Cervical radiculopathy

Cervical radiculopathy is a set of symptoms that include neurogenic pain in the neck and upper limb, caused by the cervical nerve roots. In addition to pain, there may be numbness, weakness, and decreased reflexes. Causes of cervical radiculopathy include disc herniation, stenosis of the foramen, tumor, osteophyte formation, and, rarely, infection.

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Symptoms of Cervical Radiculopathy

Patients with cervical radiculopathy complain of pain, numbness, tingling, and paresthesia in the distribution of the affected root or roots. Patients may also notice weakness and impaired movement in the affected limb. Muscle spasms and neck pain are common, as is pain radiating to the trapezius muscle and interscapular region. Physical examination may reveal decreased sensation, weakness, and reflex changes. Patients with C7 radiculopathy often place the affected arm on their head to relieve pain. Occasionally, patients with cervical radiculopathy develop compression of the cervical spinal cord, which can lead to myelopathy. Cervical myelopathy is most often caused by a median cervical disc herniation, spinal stenosis, tumor, and less commonly, infection. Patients with cervical myelopathy experience weakness in the lower limbs, bladder and bowel dysfunction. This requires emergency neurosurgical care.

Diagnosis of cervical radiculopathy

Magnetic resonance imaging provides the most complete information about the cervical spine and spinal cord. MRI is the most accurate and can identify changes that place the patient at risk for myelopathy. For patients who cannot undergo MRI (presence of pacemakers), CT or myelography are reasonable alternatives. Radionuclide bone scanning (osteoscintigraphy) and plain radiography are indicated in the diagnosis of fractures and bone changes such as metastases. These studies provide the clinician with useful information about neuroanatomy, and electromyography and nerve conduction studies provide information about function that can determine the current status of each individual nerve root and the brachial plexus. Electromyography can also differentiate plexopathy from radiculopathy and identify associated tunnel neuropathies such as carpal tunnel syndrome. If the diagnosis of cervical radiculopathy is in doubt, laboratory screening should be performed, including a complete blood count, ESR, antinuclear antibody test, HLA B-27 antigen, and blood chemistry.

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Differential diagnosis

Cervical radiculopathy is a clinical diagnosis supported by a combination of history, physical examination, radiography, and MRI. Pain syndromes that may mimic cervical radiculopathy include myogenic pain, cervical bursitis, cervical fibromyositis, inflammatory arthritis, and other disorders of the cervical spinal cord, roots, plexus, and nerves.

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Complications and diagnostic errors

Failure to accurately diagnose cervical radiculopathy may put the patient at risk for developing cervical myelopathy, which, if left untreated, may progress to tetraparesis (or tetraplegia.

Carpal tunnel syndrome must be differentiated from cervical radiculopathy, which affects the cervical nerve roots and can mimic median nerve compression. It is also important to remember that cervical radiculopathy and median nerve compression can coexist in a "double wedge" syndrome, which is often seen in carpal tunnel syndrome.

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Treatment of cervical radiculopathy

A multi-level approach is most effective in treating cervical radiculopathy. Physical therapy, including heat therapy and deep relaxation massage, combined with NSAIDs (eg, liclofenac or lornoxicam) and muscle relaxants (eg, tizanidine) are reasonable initial treatments. Cervical epidural nerve blocks may then be used. Cervical epidural blocks with local anesthetics and steroids are very effective in treating cervical radiculopathy. Sleep disturbances due to depression are best treated with tricyclic antidepressants.