Radiculopathy is a pinched nerve in the spine. It occurs when surrounding bones, cartilage, muscle, or tendons deteriorate or are injured. The trauma causes these tissues to change position so that they exert extra pressure on the nerve roots in the spinal cord.
When the nerve roots are compressed, they become inflamed. This results in numbness, weakness, and pain. The condition can usually be reversed with timely and appropriate treatment.
Types of radiculopathy are defined by the location of the compressed nerve:
- Lumbar radiculopathy is pressure on the nerve root in the lower back. It can cause sciatica, or shooting pain in the legs. Incontinence, sexual dysfunction, or severe paralysis can also occur in severe cases.
- Cervical radiculopathy is pressure on the nerve root in the neck. It can cause painful burning or tingling in the neck, shoulder, and arms.
- Thoracic radiculopathy occurs when there are pinched nerves in the middle portion of the spine. This causes pain in the chest and torso. It is uncommon and can be mistaken for shingles.
Radiculopathy occurs when a nerve is compressed by surrounding tissue. It is sometimes caused by a herniated spinal disc. This occurs when the outer rim of the disc weakens or tears. The nucleus then pushes outward and exerts pressure on a nearby spinal nerve.
Bone spurs can also cause radiculopathy. This is when extra bone forms around a disc after it weakens or collapses. These spurs can stiffen the spine and narrow the space where nerves are located, causing them to be compressed.
Pressure from a herniated disc, surrounding tissue, muscle, or tendons can cause inflammation. This interferes with nerve function. This compression can occur spontaneously. It can also result from trauma or other conditions that affect the spine. These include injury, osteoarthritis, and obesity. Age is another factor. Poor posture or stress from repetitive activities can also cause compression.
Conditions like rheumatoid arthritis, diabetes, and obesity can increase the risk of radiculopathy. Bone spurs can sometimes occur because of trauma or osteoarthritis. The condition can also be caused by repetitive hand, wrist, and shoulder movements. Pregnant women are also at a higher risk. It can be hereditary.
Symptoms of radiculopathy can range from mild to severe. The type and location of pain depends on the location of the pinched nerve root. Cervical radiculopathy usually affects the lower arm more than the neck area. Lumbar radiculopathy causes more discomfort in the lower leg than in the back area.
Symptoms of radiculopathy can incude:
- a sharp back pain that travels down to the foot
- a sharp pain that worsens with abdominal pressure from sitting or coughing
- numbness of the skin in the leg or foot
- weakness and tingling in the neck and arm
- weakness and tingling in the back and leg
- changes in sensation
- loss of reflexes
- shoulder pain
- arm pain
- pain that worsens with neck or head movement
Several tests can be used to identify and diagnose radiculopathy’s cause. After an initial physical examination, X-rays can show bone alignment or narrowing of the discs. Magnetic resonance imaging (MRI) examines soft tissue, the spinal cord, and nerve roots. A computed tomography (CT) scan looks at the fine details of the bones, including bone spurs.
An electromyogram (EMG) can measure the electrical impulses of the muscles when at rest and during contractions. This helps to find evidence of damage. A nerve conduction study (NCS) measures the ability of nerves to send electrical signals.
Typically, the first step in treating radiculopathy is conservative medical management.
Some medications can be effective in treating the pain and inflammation of radiculopathy:
- nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen
- muscle relaxants
- oral corticosteroids
- prescription opioids for severe pain
- spinal corticosteroid injections into the affected area
Physicians sometimes recommend surgery when radiculopathy doesn’t improve within a specified period of time. This is typically after about six to 12 weeks of conservative treatment. Surgery also may be considered in cases where multiple nerves are affected or where nerve function is diminishing despite treatment.
Surgery can be used to free the affected nerve from pressure. This may require a discectomy. This procedure involves removing bone spurs or part of a herniated disc. During this procedure, a section of the vertebrae may need to be removed or fused together.
Activities that aggravate the pain should usually be limited. Physicians can prescribe a splint, brace, or soft collar to immobilize the affected area. This helps to facilitate rest. In extreme cases, bed rest or traction may be necessary.
Physical therapy can teach patients how to strengthen, stretch, and protect the affected area.
For some patients, weight loss may help reduce pressure on the affected area.
Most cases of radiculopathy improve with a few days or weeks of treatment and rest. Radiculopathy caused by a herniated disc usually improves without surgery. However, recurrence of radiculopathy is possible. It can happen whether or not surgery was used for treatment.
While some causes of radiculopathy are not avoidable, there are some ways to reduce the risk. Maintaining good posture and a healthy weight reduce chances of developing radiculopathy. To prevent complications, use safe techniques when lifting heavy objects. When doing repetitive tasks, take frequent breaks.
Staying physically active can also help. Develop a regular exercise program that incorporates strength and flexibility exercises.