From the Guidelines
Yes, uncovertebral hypertrophy can contribute to radiculopathy. According to the American College of Radiology 1, cervical radiculopathy is defined as a syndrome of pain or sensorimotor deficits due to dysfunction of a cervical spinal nerve, and it can result from compressive causes related to narrowing of the neural foramina, such as by facet or uncovertebral joint hypertrophy.
Key Points to Consider
- Uncovertebral joints are located in the cervical spine between adjacent vertebral bodies, and when these joints undergo hypertrophy or develop osteophytes due to degenerative changes, they can narrow the intervertebral foramen where spinal nerve roots exit 1.
- This narrowing can directly compress nerve roots, leading to radiculopathy, a condition characterized by pain, numbness, tingling, or weakness that radiates along the path of the affected nerve 1.
- Uncovertebral hypertrophy most commonly affects the lower cervical spine (C3-C7) and typically produces symptoms in the neck, shoulder, arm, and hand corresponding to the compressed nerve root's distribution.
Treatment Options
- Conservative measures such as physical therapy, anti-inflammatory medications, and activity modification can be effective in managing symptoms 1.
- More severe cases may require epidural steroid injections or surgical decompression through procedures like anterior cervical discectomy and fusion (ACDF) or posterior foraminotomy to relieve pressure on the affected nerve root 1.
- It is essential to note that in the absence of red flag symptoms, imaging may not be required at the time of initial presentation, as spondylotic changes are commonly identified on radiographs and MRI in patients over 30 years of age and correlate poorly with the presence of neck pain 1.
From the Research
Uncovertebral Hypertrophy and Radiculopathy
- Uncovertebral hypertrophy can contribute to radiculopathy, as it can cause compression and irritation of the nerve roots in the cervical spine 2.
- Cervical radiculopathy is characterized by neurological dysfunction caused by compression and inflammation of the spinal nerves or nerve roots of the cervical spine, and uncovertebral joint (UVJ) hypertrophy is one of the possible causes 3.
- The compression of nerve roots can occur anterior and lateral within the cervical intervertebral foramen, making it challenging to achieve complete decompression through anterior cervical approaches 2.
- Studies have shown that complete uncinatectomy during anterior cervical discectomy and fusion (ACDF) can be an effective treatment for cervical radiculopathy caused by UVJ hypertrophy, but it requires a careful microsurgical technique to avoid damage to the surrounding neurovascular structures 2.
Diagnosis and Treatment
- The diagnosis of cervical radiculopathy is suggested by history and corresponding physical examination findings, and can be confirmed with MRI or other imaging modalities 4, 5, 6.
- Nonoperative treatment, including physical therapy, nonsteroidal anti-inflammatory drugs, and epidural steroid injections, is often recommended as the initial management for cervical radiculopathy 4, 5, 6.
- Surgical treatment, such as anterior cervical decompression with fusion or posterior cervical laminoforaminotomy, may be indicated for patients with severe or progressive neurological deficits, or those who have not responded to conservative treatment 2, 3, 6.