Radiculopathy

Radiculopathy, or lesion of the nerve roots, is manifested by the appearance of segmental radicular symptoms (pain or paresthesia with the distribution of the dermatome and weakness of the muscles innervated by this rootlet). To make a diagnosis, you may need neuroimaging, EMG, or somatic examination. Treatment of radiculopathy depends on the cause, but includes symptomatic therapy with NSAIDs and other analgesics).

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Causes of the radiculopathy

Chronic pressure on the spine inside the vertebral canal or next to it causes damage to the nerve root (radiculopathy). The most common cause of radiculopathy is a herniated intervertebral disc. Bone changes in rheumatoid arthritis or osteoarthritis, especially in the cervical and lumbar regions, can also exert pressure on the nerve roots. Less often, to multiple mosaic root dysfunction, the carcinomatous process results.

Spinal cord lesions (eg, epidural abscesses and tumors, spinal meningiomas, neurofibromas) can manifest not by ordinary dysfunction of the spinal cord, but by radicular symptoms. Possible radiculopathy in diabetes. The defeat of the nerve roots occurs with fungal (for example, histoplasmosis) and spirochetosis (for example, lime disease, syphilis) infections. Usually herpetic infection causes painful radiculopathy with a dermatome loss of sensitivity and a characteristic rash, but it is also possible motor radiculopathy with weakness of the myotome muscles and prolapse of reflexes.

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Symptoms of the radiculopathy

Lesions of the nerve roots cause characteristic radicular pain syndromes and segmental neurologic deposition, depending on the level.

Characteristic symptoms of radiculopathy at different levels of the spinal cord

With (a cervical department)	Pain in the trapezius muscle and shoulder area, often radiates to the thumb of the hand, there paresthesia and impaired sensitivity, weakness of the biceps and a decrease in the bi-cerebral and brachial reflexes
Th (thoracic department)	Pain in the shoulder and axillary region, radiates to the middle finger, triceps weakness, decreased tricepital reflex Tinea dysesthesia in the thoracic region
L (lumbar)	Pain in the buttocks, posterior lateral surface of the thigh, calf and foot with weakness of anterior and posterior tibial and peroneal muscles, loss of sensitivity to the tibia and dorsal surface of the foot
S (sacral department)	Pain on the back surface of the leg and buttocks, weakness of the medial gastrocnemius head with a disturbance of plantar flexion, loss of the Achilles reflex and loss of sensation on the lateral surface of the calf and foot

Muscles innervated by the affected spine become weak and atrophy; in them fasciculations are possible. The defeat of sensitive nerve roots causes a disturbance of sensitivity to dermatomes. The corresponding segmental deep tendon reflexes may be weakened or absent.

The pain is aggravated by movements that lead to pressure on the spine through the subarachnoid space (for example, with the movement of the spine, coughing, sneezing, and a Valsalva test). The defeat of the ponytail, involving a variety of lumbar and sacral roots, causes radicular symptoms in both legs, can lead to a violation of sexual function and the functioning of sphincters.

Signs of compression of the spinal cord may be the level of sensitivity impairment (sudden change in sensitivity below the level of compression), flaccid vapor or tetraparesis, changes in reflexes below the level of compression, hyporeflexia in the initial stages, then hyperreflexia and sphincter dysfunction.

Diagnostics of the radiculopathy

With radicular symptoms, it is necessary to perform CT and MRI of the affected area. With multiple levels of damage, myelography is sometimes used. The area of the study determines complaints and clinical signs, if the level of lesion is not clear, to clarify the localization should be done EMG, but it will not allow to clarify the cause of the lesion.

If neuroimaging does not reveal a structural pathology, CSF analysis is used to exclude an infectious or inflammatory cause, and to detect diabetes - fasting blood for sugar on an empty stomach.

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Treatment of the radiculopathy

Some of the causes suggest etiotropic and pathogenetic treatment of radiculopathy. In acute pain, analgesics are prescribed (eg, NSAIDs, sometimes opioids). The administration of tricyclic antidepressants before bedtime in low doses may help. Occasionally, an additional effect is brought by muscle relaxants, sedatives and topical therapy. Chronic pain is difficult to treat, NSAIDs are only partially effective, and opioids are fraught with a high risk of addiction.

A patient who has radiculopathy consult a psychiatrist, try tricyclic antidepressants, anticonvulsants, physiotherapy treatment. Occasionally, alternative treatment of radiculopathy (for example, percutaneous electrical stimulation of nerves, manual therapy, acupuncture, phytotherapy) is helpful.