What is radiculopathy?

What is Radiculopathy?

Radiculopathy is a neurological condition characterized by pain, sensory deficits, and/or motor weakness caused by compression or irritation of a spinal nerve root. 1

Clinical Definition and Pathophysiology

Radiculopathy occurs when a spinal nerve root becomes dysfunctional due to mechanical compression or chemical irritation. 2 The condition manifests as symptoms radiating in the specific dermatomal distribution of the affected nerve root, distinguishing it from other pain syndromes. 3

Cervical Radiculopathy Specifics

Cervical radiculopathy is defined as upper limb pain or sensorimotor deficit secondary to cervical nerve root impingement and/or irritation. 1

• The condition has an annual incidence of approximately 83 per 100,000 persons 1
• Most commonly affects the C5-C6 and C7 nerve roots 3
• Peak prevalence occurs in persons aged 50-54 years 4

Common Causes

The nerve root compression can result from:

• Soft disc pathology (herniated disc) 1
• Hard disc pathology (spondylarthrosis including facet or uncovertebral joint hypertrophy) 1
• Combination of both soft and hard disc disease 1
• Degenerative cervical spondylotic changes 2, 5

Clinical Presentation

Typical Symptoms

• Neck and/or upper limb pain with or without varying degrees of sensory or motor deficits 1
• Pain radiating in a dermatomal distribution of the affected nerve root 6, 4
• Sensory changes (paresthesias, numbness) in specific dermatomes 2
• Motor weakness in the distribution of the affected nerve root 6, 4
• Reflex changes (diminished deep tendon reflexes, particularly triceps) 4
• The "electric" quality of pain is characteristic of neuropathic pain seen in radiculopathy 3

Physical Examination Findings

• Painful neck movements and muscle spasm are the most common findings 4
• Diminished deep tendon reflexes are the most common neurologic finding 4
• Muscle stretch reflex assessment provides localizing value for the affected nerve root 3

Important Clinical Distinctions

Radiculopathy vs. Plexopathy

Clinical diagnosis can be challenging because considerable overlap exists between radiculopathy (single nerve root) and plexopathy (multiple nerve roots in the plexus). 1 When symptoms affect both upper and lower extremities, consider alternative diagnoses including myelopathy or multiple levels of compression. 3

Red Flags Requiring Urgent Evaluation

• Bilateral radiculopathy or bilateral radicular pain and/or sensory loss (may indicate cauda equina syndrome risk) 1
• Progressive neurological deficits 3
• New changes in bladder or bowel function 3
• Loss of perineal sensation 3
• Signs of myelopathy (spinal cord compression) 3, 6

Diagnostic Approach

Diagnosis is achieved by combination of clinical history, physical examination, and imaging. 1 However, physical examination alone has limited evidence for accuracy in diagnosing cervical radiculopathy. 1

Key Diagnostic Principle

MRI alone should not be used to diagnose symptomatic radiculopathy and must always be interpreted in combination with clinical findings, given frequent false-positive and false-negative MRI findings. 1 High rates of abnormalities are detected in asymptomatic patients on imaging. 1

Natural History and Prognosis

Radiculopathy is frequently self-limiting, with 75% to 90% of patients achieving symptomatic relief with nonoperative conservative therapy. 1 Most cases of acute cervical radiculopathy resolve spontaneously or with conservative treatment. 1, 7