion and strength
• Learn ways to manage your condition

ESI
If other treatments do not relieve your neck pain, you may be given an epidural steroid injection (ESI), also called a nerve block. An ESI provides a small amount of cortisone into the bony spinal canal. Cortisone is a strong anti-inflammatory medicine that may control the inflammation surrounding the nerves and may ease the pain caused by irritated nerve roots. This injection is often used when other conservative measures do not work, or in an effort to postpone surgery. This treatment is not always successful but may provide short-term help.

SURGICAL TREATMENT

Cervical radiculopathy doesn’t always improve with conservative care. Surgery may be recommended when the following conditions are present:

• Unbearable pain that does not respond to medical management
• Weakness that is progressing
• Evidence of spinal cord compression
• Bowel or bladder concerns

One of the most common operations used to treat a cervical radiculopathy caused by pressure from bone spurs and a herniated disc is an anterior cervical fusion.

After surgery, you may be placed in some form of neck brace for up to 12 weeks while healing. Learn more about cervical radiculopathy and treatment options on our website www.bportho.com or call (718) 759-6100 today.