Cervical Radiculopathy

THE CLINICAL SYNDROME

• Pain in the upper extremities and the neck is the primary symptom of cervical radiculopathy, which originates in the cervical nerve roots and can be caused by a number of different conditions.

• The patient may also feel numbness, weakness, and a loss of reflexes in addition to the pain they are experiencing.

• In most cases, only one side of the body is affected. The C6 and C7 nerve roots are the ones that are affected the majority of the time.

• Herniated discs, foraminal stenosis, tumors, osteophyte formation, and infection are some of the rarer causes of cervical radiculopathy, but they are all potential culprits.

• Predisposing factors include smoking, axial load bearing, female gender, white race, and the arthritides.

• The incidence of cervical radiculopathy is 83 per 100,000 people when adjusted for age.

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SIGNS AND SYMPTOMS

• Cervical radiculopathy patients often report pain, numbness, tingling, and paresthesias in the damaged nerve root or roots.
• The affected extremity may be weak and uncoordinated.
• This ailment often causes trapezius, interscapular, muscular spasms, and neck pain.
• Physical examination shows diminished feeling, weakness, and altered reflexes. C7 radiculopathy patients often find relief by laying their affected hand on their head.
• The Spurling test often worsens cervical radiculopathy. The patient extends their neck and rotates laterally at the cervical spine as the examiner adds axial stress.
• Cervical radiculopathy can cause myelopathy.
• Cervical spinal cord compression causes this.
• Cervical myelopathy is most often caused by a midline herniated disc, spinal stenosis, tumors, and, rarely, infections.
• Cervical myelopathy can cause upper-extremity weakness, lower-extremity weakness, and bowel and bladder issues.
• It should be treated as a neurosurgical emergency.

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TESTING

• The most accurate information regarding the cervical spine and the contents of the spine can be obtained by magnetic resonance imaging (MRI).
• The MRI has a high degree of accuracy and can detect any anomalies that may place the patient at an increased risk for cervical myelopathy.
• Computed tomography or myelography is a reasonable alternative to MRI for people who are unable to undergo MRI due to medical conditions, such as those who have pacemakers.
  • In cases where the findings of an MRI are inconclusive, provocative discography may also be able to provide helpful diagnostic information.
• Radionuclide bone scanning and plain radiography are both necessary diagnostic tools to use when determining the presence of fractures or skeletal abnormalities, such as metastatic disease.
• Electromyography and nerve conduction velocity testing provide neurophysiologic information that can determine the actual status of each nerve root and the brachial plexus.
• Although these tests provide the clinician with helpful neuroanatomic information, electromyography and nerve conduction velocity testing provide this information.
• Electromyography is able to differentiate between radiculopathy and plexopathy, as well as identify a coexisting entrapment neuropathy such as carpal tunnel syndrome.

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DIFFERENTIAL DIAGNOSIS

• The clinical diagnosis of cervical radiculopathy is supported by a combination of clinical history, physical exam, radiography, and MRI findings.
• Pain syndromes such as cervicalgia, cervical bursitis, cervical fibromyositis, inflammatory arthritis, cardiac pain, acute herpes zoster of the cervical dermatomes, entrapment syndromes of the upper extremity, thoracic outlet syndrome, and disorders of the cervical spinal cord, roots, plexus, and nerves can all have symptoms that are similar to those of cervical radiculopathy.

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TREATMENT

• A multidisciplinary approach is the most effective way to treat cervical radiculopathy.

• It is fair to begin with physical therapy, which may include heat modalities and deep sedative massage, along with nonsteroidal antiinflammatory medications and skeletal muscle relaxants.

• The inclusion of cervical epidural nerve blocks is the next step that makes the most sense clinically.

• When treating cervical radiculopathy, cervical epidural blocks combined with a local anesthetic and steroid are among the most effective treatments available.

• A tricyclic antidepressant, such as nortriptyline, which can be begun at a single night dose of 25 mg, is the most effective treatment for underlying sleep disruption and depression.

• If definitive surgical therapy is not an option, a trial of spinal cord stimulation is a suitable next step for individuals who have not responded to epidural steroid injections.

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COMPLICATIONS AND PITFALLS

• The patient may be put at risk for the development of cervical myelopathy if the cervical radiculopathy is not appropriately diagnosed.
• Cervical myelopathy, if left untreated, may progress to quadriparesis or quadriplegia in the event that the patient does not receive treatment.

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