Cervical radiculopathy is a deformity or change in the way the nerve works due to one of the nerve roots adjacent to the compressed cervical vertebra. These seven small vertebrae form the cervical spine, or neck, and begin beneath your skull.
Cervical radiculopathy is often caused by “wear and tear” changes that occur in the spine as we age, such as arthritis. In young people, it is often caused by a sudden injury that causes a herniated disc.
Understand nerves in your neck
Your spine has 33 small bones called vertebrae, and you place one on top of the next in a long line known as the spinal column.
The lower part is called the lumbar region, the middle is part of the chest, and the upper part of your neck is the cervical region. Each vertebra is numbered, and the cervical vertebrae are C1-C8.
Course of Cervical Radiculopathy
Cervical radiculopathy is a rare condition that occurs less frequently in men than in women. It has a high probability of occurrence in the elderly due to spinal cord deterioration, with some estimates placing the highest risk at 50 to 54 years of age.
The signs and symptoms of cervical radiculopathy often appear frequently during and out but may also occur suddenly or slowly. Some movements or head positions, such as putting the neck in extension, may increase symptoms in some cases.
Most cases of cervical radiculopathy are self-limiting and go away on their own. There is little evidence that any non-surgical treatment is more effective than others.
Cervical radiculopathy occurs with pathologies that cause symptoms in the nerve roots. These can be compression, irritation, traction, and soreness at the nerve roots caused by a herniated disc, foraminal narrowing, or destructive spondylitis changes leading to stenosis of the intervertebral foramen.
Cervical radiculopathy occurs when the nerve root near the spinal cord at the neck is compressed. This can be caused by:
- Arthritis or disc degeneration with age.
- Herniated or bulging discs due to trauma or deterioration.
- Decreased spacing of arteries.
- Tumors that impinge the nerve root
The cervical spine consists of seven vertebrae. Each vertebra is separated by a gel-like disk that provides shock absorption to the spine.
When Cervical Radiculopathy Is Serious
In rare cases, cervical radiculopathy can progress and numbness or weakness becomes worse despite treatment. The more severe the numbness or weakness in the shoulder, arm, or arm, the more likely it is that the defects will be permanent or cause paralysis.
When non-surgical treatment fails to properly control symptoms and nerve pressure is confirmed, surgery may need to be considered to reduce nervousness.
Symptoms of cervical radiculopathy
Cervical radiculopathy causes symptoms emanating from the outside of the neck. The main symptoms of cervical radiculopathy are pain that spreads to the arm, neck, chest, upper back or shoulders. Often, this affects only one side of your body. This causes a number of unpleasant symptoms that may include:
- Severe pain in the back, arms, legs or shoulders that can be worse with certain activities, even something as simple as coughing or sneezing.
- Weakness or loss of reflexes in the arms or legs
- Skin numbness, “pins and needles,” or other abnormal sensations in the hands or feet.
- Pain that is defined as “sharp,” “pins and needles” or “feeling of tingling” in the neck area.
- Pain in the neck, shoulder, shoulder, upper chest, or arm. Pain can also radiate to the fingers following the pathway of the nerve root involved.
- Severe pain, numbness, or electric shock anywhere in the nervous system.
- Weakness in shoulder or arm.
- Pain that increases with certain movements of the neck. Often looking at the ceiling and above the shoulder causes or exacerbates pain.
- Symptoms improve when the hand is raised above and behind the head. This movement removes tension in the spinal nerve.
Your specific symptoms will depend on where the spinal cord nerve is located. However, it is also possible that you do not see any symptoms or that you are experiencing recurring symptoms.
Sometimes the signs and symptoms of cervical radiculopathy are caused by certain activities, such as bending the neck forward to look at the screen of a mobile phone or laptop for a long time, and it will clear the neck when it is supported and rested. For others, the signs and symptoms may be permanent and unresolved when the neck is in a position to relax and be supported.
Causes of cervical radiculopathy
Damage can occur due to pressure from a material from a ruptured disc, damage to the bones, arthritis, or other injuries that put pressure on the nerve roots. Common causes of cervical radiculopathy include:
Degenerative changes; Like discs at the age of the spine, they lose height and begin to swell. It also loses water, begins to dry out, and becomes harder. This problem leads to resolution, or collapse, of disk space and loss of disk space length.
Bulging or herniated disc; The spinal discs act as streams between your vertebrae. At times, these discs slide out of place or break down and push on the nerves. This problem can happen to your lower back, but it can also affect your neck.
Injury; In young people, cervical radiculopathy is the result of a ruptured disc, possibly due to trauma. Disks are often accompanied by activities, such as bending, lifting, twisting, or pulling. When a disc hernia, its material then compresses or inflames the nerve root, causing pain.
Fracture; If part of the vertebra is broken, the resulting instability or foraminal degeneration in the cervical spine can affect nerve roots. Such a fracture can be caused by a wound or cervical spondylolisthesis.
Cervical foraminal stenosis; When the foramen (the openness of the bone where the nerve root exits the spinal canal) shrinks and becomes smaller, the nerve root has less space and can be blocked.
Herniated cervical disc; If the inner material of the cervical disc comes out and burns or affects the immediate nerve, it can lead to cervical radiculopathy.
