What is radiculopathy and how does it affect the spine. What are the main types of radiculopathy and their symptoms. How is radiculopathy diagnosed and treated. What lifestyle changes can help prevent or manage radiculopathy.

Understanding Radiculopathy: A Comprehensive Overview

Radiculopathy is a medical condition that occurs when nerve roots in the spinal column become compressed or irritated. This compression can lead to a range of symptoms, including pain, weakness, numbness, and tingling sensations in various parts of the body. To fully grasp the complexities of radiculopathy, it’s essential to understand its underlying causes, types, and impact on overall health.

The spine is composed of vertebrae, with the spinal cord running through a central canal. Nerve roots branch off from the spinal cord and travel between the vertebrae to different areas of the body. When these nerve roots become pinched or damaged, radiculopathy symptoms can manifest.

Key Facts About Radiculopathy:

• Radiculopathy can occur in different regions of the spine: cervical, thoracic, or lumbar.
• Symptoms vary depending on the location of the affected nerve root.
• Common causes include spinal stenosis, herniated discs, and bone spurs.
• Treatment options range from conservative approaches to surgical interventions.

Types of Radiculopathy: Cervical, Thoracic, and Lumbar

Radiculopathy can be classified into three main types based on the area of the spine affected. Each type presents unique symptoms and challenges for patients and healthcare providers.

Cervical Radiculopathy

Cervical radiculopathy occurs when a nerve root in the neck (cervical spine) becomes compressed. This condition primarily affects the arms and hands, as the nerve roots in this region control sensations in these areas.

Thoracic Radiculopathy

Thoracic radiculopathy is the least common type, involving compressed nerve roots in the upper back. Symptoms often follow a dermatomal distribution, causing pain and numbness that can wrap around to the front of the body.

Lumbar Radiculopathy

Also known as sciatica, lumbar radiculopathy affects the lower back and is the most frequently encountered form of radiculopathy. It often involves the nerve roots that make up the sciatic nerve, leading to symptoms in the lower extremities.

Symptoms of Radiculopathy: Recognizing the Signs

The symptoms of radiculopathy can vary depending on the location of the compressed nerve root. However, some common signs are consistent across all types:

• Sharp pain in the back, arms, legs, or shoulders
• Weakness or loss of reflexes in the arms or legs
• Numbness or tingling sensations (paresthesia) in affected areas
• Pain that worsens with certain activities, including coughing or sneezing

It’s important to note that some individuals may experience no symptoms or only periodic flare-ups. The severity and duration of symptoms can vary greatly from person to person.

Causes of Radiculopathy: Understanding the Root of the Problem

Radiculopathy typically results from changes in the tissues surrounding the nerve roots. These changes can lead to narrowing of the spaces where nerve roots travel inside or exit the spine, a condition known as foraminal stenosis.

Common Causes of Radiculopathy:

1. Herniated discs: When spinal discs slip out of place or become damaged, they can press on nearby nerves.
2. Bone spurs: Extra bone growth can form due to inflammation from osteoarthritis or other degenerative conditions.
3. Spinal stenosis: Narrowing of the spinal canal can put pressure on nerve roots.
4. Degenerative disc disease: As discs lose height and hydration over time, they can compress nearby nerves.
5. Trauma or injury: Accidents or sports injuries can lead to spinal damage and subsequent nerve compression.

Is age a significant factor in the development of radiculopathy. While radiculopathy can occur at any age, it is more common in older adults due to the natural degenerative processes of the spine that occur over time.

Diagnosis of Radiculopathy: Pinpointing the Problem

Accurate diagnosis of radiculopathy is crucial for effective treatment. Healthcare providers use a combination of methods to identify the condition and its underlying cause.

Diagnostic Procedures for Radiculopathy:

• Medical history review and physical examination
• Neurological tests to assess reflexes, muscle strength, and sensations
• Imaging studies such as X-rays, MRI, or CT scans
• Electromyography (EMG) and nerve conduction studies
• Selective nerve root blocks (SNRB) for both diagnostic and therapeutic purposes

How does a selective nerve root block (SNRB) help in diagnosing radiculopathy. SNRB involves injecting a local anesthetic near the affected nerve root. If the patient experiences temporary relief of symptoms, it can help confirm the specific nerve root involved in causing the radiculopathy.

Treatment Options for Radiculopathy: From Conservative Care to Surgery

The treatment of radiculopathy aims to alleviate pain, improve function, and prevent further nerve damage. The approach varies depending on the severity of symptoms and the underlying cause.

Non-Surgical Treatment Options:

• Physical therapy and exercise programs
• Medications (anti-inflammatories, muscle relaxants, pain relievers)
• Epidural steroid injections
• Chiropractic care
• Acupuncture

Surgical Interventions:

When conservative treatments fail to provide relief, surgical options may be considered. These can include:

• Microdiscectomy for herniated discs
• Laminectomy to relieve spinal stenosis
• Artificial disc replacement
• Spinal fusion in cases of instability

Can radiculopathy be completely cured. While many cases of radiculopathy can be effectively managed or resolved with proper treatment, some individuals may experience recurring symptoms or require ongoing care to maintain relief.

