our brain communicates with and controls your body using an intricate network of “wires” that form your nervous system. The thickest collection of these wires is your spinal cord, which lives inside and is protected by the bones and joints of your spinal column. Smaller branches of wires, known as nerve roots, exit off the spinal cord and leave the bony spinal column through small holes (foramina) between the bones. These nerve roots further branch off into smaller peripheral nerves that spread throughout the body.
Whenever abnormal pressure is applied to a nerve, the nerve may not transmit signals properly, resulting in pain, numbness, tingling, or even weakness downstream from the point of pressure. For instance, if you hit your “funny bone” (actually the ulnar nerve) at the elbow, you feel symptoms far away in your hand, where the ulnar nerve travels.
When these downstream symptoms occur because of pressure on a nerve root within the spinal column, the symptoms are called “radiculopathy.” Even though the pressure is caused within the spine, radiculopathy symptoms are felt far away, into the arm or leg, where the nerve travels.
Radiculopathy is most often thought of as a pain that shoots from the center of your spine down one of your limbs. But it can also take the form of tingling, numbness, or weakness in the affected limb. Doctors use the term “radicular symptoms” or “radicular pain” interchangeably with “radiculopathy” when describing the type of symptoms a patient might be experiencing.
Radiculopathy is typically classified into three different groups. Each group is based on the section of the spine that a nerve root could be pinched.
- Cervical radiculopathy occurs when a nerve root in your neck is irritated. Nerve roots in this area of the spine primarily control sensations in your shoulder, arms, and hands. Symptoms include dull, electric, or sharp pain into the arms or hands, Numbness and tingling are common. In severe cases, there may be loss of strength.
- Thoracic radiculopathy occurs when a nerve root in your upper back is irritated. These radicular symptoms will often be described as pain or numbness that wraps around from the back to the front of your chest. Thoracic radiculopathy is uncommon.
- Lumbar radiculopathy occurs when a nerve root in your lower back is irritated. Pressure on nerve roots in your lumbar spine can cause pain, numbness, or tingling sensations in your buttock, legs, and feet. In severe cases, there can be weakness in certain leg muscles. Lumbar radiculopathy is often termed “sciatica” because the sciatic nerve, which travels down the back of your leg, is composed of many nerve roots exiting the lumbar spine. Lumbar radiculopathy (sciatica) is the most common type of radiculopathy.
Radiculopathy results from pressure, or pinching, of a nerve root within the spine. Usually, this pressure is caused by a structure, near the nerve root, that has overgrown, been damaged, or lost its normal alignment. These structures include the bones of the vertebrae, the discs in between the vertebrae or even ligaments that surround the nerves.
Specific causes of radiculopathy include:
- Herniated discs
- Bone spurs
- Degenerative disc disease
- Compression fractures
- Tumors and cysts of the spine
Risk factors for developing radiculopathy include:
- Improper lifting techniques
- Poor posture
- Tobacco use
Through a detailed history and exam, your doctor can distinguish whether your pain is caused by a pinched nerve (radiculopathy), a blockage in a blood vessel, or a joint or muscle problem in the arm or leg. The exam typically includes:
- Range of motion test: Assessing how far you can move your spine in each direction and if it elicits pain.
- Neurological assessment: A group of tests that evaluates your neurological system and may aide in pinpointing the area of the spine where your symptoms are originating. This assessment includes testing:
- Strength of the limbs
- Walking and balance assessments
- Sensation to light touch and pin prick
- Palpation: Touching, pushing, and squeezing of muscles and other structures to determine the source of pain.
Depending on what your doctor finds on your exam, he or she may make a diagnosis of radiculopathy. If necessary, your doctor may order further testing to refine the diagnosis.
- X-ray: An image of the bones in your spine. An x-ray can locate arthritic changes in the vertebrae, including the location and severity of bone spurs. Load bearing X-rays can also be used to assess abnormal bone alignment, which may contribute to your radiculopathy.
- MRI (magnetic resonance imaging): An image of the soft tissues of the spine, which cannot be seen on X-ray. Most commonly an MRI will be ordered for the physician to locate the exact level of nerve compression causing radiculopathy. MRI can also locate tumors, damaged discs, and loose ligaments in the spine.
- Electromyography (EMG): An EMG measures the activity of the muscles at rest and during contraction, determining the communication of the nerve to the muscle. In an EMG test, needles are used in addition to electrodes. This study helps evaluate the extent of possible nerve damage involved in your radiculopathy.
Treatment of Radiculopathy
The two major goals of treatment for radiculopathy are:
- to decrease or eliminate the symptoms
- to address the underlying cause of the radiculopathy
Conservative, nonsurgical treatment is typically recommended first, and are extremely effective. Conservative treatments include medication, physical therapy, and corticosteroid injections. One or all may be used to treat your radiculopathy symptoms.
- Commonly used medications:
- Over-the-counter medications, such as Advil or Tylenol, may be used to treat your pain if symptoms are mild or moderate.
- Muscle relaxers, such as Flexeril or Skelaxin, are used to treat spasm often associated with radiculopathy.
- Nerve membrane stabilizers, such as Neurontin or Lyrica, help reduce the irritability of pinched nerves that are causing radiculopathy.
- Opioids are used when pain symptoms are severe. Often, they are prescribed for short term use and are only used as a last resort if nothing else is helping with the pain
- Physical Therapy: Physical therapists can perform manual therapy and provide you with a program of stretching and exercises to help alleviate your symptoms more quickly than with just rest and medication alone. Physical Therapy may be prescribed in conjunction with other treatments such as pain medication and/or epidural injections to help with your symptoms.
- Epidural Injections: A physician performs an image-guided injection of corticosteroid, directly around the nerve root thought to be the source of your pain. The corticosteroid injection helps to decrease inflammation surrounding the nerve, acting like “a bucket of water thrown on the fire,” to help your severe pain. Typically, injections are performed in a series of two or three, depending on responses.
Surgical intervention may be indicated when symptoms do not improve with conservative treatment or you are experiencing progressive neurological impairment. Surgical Interventions include:
- Discectomy or Microdiscectomy: A minimally invasive procedure where a small portion of herniated disc is removed, relieving pressure and related inflammation around the nerve root.
- Laminectomy: A portion of the vertebrae known as the lamina, along with overgrown joints or ligaments, are removed to allow nerve roots more room to travel within the spine. Laminectomy can be performed with minimally invasive techniques, and can offer immediate relief of radiculopathy symptoms.
- Spinal Fusion: If spinal instability is contributing to your radiculopathy symptoms, simple decompression with laminectomy may not be enough to relieve symptoms. In cases of instability, decompression has to be supplemented with stabilization and fusion of the unstable segment of your spine. This procedure is more involved that simple laminectomy, and requires cages, bone graft, and often metal screws and rods. However, fusion can now be offered with minimally invasive techniques, allowing for rapid return to normal function.
Most cases of radiculopathy result from common degenerative changes in the spine, and are corrected with conservative treatment such as medication, epidural injections, and physical therapy. When symptoms cannot be corrected this way or are causing progressive neurological impairment, surgery such as a microdiscectomy, laminectomy, or spinal fusion can be performed. Fortunately, many surgeries can now be performed with minimally invasive techniques, with less postoperative pain and quicker recovery to normal function.
If you notice increasing neck or low back pain, numbness, tingling, or weakness radiating into the arms and legs you should seek experienced help from a spine expert.