From the Guidelines
Radiculopathy is a condition characterized by compression, inflammation, or injury of a nerve root in the spine, leading to pain, numbness, tingling, or weakness along the affected nerve's path, with most patients experiencing improvement within the first 4 weeks with noninvasive management. This condition typically affects the cervical or lumbar regions of the spine, with symptoms following a specific pattern corresponding to the dermatome. Common causes include herniated discs, spinal stenosis, degenerative disc disease, or bone spurs that compress the nerve as it exits the spinal column 1.
Key Points
- The natural history of lumbar disc herniation with radiculopathy in most patients is for improvement within the first 4 weeks with noninvasive management 1.
- There is no compelling evidence that routine imaging affects treatment decisions or improves outcomes, but magnetic resonance imaging (MRI) or CT is recommended for evaluating patients with persistent back and leg pain who are potential candidates for invasive interventions 1.
- Treatment options for prolapsed lumbar disc with persistent radicular symptoms despite noninvasive therapy include discectomy or epidural steroids 1.
- Clinicians should provide patients with evidence-based information on low back pain, advise patients to remain active, and provide information about effective self-care options, as recommended by the American College of Physicians and the American Pain Society 1.
Management
- Conservative approaches such as rest, physical therapy, and anti-inflammatory medications are usually the first line of treatment.
- For more severe cases, epidural steroid injections may provide temporary relief.
- Surgery might be considered if conservative treatments fail or if there are progressive neurological deficits.
- The underlying mechanism involves inflammation and mechanical compression of the nerve root, which disrupts normal nerve function and creates the characteristic radiating pain and neurological symptoms.
From the Research
Definition of Radiculopathy
- Radiculopathy refers to pain in one or both of the upper or lower extremities, often accompanied by neck or back pain, secondary to compression or irritation of nerve roots in the spine 2.
- It can be accompanied by motor, sensory, or reflex deficits and is most prevalent in persons 50 to 54 years of age 2.
Causes of Radiculopathy
- Cervical radiculopathy most often stems from degenerative disease in the cervical spine 2.
- Lumbar radiculopathy can be caused by disc herniation, such as L4-L5 or L5-S1 disk herniations 3.
Symptoms and Diagnosis
- The most common examination findings are painful neck or back movements and muscle spasm 2.
- Diminished deep tendon reflexes, particularly of the triceps, are the most common neurologic finding 2.
- The Spurling test, shoulder abduction test, and upper limb tension test can be used to confirm the diagnosis of cervical radiculopathy 2.
- Imaging is not required unless there is a history of trauma, persistent symptoms, or red flags for malignancy, myelopathy, or abscess 2.
Treatment Options
- Nonoperative treatment includes physical therapy involving strengthening, stretching, and potentially traction, as well as nonsteroidal anti-inflammatory drugs, muscle relaxants, and massage 2.
- Pharmaceutical treatments for radiculopathy include opioid, antiinflammatory (steroidal and nonsteroidal), neuromodulating, topical, and adjuvant treatments 4.
- Paravertebral injections of oxygen-ozone may be a rapidly effective therapy for patients with lumbar radicolopathies secondary to disc herniation 3.
- Medications such as NSAIDs, muscle relaxants, and antidepressants may be effective for treating low back pain, but their use should be cautious and considered on a case-by-case basis 5.