Prevention and Management of Radiculopathy: Lifestyle Considerations

While not all cases of radiculopathy can be prevented, certain lifestyle modifications can help reduce the risk and manage symptoms:

• Maintaining a healthy weight to reduce stress on the spine
• Regular exercise to strengthen core and back muscles
• Practicing proper posture and ergonomics
• Using correct lifting techniques
• Avoiding prolonged periods of sitting or standing
• Quitting smoking, as it can contribute to disc degeneration

How does exercise benefit individuals with radiculopathy. Regular, targeted exercise can help strengthen the muscles supporting the spine, improve flexibility, and enhance overall spinal health, potentially reducing the risk of nerve compression and alleviating symptoms.

Radiculopathy and Quality of Life: Coping Strategies and Support

Living with radiculopathy can be challenging, but there are various strategies to help manage the condition and improve quality of life:

• Stress management techniques such as meditation or yoga
• Joining support groups to connect with others experiencing similar challenges
• Exploring pain management techniques like biofeedback or cognitive behavioral therapy
• Making workplace accommodations to reduce strain on the spine
• Utilizing assistive devices when necessary

Are there any alternative therapies that can help manage radiculopathy symptoms. Some individuals find relief through alternative approaches such as massage therapy, acupuncture, or herbal supplements. However, it’s important to consult with a healthcare provider before trying any new treatments.

Radiculopathy is a complex condition that can significantly impact an individual’s daily life. By understanding its causes, recognizing symptoms, and exploring various treatment options, those affected by radiculopathy can work towards effective management and improved quality of life. As research in this field continues to advance, new diagnostic tools and treatment modalities may offer even more promising outcomes for patients in the future.

Radiculopathy | Johns Hopkins Medicine

What You Need to Know

• Radiculopathy describes a range of symptoms produced by the pinching of a nerve root in the spinal column.
• The pinched nerve can occur at different areas along the spine (cervical, thoracic or lumbar).
• Symptoms of radiculopathy vary by location but frequently include pain, weakness, numbness and tingling.
• A common cause of radiculopathy is narrowing of the space where nerve roots exit the spine, which can be a result of stenosis, bone spurs, disc herniation or other conditions.
• Radiculopathy symptoms can often be managed with nonsurgical treatments, but minimally invasive surgery can also help some patients.

What is radiculopathy?

Your spine is made of many bones called vertebrae, and your spinal cord runs through a canal in the center of these bones. Nerve roots split from the cord and travel between the vertebrae into various areas of your body. When these nerve roots become pinched or damaged, the resulting symptoms are called radiculopathy.

Types of Radiculopathy

Radiculopathy can have different symptoms and different names depending on where in the spine it occurs.

Lumbar Radiculopathy

When radiculopathy occurs in the lower back, it is known as lumbar radiculopathy, also referred to as sciatica because nerve roots that make up the sciatic nerve are often involved. The lower back is the area most frequently affected by radiculopathy.

Radiculopathy Prevention

While radiculopathy can’t always be prevented, staying physically fit and maintaining a healthy weight may reduce your risk of radiculopathy. Using best practices for good posture while sitting, playing sports, exercising or lifting heavy objects is also important for preventing injuries.

Cervical Radiculopathy

Cervical radiculopathy describes a compressed nerve root in the neck (cervical spine). Because the nerve roots in this area of the spine primarily control sensations in your arms and hands, this is where the symptoms are most likely to occur.

Thoracic Radiculopathy

Thoracic radiculopathy refers to a compressed nerve root in the thoracic area of the spine, which is your upper back. This is the least common location for radiculopathy. The symptoms often follow a dermatomal distribution, and can cause pain and numbness that wraps around to the front of your body.

Symptoms of Radiculopathy

When a nerve root is compressed, it becomes inflamed. This results in several unpleasant symptoms that may include:

• Sharp pain in the back, arms, legs or shoulders that may worsen with certain activities, even something as simple as coughing or sneezing

• Weakness or loss of reflexes in the arms or legs

• Numbness of the skin, “pins and needles,” or other abnormal sensations (paresthesia) in the arms or legs

Your specific symptoms will depend on where in the spine the nerve root is pinched. However, it’s also possible that you don’t experience any symptoms or you go through periodic flare-ups of symptoms.

Causes of Radiculopathy

Radiculopathy is typically caused by changes in the tissues surrounding the nerve roots. These tissues include bones of the spinal vertebrae, tendons and intervertebral discs. When these tissues shift or change in size, they may narrow the spaces where the nerve roots travel inside the spine or exit the spine; these openings are called foramina. The narrowing of foramina is known as foraminal stenosis, which is very similar to spinal stenosis that affects the spinal cord.

In most cases, foraminal stenosis is caused by gradual degeneration of the spine that happens as you age. But it can also be a result of a spinal injury.

Herniated Discs

One common cause of foraminal stenosis and radiculopathy is a bulging or herniated disc. Spinal discs act as cushions between your vertebrae. On occasion, these discs slip out of place or become damaged and press on nerves. This problem is most likely to occur in your lower back, but it can also affect your neck.

