From the Guidelines
Radiculopathy is a condition characterized by dysfunction of a nerve root associated with pain, sensory impairment, weakness, or diminished deep tendon reflexes in a nerve root distribution, as defined by the American College of Physicians and the American Pain Society 1.
Definition and Causes
Radiculopathy occurs when a nerve root near the spinal column becomes compressed, inflamed, or damaged, causing pain, numbness, tingling, or weakness that radiates along the path of the affected nerve. This condition commonly affects the cervical (neck) or lumbar (lower back) regions of the spine, resulting in symptoms that extend into the arms or legs respectively.
- The condition is often caused by herniated discs, bone spurs, spinal stenosis, or degenerative disc disease that puts pressure on nerve roots as they exit the spinal column.
- According to the American College of Physicians and the American Pain Society, radiculopathy is associated with pain, sensory impairment, weakness, or diminished deep tendon reflexes in a nerve root distribution 1.
Diagnosis and Treatment
- Treatment typically begins with conservative approaches including rest, physical therapy, anti-inflammatory medications like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), and sometimes muscle relaxants such as cyclobenzaprine (5-10mg three times daily) for acute episodes.
- For more severe pain, short-term oral steroids like prednisone (starting at 60mg daily with a tapering schedule over 1-2 weeks) may be prescribed, as recommended by the American College of Physicians and the American Pain Society 1.
- If conservative treatments fail, epidural steroid injections might be considered before surgical options, as suggested by recent studies 1.
- The goal of treatment is to alleviate pain, improve function, and prevent further nerve damage, while also considering the potential risks and benefits of each treatment option, as emphasized by the American College of Physicians and the American Pain Society 1.
From the Research
Definition of Radiculopathy
- Radiculopathy is defined as a syndrome of pain and/or sensorimotor deficits due to compression of a nerve root 2.
- It is characterized by neurological dysfunction caused by compression and inflammation of the spinal nerves or nerve roots of the cervical spine 3.
- Cervical radiculopathy is a neurological condition caused by dysfunction or compression of a cervical nerve root 4.
Causes and Symptoms
- The most common causes of cervical radiculopathy are cervical disc herniation and cervical spondylosis 2, 3.
- Symptoms include neck and arm pain, sensory loss, motor dysfunction, and reflex changes according to the dermatomal distribution 3.
- Patients often report unilateral neck pain with radiation to the ipsilateral arm, often with sensory changes in a dermatomal distribution 4.
- Weakness and reflex changes are also commonly found and can be very troubling for patients 4.
Diagnosis and Treatment
- Diagnosis is suggested by history and corresponding physical examination findings, and confirmation is achieved with MRI 5.
- A multimodal approach to treatment helps patients improve, including medications, physical therapy, and guided corticosteroid injections 5.
- Non-surgical treatments are recommended as an initial management, and surgery is applicable to patients with intractable or persistent pain despite sufficient conservative management or with severe or progressive neurological deficits 3.
- Surgical treatment options include anterior cervical decompression with fusion and posterior cervical laminoforaminotomy 2.