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Cervical radiculopathy
Last reviewed: 23.04.2024
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Cervical radiculopathy is a combination of symptoms, including neurogenic pain in the neck and upper limb, caused by the cervical nerve roots. In addition to pain, numbness, weakness, and decreased reflexes can occur. Causes of cervical radiculopathy include a herniated disc. Stenosis of the opening, tumor, formation of osteophytes and, rarely, an infectious process.
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Symptoms of cervical radiculopathy
Patients suffering from cervical radiculopathy, complain of pain, numbness, tingling and paresthesia in the innervation zones of the affected rootlet or roots. Patients can also pay attention to weakness and impaired movement in the affected limb. Muscle spasms and pain in the neck are often observed, as does the pain radiating into the trapezius muscle and the interscapular region. In the physical examination, a decrease in sensitivity, weakness and changes in reflexes are detected. Patients with radiculopathy C7 often to ease the pain put an affected hand on the head. Sometimes in patients with cervical radiculopathy there is compression of the cervical spinal cord, which can lead to myelopathy. Most often cervical myelopathy is due to the middle hernia of the cervical disc, stenosis of the spinal canal, a tumor, less often an infection. Patients with cervical myelopathy experience weakness in the lower limbs, impaired function of the bladder, intestines. This requires emergency neurosurgical care.
Diagnosis of cervical radiculopathy
The most complete information about the cervical spine and the spinal cord is provided by magnetic resonance imaging. MRI is the most accurate and can identify changes that put the patient at risk for myelopathy. For patients who can not be MRI (presence of pacemakers), a reasonable alternative is CT or myelography. In the diagnosis of fractures and bone changes, such as metastases, radionuclide bone scanning (osteoscintigraphy) and survey radiography are shown. These studies give the clinician useful information on neuroanatomy, and electromyography and the study of nerve conduction velocity-information about a function that can determine the present state of each nerve root and brachial plexus separately. Also, electromyography can distinguish between plexopathy and radiculopathy and identify concomitant tunneling neuropathy, cancerous as a carpal tunnel syndrome. If the diagnosis of cervical radiculopathy is doubtful, a laboratory screening should be performed, including a general blood test, an ESR, a study of antinuclear cells, an HLA B-27 antigen, and a biochemical blood test.
Differential diagnosis
Cervical radiculopathy is a clinical diagnosis, supported by a combination of anamnesis, physical examination, radiography and MRI. Pain syndromes capable of mimicking cervical radiculopathy include myogenic pain, scaly bursitis, cervical fibromyositis, inflammatory arthritis and other diseases of the cervical spine, roots, plexus and nerves.
Complications and Diagnostic Errors
Failure to accurately diagnose cervical radiculopathy can expose the patient to the risk of developing cervical myelopathy, which, if untreated, can progress to tetraparesis (or tetraplegia.
Carpal tunnel syndrome should be differentiated from cervical radiculopathy, affecting the cervical nerve roots, which can mimic the compression of the median nerve. Further it is necessary to remember that cervical radiculopathy and infringement of the median nerve can co-exist in the syndrome of "double compression", which is often observed with carpal tunnel syndrome.
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Treatment of cervical radiculopathy
In the treatment of cervical radiculopathy, a multi-level approach is most effective. Physiotherapy, including thermal treatments, and a deep relaxing massage in combination with NSAIDs (eg, lyclofenac or lornoxicam) and muscle relaxants (eg, tizanidine) are a reasonable start to therapy. Then, cervical epidural nerve blockades can be used. Cervical epidural blockades with local anesthetics and steroids are very effective in treating cervical radiculopathy. Sleep disorders due to depression are best treated with tricyclic antidepressants.