Bone Spurs

Another possible cause of radiculopathy that may lead to narrowing of foramina is bone spurs — areas of extra bone growth. Bone spurs can form in the spine due to inflammation from osteoarthritis, trauma or other degenerative conditions.

Other Causes

Thickening (ossification) of the spinal ligaments may also lead to narrowing of the space around the nerve roots and subsequent nerve compression. Less common causes of radiculopathy include spinal infections and various cancerous and noncancerous growths in the spine that may press against the nerve roots.

Radiculopathy and Myelopathy

Sometimes, radiculopathy can be accompanied by myelopathy — compression of the spinal cord itself. Herniated or bulging discs can sometimes press on the spinal cord and on the nerve roots. When the spinal cord is involved, the symptoms can be more severe, including poor coordination, trouble walking and paralysis.

Radiculopathy Versus Neuropathy

Radiculopathy symptoms may overlap with those of peripheral neuropathy, making it difficult to pinpoint the source of the problem. Peripheral neuropathy is the damage of the peripheral nervous system, such as carpal tunnel syndrome that involves trapped nerves in the wrist. Radiculopathy is the pinching of the nerves at the root, which sometimes can also produce pain, weakness and numbness in the wrist and hand. Consult a spine specialist for an accurate diagnosis.

Radiculopathy Diagnosis

Your doctor may take several steps to diagnose radiculopathy:

• A physical exam and physical tests may be used to check your muscle strength and reflexes. If you have pain with certain movements, this may help your doctor identify the affected nerve root.

• Imaging tests, such as an X-ray, CT scan or MRI scan, are used to better see the structures in the problem area.

• Nerve conduction studies, along with electromyography, can also be used to help pinpoint whether the problem is neurological or muscular.

Radiculopathy Treatment

Radiculopathy treatment will depend on the location and the cause of the condition as well as many other factors. Nonsurgical treatment is typically recommended first and may include:

• Medications, like nonsteroidal anti-inflammatory drugs, opioid medicines or muscle relaxants, to manage the symptoms

• Weight loss strategies to reduce pressure on the problem area

• Physical therapy to strengthen the muscles and prevent further damage

• Steroid injections to reduce inflammation and relieve pain

Some people may need more advanced treatments, such as surgery. Surgery is typically used to reduce the pressure on the nerve root by widening the space where the nerve roots exit the spine. This may involve removing all or parts of a disc and/or vertebrae. Cervical posterior foraminotomy is one of the minimally invasive spine surgery options available.

Cervical Spondylosis | Neck Pain | Symptoms & Treatment

In this series Neck Pain Whiplash Neck Sprain Torticollis (Twisted Neck)

This leaflet is aimed at people who have been told they have cervical spondylosis as a cause of their neck symptoms. Cervical spondylosis is a ‘wear and tear’ of the vertebrae and discs in the neck. It is a normal part of ageing and does not cause symptoms in many people. However, it is sometimes a cause of neck pain. Symptoms tend to come and go. Treatments include keeping the neck moving, neck exercises and painkillers. In severe cases, the degeneration may cause irritation or pressure on the spinal nerve roots or spinal cord. This can cause arm or leg symptoms (detailed below). In these severe cases, surgery may be an option.

Understanding the neck

The back of the neck includes the cervical spine and the muscles and ligaments that surround and support it. The cervical spine is made up of seven bones called vertebrae. The first two are slightly different to the rest, as they attach the spine to the skull and allow the head to turn from side to side. The lower five cervical vertebrae are roughly cylindrical in shape – a bit like small tin cans – with bony projections.

The sides of the vertebrae are linked by small facet joints. Between each of the vertebrae is a ‘disc’. The discs are made of a tough fibrous outer layer and a softer gel-like inner part. The discs act like shock absorbers and allow the spine to be flexible.

Strong ligaments attach to adjacent vertebrae to give extra support and strength. Various muscles attached to the spine enable the spine to bend and move in various ways. (The muscles and most ligaments are not shown in the diagram, for clarity.)

The spinal cord, which contains nervous tissue carrying messages to and from the brain, is protected by the spine. Nerves from the spinal cord come out from between the vertebrae in the neck to take and receive messages to the neck and arms. A major blood vessel called the vertebral artery also runs alongside the vertebrae to carry blood to the rear (posterior) part of the brain.

Cervical spine

Side view of part of the spine

What is cervical spondylosis?

Cervical spondylosis is an age-related degeneration (‘wear and tear’) of the bones (vertebrae) and discs in the neck. To an extent, we all develop some degeneration in the vertebrae and discs as we become older. It tends to start sometime after the age of about 30.

One feature of the degeneration is that the edges of the vertebrae often develop small, rough areas of bone called osteophytes. Also, over many years, the discs become thinner. This degeneration is a normal ageing process which can be likened to having ‘wrinkles in the spine’. In many people, the degeneration does not cause any symptoms. For example, routine X-rays of the neck will show these features (osteophytes and disc thinning) in many people who do not have any symptoms.