Infections; Various meningitis and abnormal systemic infections can cause inflammation or damage to the nerve root.
Pinched nerve from a herniated disc; Folding the neck forward and back, and folding left and right, puts a lot of pressure on the vertebrae and discs. The disc responds to pressure from the vertebrae by acting as a shock absorber.
Bone Spurs; Another possible cause of radiculopathy that can lead to a decrease in foramina are areas of excess bone growth. Bone marrow can form on the spine due to inflammation of osteoarthritis, injuries or other degenerative conditions.
Diagnosis and Tests
To diagnose cervical radiculopathy, your doctor will first ask you to diagnose all your symptoms and review your medical history. They will also do a physical exam.
The test will include an examination of your neck, shoulders, arms and hands for muscle weakness and emotional problems or reflexes. Your doctor may ask you to move your arms or neck to see if certain movements cause or reduce pain or other symptoms. Your doctor may take several steps to diagnose radiculopathy:
Physical exercise and physical tests can be used to check your muscle strength and reflexes. If you have pain and certain movements, this may help your doctor identify the affected nerve roots.
- X-rays; These provide images of dense structures, such as bone. An X-ray will show the arrangement of the bones in your neck. It can also reveal if there is any foramen deficiency and disk damage.
- Computerized tomography (CT) scans; More detailed than an open x-ray, a CT scan can help your doctor determine if you have developed bone spurs around the foramen on your cervical spine.
- Magnetic resonance imaging (MRI); These studies create better images of the soft tissues of the body. A MRI of the neck can show if your nerve compression is caused by soft tissue damage such as a bulging or herniated disk.
Neurosurgery studies, as well as electromyography, can also be used to help determine if the problem is mental or muscular.
Several other conditions have symptoms and signs similar to cervical radiculopathy, so getting a proper diagnosis is important. For example, cervical radiculopathy involves inflammation of the nerves in the neck while carpal tunnel syndrome involves a nerve entrapment in the wrist, but both may have similar symptoms of irritation and numbness.
Treatment for cervical radiculopathy
It is important to note that most patients with cervical radiculopathy get better over time and do not need treatment. For some patients, the pain passes quickly for days or weeks. For some, it may take longer.
1. Medication
These may include corticosteroids (strong anti-inflammatory drugs) or non-steroidal pain medications such as ibuprofen or naproxen. Steroids can be prescribed either orally or injected epidurally (in the space around the dura, which is the membrane around the spinal cord).
In some cases, medications can help improve your symptoms.
- Non-steroidal anti-inflammatory drugs; NSAIDs, including aspirin, ibuprofen, and naproxen, can provide relief if your pain is caused by nerve irritation or inflammation.
- Oral corticosteroids; A short course of oral corticosteroids can help reduce pain by reducing swelling and inflammation around the nerve.
2. Ice and heat treatment
Putting an ice pack or a warm gel pack on the neck can provide pain relief for some people. For example, taking cold therapy after an activity-related pain outbreak may help reduce swelling and pain. When using ice or heat treatment, it is important to have a layer that prevents direct contact with the skin, and reduce consumption to 15 or 20 minutes at a time with a 2-hour break between them.
3. Cervical epidural steroid injection
If the image confirms which nerve root has been burned or squeezed, an injection of an epidural steroid injection may be considered. Using a different color and manual fluoroscopy, the needles are carefully placed in the epidural position of the cervical spine to bathe the affected nerve roots in steroid therapy.
4. Steroid injections
In this procedure, steroids are injected around the affected nerve to reduce internal inflammation. The needle can be placed between the laminae, in the fork, or in the joint. Although steroid injections do not relieve pressure on the nerve caused by a thin fork or by bulging or herniated disk, they can reduce inflammation and reduce pain long enough to allow nerve to heal.
5. Surgery
If, over time, non-surgical treatment does not relieve your symptoms, your doctor may recommend surgery. There are several surgical procedures to treat cervical radiculopathy. The procedure your doctor recommends will depend on a number of factors, including what symptoms you are experiencing and the location of the nerve roots involved.
6. Physical therapy
This may include cervical cancer and mobilization, exercise, and other ways to reduce pain. A chiropractor or other licensed health professional may prescribe exercises and stretching procedures that are specific to the patient’s needs. Improving neck and spine strength and flexibility can help them maintain a better posture and become more resistant to pain.
7. Cervical tension
The cervical pull device gently places the weight in the form of a slight pull over the head. This procedure aims to increase the space between the cervical vertebrae, especially in the intervertebral foramina where nerve roots pass. If the patient recovers from symptoms while trying to inhale in a clinical setting, a home traction device may be recommended.
8. Soft cervical collar
This is a covered ring that wraps around the neck and is held in place. Your doctor may advise you to wear a soft cervical collar to allow your neck muscles to relax and reduce neck stiffness.
This can help reduce the pressure on the nerve roots that accompany the neck movement. The soft collar should be worn only for a short time as long wear can reduce the strength of the muscles in your neck.
Some people may need more advanced treatment, such as surgery. Surgery is usually used to reduce pressure on the nerve root by expanding the space where the nerve roots exit the spine. This may involve removing all or part of the disc or vertebrae.