Cervical Radiculopathy

Cervical radiculopathy refers to neck pain that radiates to the shoulder and arm caused by injury or compression of a spinal nerve root in the neck region. Cervical radiculopathy is also referred to as nerve root impingement, nerve entrapment, or pinched nerve. The condition is more common in adults and elderly individuals and rare among young individuals.

The cervical spine begins at the base of the skull and is made up of the first 7 vertebrae of the neck and comprises of 8 pairs of cervical nerves. The cervical nerve roots are large nerves that branch from the cervical region of the spinal cord and leave the spinal column to travel into the arms, shoulders, upper back and hands. The cervical nerves control upper body motor and sensory activities. Therefore cervical radiculopathy can affect hand movements and coordination or cause numbness or decreased sensation. Cervical radiculopathy occurs when a nerve in the neck (cervical region) is irritated or pinched while it leaves the spinal canal.

Nerve root compression may occur at 3 locations:

• Neuroforamen- natural passageways on either side of the vertebrae.
• Right or left of the neck and upper extremity
• Central canal (area surrounding the spinal cord)

Causes

Cervical radiculopathy can be caused by herniated disc, bony overgrowths (osteophytes), spinal stenosis, and degenerative disc disease.

Symptoms

The main symptom of cervical radiculopathy is neck pain that spreads into the arm and shoulders. A person with radiculopathy may experience lack of coordination especially in the hands, difficulty lifting things, headache, and muscle weakness and numbness or tingling in fingers or hands.

Diagnosis

The diagnosis for cervical radiculopathy comprises of medical history, evaluation of the presenting signs and symptoms, physical examination, and neurological examination. Your doctor will test your strength of the muscles and sensation as well as reflexes. Your doctor will suggest certain diagnostic tests such as X-rays, CT or MRI scans, or myelography to provide better visualization of the anatomy of the intervertebral discs and spinal cord. Other tests that may be performed are electromyography (EMG) to measure the electrical activity of the muscles and nerve conduction study (NCS) to evaluate the transmission of electrical signals as they move through a nerve.

Treatment

The majority of patients with cervical radiculopathy can often be treated conservatively. The conservative treatment options include anti-inflammatory and pain medications, muscle relaxants, spinal injections, physical therapy, braces to support the spine, traction, and acupuncture. Your doctor may recommend combining two or more treatment modalities, in order to increase your chances of successful treatment.

Surgery is usually recommended for patients with persistent pain, spinal instability or neurological dysfunction. There are several surgical procedures for cervical radiculopathy, performed using minimally invasive techniques. Surgery involves removing parts of bone or soft tissue causing the compression. The aim of the surgery is to decompress nerves and relieve the pressure. Surgical techniques that may be used include:

• A decompressive laminectomy: It is a surgical procedure in which a portion of the bone or lamina responsible for the compression is removed.
• Laminoplasty: It is a surgical procedure to expand the size of the spinal canal and release the pressure over the spinal cord and nerve roots.
• Discectomy: It is a surgical procedure for the removal of a herniated or ruptured disc from the affected region.
• Foraminotomy: It is a surgical procedure for widening the neuroforamen, to relieve the pressure over the compressed nerves.
• Instrumentation and fusion: Spinal Fusion is a surgical technique in which two or more vertebrae are joined with the help of bone grafts and/or instrumentation. Spinal instrumentation is a method of stabilizing the spine with the help of implants such as rods, plates, screws, and interbody devices.

Your surgeon will discuss surgical options and the associated risks and benefits as well as recommend the most appropriate procedure for you. Your doctor is a reliable resource to help you understand your condition better.

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