However, in some people, the nearby muscles, ligaments, or nerves may become irritated or pressed on by the degenerative changes. So, cervical spondylosis often causes no problems but can be a cause of neck pain, particularly in older people.

What are the symptoms of cervical spondylosis?

If symptoms develop, they can range from mild to severe. Symptoms may include:

• Pain in the neck:
  • This may spread to the shoulders and base of the skull. Movement of the neck may make the pain worse.
  • The pain sometimes spreads down an arm to a hand or fingers. This is caused by irritation of a nerve which goes to the arm from the spinal cord in the neck.
  • The pain tends to come and go with flare-ups from time to time. You may have a flare-up of pain after unaccustomed use of your neck, or if you sprain a neck muscle or ligament.
  • However, a flare-up often develops for no apparent reason. Some people develop chronic (persistent) pain.
• Some neck stiffness, particularly after a night’s rest.
• Headaches may occur. The headaches often start at the back of the head just above the neck and travel over the top to the forehead.
• You may develop ‘pins and needles’ in part of an arm or hand. This symptom is caused by irritation of a spinal nerve as it leaves the bony (vertebral) area. However, do tell a doctor if loss of feeling (numbness) or weakness develops in a part of a hand or arm. These symptoms suggest more pressure on a nerve. This is called a ‘cervical radiculopathy’.
• More rarely, clumsiness of a hand, problems with walking, or problems with bladder function occur when pressure from a worn bone (vertebra) or disc damages the spinal cord. This is called ‘cervical myelopathy’. Again, it is important to report these symptoms to a doctor.

Note: cervical radiculopathy and cervical myelopathy are discussed further later in the leaflet. The following section concerns cervical spondylosis without radiculopathy or myelopathy.

What are the treatments for cervical spondylosis without radiculopathy or myelopathy?

Exercise your neck and keep active

Aim to keep your neck moving as normally as possible. During flare-ups the pain may be quite bad and you may need to rest for a day or so. However, gently exercise the neck as soon as you are able to do so. You should not let it stiffen up. Gradually try to increase the range of the neck movements. Every few hours gently move the neck in each direction. Do this several times a day.

As far as possible, continue with normal activities. You will not cause damage to your neck by moving it. 

Medicines

Painkillers are often helpful.

• Paracetamol at full strength is often sufficient. For an adult this is two 500 mg tablets, four times a day.
• Anti-inflammatory painkillers. Some people find that these work better than paracetamol. They can be used alone or in combination with paracetamol. They include ibuprofen which you can buy at pharmacies or obtain on prescription. Other types such as diclofenac or naproxen need a prescription. Some people with stomach ulcers, asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers.
• A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. Constipation is a common side-effect from codeine. To prevent constipation, have lots to drink and eat foods with plenty of fibre.
• A low-dose tricyclic antidepressant, such as amitriptyline, is sometimes used for persistent (chronic) neck pain. The dose of amitriptyline used for pain is 10-30 mg at night. At higher doses, tricyclic antidepressants are used to treat depression. However, at lower doses they have been found to help relieve certain types of pain, including neck pain.

Physiotherapy

If symptoms do not improve over a week or so, you may then be referred to a physiotherapist to help with pain relief and for advice on specific neck exercises.

Various treatments may be advised by a physiotherapist. These include traction, heat, cold, manipulation, etc. The value of each of these treatments is uncertain, as the results of research studies looking at which treatments work best can be conflicting.

However, what is often most helpful is the advice a physiotherapist can give on neck exercises to do at home. A common situation is for a doctor to advise on painkillers and gentle neck exercises.

Other treatments

Some other treatments which may be advised include:

• A good posture may help. Check that your sitting position at work or at the computer is not poor (that is, not with your head flexed forward with a stooped back). Sit upright. Yoga, Pilates and the Alexander Technique all improve neck posture; however, their value in treating neck pain is uncertain.
• A firm supporting pillow seems to help some people when sleeping. Try not to use more than one pillow.

Treatment may vary and you should go back to see a doctor:

• If the pain becomes worse or severe.
• If other symptoms develop such as loss of feeling (numbness), weakness, or persistent pins and needles in a part of an arm or hand, as described previously.
• If you develop any problems with walking or with passing urine. Again these symptoms suggest that cervical myelopathy may be developing as a complication of the cervical spondylosis.
• If you develop dizziness or blackouts when turning the head or bending the neck. This can suggest that the vertebral artery which supplies the brain is being nipped by the degenerative changes in the spine.

Other pain-relieving techniques may be tried if the pain becomes chronic. For example, you may be referred to a pain clinic and a pain management programme may be offered to help you control and live with your pain.

Chronic neck pain is also sometimes associated with anxiety and depression which may also need to be treated.

Cervical radiculopathy and cervical myelopathy

Cervical spondylosis is an age-related degeneration (‘wear and tear’) of the bones (vertebrae) and discs in the neck. It can progress to cause cervical radiculopathy or cervical myelopathy (described below). Most cases do not. However, it may be useful to be aware of the symptoms that suggest they may be happening, particularly as some of them may develop slowly. See a doctor if you suspect that you are developing cervical radiculopathy or cervical myelopathy.

