The Basics of Radiculopathy

 

sciaticaRadiculopathy is the term for the condition that occurs from a pinched nerve in the spine. The symptoms occur when surrounding bones, muscles, cartilage, and/or tendons are injured or deteriorate.

Trauma causes these structures to change positions so they put pressure on the nerve roots that exit the spinal cord. When nerve roots are compressed, they become irritated and inflamed, which results in weakness, numbness, tingling, and pain.

The type of radiculopathy depends on the location of the compressed nerve. The spine has three main sections: cervical (neck), thoracic (mid-back), and lumbar (low back). Cervical radiculopathy is pressure on a nerve root of the cervical vertebrae, which leads to burning, tingling, and weakness of the neck, arms, and shoulders.

Thoracic radiculopathy occurs when there is a pinched nerve in the middle section of the spine. This results in pain and tingling of the torso and chest. With lumbar radiculopathy, there is pressure on a nerve root of the low back area, which leads to sciatica (shooting pain down the legs).

Causes of Radiculopathy

Radiculopathy occurs when a nerve root is compressed by one of the neck or back structures, and most often from a herniated spinal disc. The pressure from the herniated disc leads to inflammation, which interferes with nerve function. The outer rim of the disc tears or weakens, causing the central jelly-like material (nucleus) to push outward and put pressure on the spinal nerve.

Additionally, bone spurs can form around a disc, which will cause it to weaken or collapse. Bone spurs also invade the narrow spinal column space, causing compression of nerve roots.herniated disc4

Risk Factors for Radiculopathy

Lumbar radiculopathy occurs in approximately 4% of the population, affecting men and women equally. However, men are usually affected in their 40s, whereas women are affected in their 50s. Cervical radiculopathy occurs much less than lumbar radiculopathy with an annual incidence of 85 cases per 100,000 people. Risk factors include:

  • Age – Changes in the disc and vertebrae occur with age, with radiculopathy mostly affecting people between 30 and 50 years.
  • Conditions – Certain conditions increase the risk of radiculopathy, such as arthritis, obesity, and diabetes.
  • Bone spurs – These occur from osteoarthritis and trauma.
  • Heredity – Many orthopedic conditions have a genetic component.

Radiculopathy Symptoms

The symptoms of radiculopathy vary from patient to patient. Symptoms also depend on the location of the compressed nerve. The manifestations include:

  • Sharp pain that travels down to the arm or foot
  • Sharp pain that worsens with abdominal pressure from coughing or sneezing
  • Numbness of the foot and/or leg
  • Weakness or tingling of the extremity
  • Changes in sensation
  • Hypersensitivity
  • Loss of reflexes

Treatment of Radiculopathy

Ideally, treatment aims to resolve the underlying cause of radiculopathy and focuses on restoring the nerve root to normal function. Effective treatment options include:

  • Medications – The doctor can prescribe topical agents (patches, creams, and gels) or oral pain medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or narcotics.

 

  • Physical therapy – The therapist instructs the patient on exercises that allow for improved strength and flexibility of the spine.Lumbar_Transforaminal_Epidural(1)

 

  • Epidural steroid injection (ESI) – The layer of tissue outside of the spinal cord is called the epidural. With ESI, the doctor injects a steroid medication with or without an anesthetic into the epidural space.

 

  • Intradiscal injection – The doctor injects a combination of steroid, local anesthetic, and physiologic saline into the disc. This injection, done under x-ray guidance, creates pressure in the disc to alleviate the pain associated with bulging.

 

  • Trigger point injection (TPI) – Near the bulging disc along the spine, the doctor injects a local anesthetic with or without a corticosteroid directly into the muscle or soft tissue.

 

  • Transcutaneous electrical nerve stimulation (TENS) – The TENS unit is a small device that delivers electrical impulses to the nerve strands near the bulging disc. This stimulates the body to produce endorphins (natural painkillers) and prevents pain signals from reaching the brain.

 

  • Regenerative therapy – Stem cells, collected from the bone marrow and adipose tissue, are transferred into the disc in an outpatient procedure. This allows the disc to essentially repair itself.

 

  • Spinal decompression therapy – This is a type of traction applied to the spine to create a negative pressure in the disc to reposition the bulging disc material. It also allows for a lower disc pressure that causes healing nutrients to go into the disc.

 

Resources

Tarulli AW, Raynor EM. Lumbosacral radiculopathy. Neurol Clin. May 2007;25(2):387-405.

Radhakrishnan K, Litchy WJ, O’Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. Apr 1994;117(pt 2):325-35