Radiculopathies

Definition

Radiculopathy refers to a condition where one or more nerves are affected and do not work properly (a neuropathy).
This can result in pain, weakness, numbness, or difficulty controlling specific muscles.
It is often due to compression of the nerve root where it exits the spine.

Epidemiology

Pathophysiology

Nerve root compression often due to herniated disc, bone spur, or spinal stenosis.
Inflammation around the nerve root contributes to symptoms.
Impairment of blood flow to the nerve can also play a role.
Compression leads to demyelination and potential axonal loss.
Results in altered signal transmission and subsequent pain and sensory/motor deficits.

Aetiology/Causes/Risk factors

Types

Cervical radiculopathy – affects nerves in the neck.
Thoracic radiculopathy – less common, affects nerves in the mid-back.
Lumbar radiculopathy (sciatica) – affects nerves in the lower back.
Each type can be identified based on the specific nerve roots involved and corresponding clinical features.

Symptoms

Pain radiating along the affected nerve root distribution (dermatome).
Numbness and tingling in the area supplied by the nerve.
Muscle weakness in the muscles innervated by the affected nerve.
Loss of reflexes in the involved region.
Pain typically worsens with movements that compress the nerve (e.g., neck or back movements).
Symptoms may be aggravated by coughing or sneezing.
In severe cases, bladder and bowel dysfunction can occur (emergency).

Signs

Decreased muscle strength in the distribution of the affected nerve root.
Reduced or absent deep tendon reflexes.
Sensory loss corresponding to the dermatome.
Positive Spurling’s test in cervical radiculopathy (pain with neck extension and rotation).
Positive straight leg raise test in lumbar radiculopathy (pain with leg raising).
Gait abnormalities if lower limb involvement is significant.
Muscle atrophy in chronic cases.

Initial tests

Clinical history and physical examination to identify signs and symptoms.
X-rays to assess for bony abnormalities and alignment.
MRI is the gold standard for visualizing soft tissue structures, including disc herniation and nerve compression.
CT myelography if MRI is contraindicated.
Electromyography (EMG) and nerve conduction studies to assess nerve function.
Blood tests if an infectious or inflammatory cause is suspected.
Ultrasound can be used to visualize peripheral nerve involvement.

Diagnostic tests

MRI to identify disc herniations, nerve root compression, and other soft tissue abnormalities.
CT scan for detailed bone assessment.
Electromyography (EMG) to evaluate electrical activity of muscles and confirm radiculopathy.
Nerve conduction studies to assess the speed and strength of signals in the nerves.
Myelography to evaluate the spinal canal and nerve roots using contrast dye and X-rays.
Blood tests to rule out other causes like infection or systemic diseases.

Management

Conservative treatment includes physical therapy, NSAIDs, and activity modification.
Epidural steroid injections for inflammation and pain relief.
Surgical options if conservative measures fail or neurological deficits progress.
Discectomy or laminectomy to relieve nerve compression.
Rehabilitation post-surgery to restore function and strength.
Education on ergonomics and posture to prevent recurrence.
Pain management with medications or physical modalities.
Lifestyle modifications such as weight management and smoking cessation.

Complications

Prognosis

Key points

Radiculopathy is a common condition caused by nerve root compression.
Early diagnosis and treatment are crucial for preventing chronic symptoms.
MRI is the preferred diagnostic tool for visualizing nerve compression.
Conservative management is effective for most patients.
Surgical intervention may be necessary for severe or refractory cases.
Patient education and lifestyle modifications are essential for long-term management.
Regular follow-up and rehabilitation improve outcomes.

Neurosciences