Cervical radiculopathy

This occurs when the root of a nerve is pressed on or damaged as it comes out from the spinal cord in the neck (cervical) region. Although there are other causes of radiculopathy, cervical spondylosis is a common cause.

Degenerative changes to the joints around the vertebrae and osteophyte formation produce areas of narrowing which may nip the nerve. Another cause is a prolapsed disc. This is sometimes called a ‘slipped disc’ although the disc does not actually slip. What happens is that part of the inner softer area of the disc bulges out (prolapses) through a weakness in the outer harder part of the disc. This presses on the nerve as it passes out between the vertebra (see diagram).

Cervical vertebra

As well as neck pain, symptoms of radiculopathy include loss of feeling (numbness), pins and needles, pain and weakness in parts of an arm or hand supplied by the nerve. These other symptoms may actually be the main symptoms rather than neck pain. There may be shooting pains down into the arm. The symptoms are usually worse in one arm but may affect both. The pain may be severe enough to interfere with sleep. The lower cervical vertebrae are the usual ones affected, causing these symptoms in the arms. However, if the upper vertebrae are involved, the pain and numbness occur at the back and the side of the head.

Your doctor may suspect a radiculopathy if you have the typical symptoms. A doctor’s examination may show changes to the sensation, power and tendon reflexes to areas of the arm supplied by the affected nerve. You may then be referred to a specialist for further tests. These may include an MRI scan which will show whether the nerve roots are being pressed on.

Treatment will depend on how severe the pressure and damage are. In many cases the symptoms settle over time. A course of physiotherapy or a neck collar used for a prescribed period may help. However, in some situations, surgery may be recommended which aims to relieve the pressure on the nerve. Depending on the cause, this may involve surgery to the disc or to the vertebra itself.

Cervical myelopathy

This occurs when there is pressure on or damage to the spinal cord itself. Again, cervical spondylosis is a common cause of this condition, as the degenerative changes to the vertebra can narrow the canal through which the spinal cord passes. A prolapse of a cervical disc can also cause myelopathy if the prolapse is into the central canal of the vertebra. This may happen suddenly or develop over a period of time. There are various other rare causes of cervical myelopathy. For example, a tumour or infection that affects this part of the spinal cord.

As the spinal cord is made up of groups of nerve fibres carrying messages to the brain from the rest of the body, pressure on these nerves in the neck region can produce symptoms from several parts of the body.

The symptoms of a cervical myelopathy may include:

• Difficulties with walking. For example, the legs may feel stiff and clumsy.
• Changes to the sensation of the hands. For example, it may be difficult to feel and recognise objects in the usual way and you may have a tendency to drop things.
• Problems with your bladder. For example, you may experience problems with emptying your bladder, or incontinence.

A doctor’s examination may show changes to the sensation, power and tendon reflexes to the legs and arms. You are likely to be referred to a specialist for further tests, usually an MRI scan. This will show how the spinal cord is affected and whether any surgical treatment to relieve the pressure is likely to help.  

Radiculitis (radiculopathy). Sciatica Treatment, Symptoms, Causes, Diagnosis

Sciatica (radiculopathy) is a general medical term for symptoms associated with a pinched or inflamed spinal cord. Symptoms may include pain in the neck or back, radiating along the innervation of the nerves from the root, and weakness in the muscles, numbness, tingling in the innervated area of ​​the extremities. The most common cause of sciatica (radiculopathy) is an intervertebral disc herniation. The disk located between the vertebrae, having an elastic structure, performs shock-absorbing functions in the spine. Discs give the spine mobility, flexibility and the ability to withstand stress. As life progresses, disc wear, degeneration, and sometimes herniated discs occur. As a result of this, the substance of the disc can come into contact with the nearby roots of the spinal cord. In this case, compression and irritation of the root occurs. In other cases, the root can be affected by osteophytes, stenosis of the spinal canal or foraminal canal. Compression and inflammation of the nerve roots can result in chronic pain both in the neck or lower back, and distally in the area of ​​innervation. Therefore, radicular pain means not only localization in the spine, but also at a significant distance along the nerve fibers. In addition, when the root is compressed, the conduction of nerve fibers can be impaired, which leads to sensory disturbances (numbness, tingling or burning) and muscle weakness in the limbs. The treatment of such symptoms depends on the causes of sciatica (radiculopathy). It is necessary to find out what exactly affects the root – disc herniation, osteophyte, arthritis or foraminal stenosis.

Causes and types of radiculitis (radiculopathy)

Anatomical causes of radiculitis (radiculopathy) – in violation of the function of one of the roots. When the root is compressed, symptoms appear on the side of the lesion and in the zone of innervation. Usually, when symptoms appear, such as pain in the neck or lower back, radiating to the arm or leg, numbness or muscle weakness in the limbs, then one should suspect that compression and irritation of the root exiting the spinal cord has occurred. Most often, the discs and sometimes the vertebrae themselves affect the spine. For example, when a disc is torn, it bulges into the spinal canal and affects the root. Bone structures can also affect the root with degeneration or bone growths (osteophytes). Patients with sciatica (radiculopathy) experience various symptoms: wandering pains from the neck to the arms and from the lower back to the legs, various disturbances or changes in sensation (numbness, tingling, burning in the limbs) decreased muscle strength in certain muscles. The main causes of sciatica (radiculopathy)

• Herniated disc in the lumbar, cervical or thoracic spine.
• Spinal stenosis
• Foraminal stenosis (narrowing of the canal through which the root passes)
• Disc degeneration
• Trauma
• Presence of osteophytes, tumors

Depending on the localization of radiculitis (radiculopathy), cervical, thoracic or lumbar sciatica are distinguished.

