From the Guidelines
Cervical radiculopathy is a syndrome of pain or sensorimotor deficits due to dysfunction of a cervical spinal nerve, the roots of the nerve, or both, commonly presenting with neck pain and pain in one arm accompanied by sensory or motor function loss in the affected nerve-root distribution. This condition is less prevalent than cervical or neck pain, with an average annual age-adjusted incidence of 83.2 per 100,000 people 1. The most common causes of cervical radiculopathy include compressive factors such as narrowing of the neural foramina due to facet or uncovertebral joint hypertrophy, disc bulging or herniation, and degenerative spondylosis.
Some key points to consider in the diagnosis and management of cervical radiculopathy include:
- The clinical presentation often involves a combination of neck pain and arm pain with varying degrees of sensory or motor function loss 1.
- Physical examination tests have limited correlation with MRI evidence of cervical nerve root compression, leading to potential false-positive and false-negative findings 1.
- In the absence of red flag symptoms, imaging may not be required at the time of initial presentation, as spondylotic changes are common in patients over 30 years of age and correlate poorly with neck pain 1.
- Red flag symptoms that may necessitate immediate imaging or further evaluation include trauma, malignancy, prior neck surgery, spinal cord injury, systemic diseases, and others 1.
Given the information from the study by 1, the initial approach to managing cervical radiculopathy should focus on conservative treatment measures, including anti-inflammatory medications, physical therapy, and potentially short-term use of muscle relaxants, with most cases resolving within 4-6 weeks. For severe or persistent symptoms, further interventions such as oral steroids, epidural steroid injections, or surgical options may be considered.
From the Research
Definition and Causes of Cervical Radiculopathy
- Cervical radiculopathy is defined as a syndrome of pain and/or sensorimotor deficits due to compression of a cervical nerve root 2.
- The most common causes of cervical radiculopathy are cervical disc herniation and cervical spondylosis 2, 3, 4.
- It is characterized by neurological dysfunction caused by compression and inflammation of the spinal nerves or nerve roots of the cervical spine 3.
Symptoms and Diagnosis
- The clinical consequence of radiculopathy is arm pain or paresthesias in the dermatomal distribution of the affected nerve and may or may not be associated with neck pain and motor weakness 2.
- Symptoms may include neck and arm pain, sensory loss, motor dysfunction, and reflex changes according to the dermatomal distribution 3.
- Diagnosis is suggested by history and corresponding physical examination findings, and confirmation is achieved with MRI 5.
- Patient history and clinical examination are important for diagnosis, and further imaging modalities such as x-ray, computed tomography, and electrophysiologic testing are also of importance 2.
Treatment Options
- Most patients will significantly improve from non-surgical active and passive therapies 2.
- 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.
- Epidural steroid injection (ESI) has been used to treat cervical radiculopathy, but it is not considered a first line treatment and is undertaken after non-interventional treatments have been adequately provided 6.