Cervical Radiculopathy

Cervical radiculopathy refers to neck pain that radiates to the shoulder and arm caused by compression or inflammation of a spinal nerve root in the neck region. Cervical radiculopathy is also referred to as nerve root impingement, nerve entrapment, or pinched nerve.

The cervical spine begins at the base of the skull and is made up of the first 7 vertebrae of the neck and comprises of 8 pairs of cervical nerves. The cervical nerve roots are large nerves that branch from the cervical region of the spinal cord and leave the spinal column to travel into the arms, shoulders, upper back and hands. The cervical nerves control upper body motor and sensory activities. Therefore, cervical radiculopathy can affect hand movements and coordination or cause numbness or decreased sensation. Cervical radiculopathy occurs when a nerve in the neck (cervical region) is irritated or pinched while it leaves the spinal canal.

Nerve root compression may occur at 3 locations:

  • Neuroforamen- natural passageways on either side of the
  • Right or left of the neck and upper extremity
  • Central canal (area surrounding the spinal cord)

Causes

Cervical radiculopathy can be caused by herniated disc, bony overgrowths (osteophytes) from arthritis, spinal stenosis, and degenerative disc disease.

Symptoms

The main symptom of cervical radiculopathy is neck pain that spreads into the arm and shoulders. People can also get pain in between their shoulder blades. Occasionally neck pain that radiates and causes headaches can be a sign of cervical radiculopathy. A person with radiculopathy may experience difficulty lifting things, headache, and muscle weakness and numbness or tingling in fingers or hands.

Diagnosis

The workup for cervical radiculopathy consists of a detailed medical history, evaluation of the presenting signs and symptoms, physical examination, and neurological examination. Your doctor will test your strength of the muscles and sensation as well as reflexes. Your doctor will suggest certain diagnostic tests such as X-rays, CT or MRI scans, or myelography to provide better visualization of the anatomy of the intervertebral discs, spinal cord, and nerve roots. Other tests that may be performed are electromyography (EMG) to measure the electrical activity of the muscles and nerve conduction study (NCS) to evaluate the transmission of electrical signals as they move through a nerve.

Treatment

The majority of patients with cervical radiculopathy can often be treated conservatively. The conservative treatment options include anti-inflammatory and pain medications, muscle relaxants, spinal injections, physical therapy, braces to support the spine, traction, and acupuncture. Your doctor may recommend combining two or more treatment modalities, in order to increase your chances of successful treatment.

Surgery is usually recommended for patients with persistent pain or neurological dysfunction. There are several surgical procedures for cervical radiculopathy, which involves removing parts of bone or soft tissue causing the compression. The aim of the surgery is to decompress nerves and relieve the pressure. Surgical techniques that may be used include:

  • Anterior cervical discectomy and fusion : A surgical procedure where the disc and bone compressing the nerves is removed from the spinal level involved and the two vertebrae are fused together with bone graft and instrumentation.
  • Anterior cervical disc replacement : A surgical procedure performed in younger patients, typically with radiculopathy from a soft disc herniation, where the disc pressing on the nerves is removed and in its place a replacement disc prosthesis is implanted
  • Posterior foraminotomy : A surgical procedure for widening the neuroforamen, to relieve the pressure over the compressed nerves.

Your surgeon will discuss surgical options and the associated risks and benefits as well as recommend the most appropriate procedure for you. Your doctor is a reliable resource to help you understand your condition better.