Cervical sciatica (radiculopathy)

Cervical sciatica by its name indicates localization in the neck, namely in the cervical spine. Symptoms (pain, sensory disturbance or muscle weakness) can be either on the right or on the left, depending on the location of the root involved. Causes of cervical sciatica can be different: disc herniation, disc protrusion, disc degeneration, osteoarthritis, foraminal stenosis, etc. Symptoms can appear both in the area of ​​localization of the irritated root, and radiate to the hands, shoulders, fingers. Between the 7 cervical vertebrae (C1-C7) there are 8 pairs of spinal cord roots that conduct electrical impulses from the central nervous system and spinal cord. The area of ​​innervation has a clear topic and depends on the specific root. Roots in the cervical region – C1-C8. Each pair is responsible for a specific area:

• C1-C2 – head
• C3-C4 – Diaphragm
• C5- upper body
• C6 – wrist and biceps
• C7- triceps
• C8 – brush

Thoracic sciatica (radiculopathy)

Thoracic sciatica means localization in the middle of the back (in the thoracic spine, consisting of 12 vertebrae). Symptoms are typical for sciatica: pain with irradiation, tingling, numbness, muscle weakness. Compared to cervical or lumbar sciatica, thoracic sciatica is rare. This is due to the relative rigidity of the thoracic spine, which serves as the attachment point for the ribs and is the supporting part for the upper and lower torso. The slight flexibility of this section prevents the vertebrae and discs in this section from age-related changes too. But, nevertheless, in the presence of symptoms, the possibility of such a variety of sciatica cannot be completely ruled out. Potential causes of the development of thoracic radiculitis may be the following factors: degenerative changes in the discs, disc protrusion, disc herniation, osteoartitis, osteophyte, spinal injury (especially with twisting), spinal canal stenosis, foraminal stenosis.

Lumbar sciatica

Lumbar sciatica means localization in the lower back (in the lumbar spine, consisting of 5 large and fairly mobile vertebrae), where the center of gravity of the human body is located. Signs of sciatica are similar to other departments (pain, sensory disturbance and muscle weakness) and the affected area corresponds to the zone of innervation (that is, pain and other symptoms accompany the nerve fiber along its course in the body). Lumbar sciatica (radiculopathy) is often called sciatica. This term implies irritation of the major sciatic nerve, which begins at the exit from L1-L5, passes the small pelvis to the legs and reaches the feet. The most striking symptom of sciatica is intense pain in the buttocks, thigh and foot (usually unilateral). The main causes of lumbar sciatica (radiculopathy) are: arthritis, degenerative changes in the vertebrae, spinal canal stenosis, foraminal stenosis, compression fracture, disc herniation, disc protrusion, spondylolisthesis.

Symptoms of radiculopathy

Physicians use the term radiculitis (radiculopathy) to describe the complex of symptoms that appear when pressure is applied to the roots of the spinal cord (which is a bundle of nerve fibers emanating from the spinal cord). However, sciatica (radiculopathy) is not an independent disease, but only a complex of symptoms including pain, muscle weakness and sensory disturbances that originate in the spine and go to the extremities. The human spine is divided into five sections and sciatica (radiculopathy) is most common in the cervical, thoracic and lumbar regions. 31 pairs of roots depart from a long spinal cord in a rather narrow spinal canal of the spine. Various reasons can reduce the space where the roots are located and exert compression on them – this is a disc herniation or protrusion, stenosis, tumor, infectious process, osteophyte. Despite the variability of symptoms, the most common symptoms are:

• Pain (discomfort) from dull and intermittent to constant and debilitating with irradiation. Pain (as a protective factor in the body) indicates that there is a damaging effect on nerve fibers.
• Violation of sensitivity. It should be noted that the spine is a rather complex structure. We unconsciously carry out a huge number of movements, and this happens automatically. But in order for the movements to be harmonious, it is necessary that there is a feedback from the brain with the muscles and sensitive receptors. When the roots are compressed, there is a violation of the conduction of impulses in both directions. Accordingly, both sensitivity (numbness, burning, tingling) and impulse conduction to the muscles are disturbed.
• Weakness in the muscles. Sometimes muscle weakness occurs in isolation (with isolated compression of motor neurons). For the normal functioning of the muscles, two-way communication is necessary, both with the spinal cord and the brain. When the root is compressed (by a disc herniation, osteophyte, or something else), the impulses are interrupted, and the muscle stops working normally. With prolonged disruption of the normal conduction of impulses, muscle atrophy or even flaccid paresis occurs.

