Cervical radiculopathy, commonly known as a "pinched" nerve, is caused by an injury to the root of a spinal nerve. It is characterized by neck pain that radiates to the shoulder and arms. As we grow older, the spinal discs degenerate, bulge and lose height. The intervertebral disc collapses and the vertebrae come closer to one another forming bone spurs and causing stiffness of the spine. The bone spurs constrict the foramen and compress the nerve root. If these changes are secondary to ageing, the condition is referred to as arthritis or spondylosis. The other disorders that can cause radiculopathy are herniated disc, degenerative disc disease, bony outgrowths and thickening of spinal ligaments.
Patients suffering from cervical radiculopathy may experience pain radiating to the arm, pins and needles sensation, or complete numbness and weakness while performing certain body activities. Movements of the neck and head can aggravate the symptoms. Sometime patients get some symptomatic relief by placing their hand on their head and stretching the shoulder.
As neck pain is the most common symptom, the doctor starts with an examination of the neck including tests for evaluating strength and a neurological examination. The basic steps in diagnosis include:
- Medical family history of the patient
- Physical and neurological examinations
- Testing of reflexes to evaluate muscle weakness, sensitivity, and other symptoms of neurological injury
- Diagnostic imaging techniques such as X-rays, CT scan, MRI scans and myelography are employed to increase the accuracy of diagnosis
- Additional tests such as nerve conduction study (NCS) and electromyography (EMG) may also be performed
Cervical radiculopathy is usually treated with non-surgical methods. The doctor may prescribe a single non-surgical method or a combination of two or more therapeutic approaches for better results. The non-surgical treatment options include medications such as pain medication, spinal injection, soft neck collars and physical therapy.
Surgical procedures can be considered in patients not responding to non-surgical approach. The surgical procedure depends on many factors and the specific underlying condition of the patient. The main objective of any surgery is to decompress the nerve roots and spinal cord to relieve the symptoms. The most common surgical procedures include:
- Decompressive laminotomy: Removal of the lamina which creates more space
- Laminoplasty: Increase one side of the lamina to expand the size of the spinal canal
- Discectomy: The removal of a portion or the whole of the intervertebral disc
- Foraminotomy: Expand the area around the neuroforamen to decompress the nerve roots
In certain surgical procedures screws and plates are employed to fuse the vertebrae with bone graft after the disc is removed. The bone graft helps in healing and better fusion.