Diagnosis of sciatica

Radiculitis is not a disease, but only a set of symptoms that indicate the presence of an effect on one of the 31 pairs of spinal cord roots. The complex of symptoms includes: pain, impaired sensitivity, weakness in the muscles along the innervation of the nerves concerned. The causes of radiculitis (radiculopathy) can be: disc herniation, disc protrusion, stenosis, etc. In order for the doctor to make an accurate diagnosis, a number of measures are necessary: ​​

• clarifying symptoms (nature of pain, intensity, duration, presence of sensory disturbances)
• examination (to determine muscle strength, range of motion)

Neurological examination – check of reflex activity and sensitivity.
X-ray is a routine method to show the degree of degenerative changes in the spine.
MRI, CT – allow you to clearly visualize the presence of root compression.
EMG is a method that allows you to determine the degree of damage to nerve fibers.

Treatment

Treatment depends on the severity of the symptoms (pain, sensation and motor disturbances). In any case, it is first necessary to exhaust all the possibilities of conservative treatment.

Drug treatment

The task of drug treatment is to relieve inflammation, reduce swelling of underlying tissues and reduce pain.
Physiotherapy. There are many physiotherapy techniques that improve blood circulation in the tissues adjacent to the root, reduce pain, and improve the conduction of impulses along nerve fibers.
Manual therapy and massage. Helps relieve muscle blocks and muscle spasms.
IRT. Acupuncture, by influencing biologically active points, helps to restore the process of conducting impulses along nerve fibers.
LFK. Dosed physical activity helps to restore the normal biomechanics of the spine and the normal stereotype of movements. With the help of exercises, it is often possible to relieve root compression due to the redistribution of load vectors. In addition, exercises stop degenerative processes in the spine, increase the elasticity of ligaments, muscles and, thus, increase the range of motion. Exercises are used both with weights (on simulators) and various gymnastics (including such as Qi-gong). Systematic exercises are, in addition, the prevention of recurrence of various conditions in the spine. Currently, the most conclusive is the effect of training on simulators.
In case of persistent pain syndrome and in the presence of a pronounced clinical picture (paresis in the muscles and impaired sensitivity), surgical decompression of the root is performed.

Cervical, thoracic and lumbosacral radiculopathy / Diseases / Clinic EXPERT

Radiculopathy (radicular syndrome) is a neurological syndrome caused by irritation of the spinal roots. Each root corresponds to the body of its vertebra and is located at the same level with it. It passes in a narrow intervertebral foramen, surrounded by muscles, ligaments and choroid plexuses. Problems with any of these formations can cause irritation and/or compression of the root.

Thus, the origin of radiculopathy and the occurrence of pain is due to the position of the roots.

Causes

Possible causes of radicular syndrome:

• mechanical injuries
• weak muscular frame of the back
• metabolic disorders
• hormonal disorders
• age degenerative changes
• chronic inflammatory process
• consequences of surgical interventions
• postural disorders (scoliosis, etc. )
• severe physical (dynamic and static) loads
• gravitational loads
• anomalies in the development of the spine
• tumor processes
• narrowing of the spinal canal ( due to displacement of the vertebrae)
• narrowing of the foraminal (intervertebral) foramens

• protrusions and herniations of the intervertebral discs

The development of degenerative-dystrophic changes in the intervertebral discs occurs over time as a result of a combination of factors. Changes in the intervertebral discs are manifested by thinning and loss of elasticity. In the absence of adequate treatment, their destruction occurs.

Thus, the conditions for disc protrusion are created. The process is carried out in the most thinned area of ​​the outer fibrous ring.

When the fibrous membrane ruptures, the nucleus of the disc protrudes.

The initial stage is characterized by the formation of a protrusion of the intervertebral disc. Rupture of the fibrous ring in this case does not occur.

Both in the case of a rupture of the annulus fibrosus, and in the case of a protrusion, when the annulus remains intact, the vertebral disc acts on the nerve roots that are located on the sides of the spinal column. In the initial stage of the process, irritation affects only the membranes. In the future, if the process is not stopped, the roots are squeezed. This process is called discogenic radiculopathy.

Radicular syndrome occurs in two stages:

• at the first, neurological stage, there is an increase in sensitivity, sharp and unexpected acute pain, characteristic muscle tension, pain in paravertebral points when pressed
• at the second, neurotic stage, there is a decrease in sensitivity in the area innervation of nerve bundles formed from damaged roots; during a medical examination, the extinction of the periosteal reflex is revealed and partial malnutrition is diagnosed. Muscle tension and intense pain characteristic of the first stage are preserved.

Types of radiculopathy

• cervical (common)
• thoracic (rare)
• cervicothoracic
• lumbar
• lumbosacral
• combined form (common)
• generalized form

Symptoms

Each type of radiculopathy is characterized by the presence of a certain set of symptoms.

The general symptom is pain of varying severity. The pain can range from not very intense to very significant. Acute pain often limits the mobility of the limbs and body and leads to the fact that it becomes impossible to lead a normal life, which affects the quality of life of the patient.

Symptoms of cervical radiculopathy

Most often, acute pain occurs in the morning. These could be:

• neck pain
• headache (sometimes very intense)
• shoulder pain
• arm pain
• neck pain and/or stiffness
• paresthesia (disturbance of sensitivity, accompanied by a burning sensation, tingling, numbness, cold)
• metabolic disorders (dry skin, peeling, cold skin when touching the affected area)

Important! If you find yourself with such symptoms, treatment should be started without delay. Do not rely on “home” methods. They are able to give only a temporary effect and will not eliminate the cause of the disease.

Only a qualified neurologist will accurately determine the type of disease, prescribe an examination and adequate treatment.

Symptoms of thoracic radiculopathy

Along with the general symptoms characteristic of all types of radiculopathy, the following are observed in the thoracic form:

• girdle pain, pain between the shoulder blades, behind the sternum and in the region of the lower ribs
• pain radiating to the shoulder and armpit
• pain radiating to the middle finger
• weakness of the triceps
• during a medical examination detection of decreased triceps reflex

It is difficult to self-diagnose the disease. It should be borne in mind that the symptoms of thoracic radiculopathy resemble those of angina pectoris and other dangerous diseases.

Self-treatment can cause irreparable harm!

Symptoms of lumbosacral radiculopathy

Lumbosacral neurological syndrome is characterized (along with similar symptoms in other types of radiculopathy):

• luma in the lower back radiating to the limb
• impaired motor function due to awkward bending or abrupt movement
• loss of sensation of the lower limb, weakening of the muscles of the lower limbs

Diagnostics

To make an accurate diagnosis and prescribe adequate treatment, a neurologist at the initial appointment conducts a neurological examination and finds out the nature, duration and intensity of pain, as well as the nature of sensory disturbances and movement disorders. If necessary, additional instrumental studies can be prescribed in our clinic (X-ray examination, which determines the degree of deformation and degenerative-dystrophic changes, signs of instability and displacement of the vertebrae) or in the diagnostic centers of the city (magnetic resonance imaging, computed tomography, electromyography, etc. .)

Treatment of radiculopathy

The beginning of treatment is the observance of complete rest and the use of various local remedies.

Since the effectiveness of treatment depends on establishing an accurate diagnosis and clarifying the cause that caused the compression of the nerve roots, contacting a qualified neurologist is a top priority. In some cases, the severity of the consequences will be less after quick help, which can be provided by an osteopathic doctor using manual or traction therapy (traction).

The next stage of treatment is the removal of pain. To do this, various drugs are used, which can be prescribed in the form of injections, including intravenously, drip in the comfortable conditions of a day hospital.

The third stage is a recovery course that starts the processes of physiological restoration of nerves, spinal roots and cartilaginous tissue of intervertebral discs.

Patients are recommended massage, physiotherapy, reflexology.

Qualified neurologists of our clinic, who have extensive experience in the treatment of radiculopathy, will give you an individual consultation and develop an individual treatment plan for you with and subsequent rehabilitation.

Forecast

In most cases, the prognosis is favorable. However, in some cases, patients are referred for a consultation with neurosurgeons and orthopedists.

Adverse factors:

• advanced age
• prolonged static or physical activity
• whiplash
• smoking
• developmental anomalies

Prevention and recommendations

The recommendations are of a general nature and should not be used for self-treatment.

Shows psychotherapy, massage, physiotherapy, swimming, physiotherapy, spa treatment (balneological resorts). A good result is given by galvanization, phonophoresis, amplipulse therapy, magnetotherapy, laser therapy, laser magnetotherapy.

Radon, mineral and pearl baths are prescribed for post-treatment and prevention of recurrent attacks.

There are many modern and effective methods. Only a qualified neurologist can determine the appropriateness of their appointment.

Don’t risk your health!

Frequently asked questions

Is it possible to heat the lower back with a heating pad in case of sciatica?

During an exacerbation of radiculopathy, it is recommended to keep the lower back warm. However, warming with a heating pad, a “blue lamp”, heated salt or sand is not recommended. This can increase the swelling of the roots and lead to increased pain. You can use special belts, including those made of dog hair, etc.

I have a stomach ulcer. What painkillers can I take for sciatica?

Many drugs used in exacerbation of radiculopathy are not recommended for patients with a history of gastric and duodenal ulcers. Only a doctor can prescribe adequate treatment after examination. Do not self-medicate!

MRI of the spine revealed a herniated disc. Do I need to delete it?

Indications for surgery to remove a herniated disc can be determined by a doctor during a consultation. Hernias most often do not require surgical intervention. It is necessary to observe a special protective regime, carry out preventive treatment and engage in physiotherapy exercises.

Treatment histories

Case №1

Patient S., 25 years old, after skiing and falling, felt a sharp pain in the lower back and numbness in the right foot. She started taking painkillers. However, due to the appearance of pain in the abdomen and heartburn, she was forced to abandon them. On the second day, she turned to a neurologist at the EXPERT Polyclinic.

The patient was prescribed treatment and consultation with a gastroenterologist. The patient underwent a course of intramuscular and intravenous drip injections in the day hospital of the Polyclinic EXPERT.