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.

Treatment of spondylosis of the cervical spine in Moscow at the Dikul clinic: prices, appointments

Cervical spondylosis is a common degenerative disease of the cervical spine. It is believed that the development of spondylosis is associated with age-related changes in the intervertebral discs. Several syndromes are clinically observed. These include: neck and shoulder pain, suboccipital and headache pain, radicular symptoms, and cervical spondylogenic myelopathy. As the disc degenerates, mechanical stresses increase and osteophytes form along the ventral part of the spinal canal.

Often associated with spondylosis are degenerative changes in the facet joints, hypertrophy of the ligamentum flavum and ossification of the posterior longitudinal ligament. All this can contribute to damage to pain-sensitive structures (eg, nerves, spinal cord), which creates various clinical syndromes. Spondylotic changes are often observed in people of the older age group. However, only a small percentage of patients with radiographic evidence of cervical spondylosis are symptomatic.

Treatment of cervical spondylosis is usually conservative; the most commonly used treatments are non-steroidal anti-inflammatory drugs (NSAIDs), physical modalities, and lifestyle modifications. Sometimes surgical treatment is performed.

Surgery is recommended for cervical radiculopathy with persistent symptoms and failure of conservative treatment.

The indications for surgical treatment of cervical spondylogenic myelopathy are somewhat controversial, but most clinicians recommend surgery for moderate to severe myelopathy.

Epidemiology

Cervical spondylogenic myelopathy is the most common cause of non-traumatic spastic paraparesis and quadriparesis. Almost 23.6% of patients with non-traumatic myelopathic symptoms had cervical spondylogenic myelopathy.

Cervical spondylosis is more common in men.

The results of studies using radiographic data showed that spondylosis changes are most common in people over 40 years of age. After all, more than 70% of men and women have spondylosis in adulthood, but radiographic changes are more pronounced in men than in women.

Causes of cervical spondylosis

The bones and cartilage in the neck are prone to wear and tear, which can lead to the development of cervical spondylosis. The most likely causes of the development of the condition:

• Bone spines (osteophytes)

These bone growths are the result of the body trying to increase the amount of bone tissue in response to increased stress in order to strengthen the spine. However, additional bone formations can put pressure on the nerve structures with the formation of pain manifestations.

• Disc degeneration

Between the spinal bones are discs, which are thick pads that absorb force vectors from lifting, twisting, and other activities. The material inside these discs can dry out over time. This leads to the fact that the bony surfaces of the vertebrae begin to touch when moving, which can become a source of pain. According to the Mayo Clinic, the process of degeneration typically begins around the age of 40.

• Herniated disc

Intervertebral discs may develop cracks, allowing the shock-absorbing material of the disc to leak out. Bulging discs can have a compressive effect on the roots or spinal cord with the development of certain neurological symptoms (pain, sensory disturbances, muscle weakness).

• Trauma

If the patient had a neck injury, such as a whiplash injury during an accident, this accelerates the degenerative processes.

• Bundle seal

The tight ligaments that connect the spinal bones to each other can become even more rigid over time, which affects the mobility of the movement segments of the neck.

• Overload

Some occupations or hobbies involve repetitive movements or heavy lifting.

Risk factors

The greatest risk factor for developing cervical spondylosis is aging. Cervical spondylosis is usually associated with involutional changes in the joints of the neck. Disc herniation, degeneration and bone growths (osteophytes) – all this is associated with involutional changes in the body.

Other risk factors:

• neck injuries
• heavy lifting work that puts extra strain on the neck
• holding the neck in an uncomfortable position for a long time or repeating the same neck movements throughout the day
• genetic determinism
• smoking
• overweight and inactivity

Cervical spondylosis symptoms

Most people with cervical spondylosis may not have significant symptoms. If symptoms do occur, they can be variable (mild or severe), acute or chronic.

A common symptom is pain around the shoulder blade. Some complain of pain in the course of the hand and fingers. Pain may increase:

• standing
• seated
• when sneezing
• when coughing
• neck extension

Another common symptom is muscle weakness. Muscle weakness makes it difficult to raise arms or grasp objects.

Other common symptoms include:

• Stiffness that gradually increases
• headaches most often occurring in the back of the head
• sensory disturbances in the upper or lower limbs

Symptoms, which are less common, often include incoordination and loss of bladder or bowel control. These symptoms require emergency medical attention.

When should I see a doctor?

If a person suddenly develops numbness or tingling in the shoulder, arms or legs, or if the patient has lost bowel or bladder control, seek medical attention as soon as possible!

If discomfort and pain begin to interfere with daily activities, a consultation with a neurologist is necessary. Despite the fact that spondylosis is part of the involutional changes, nevertheless, there are various methods of treatment that can improve well-being and reduce symptoms.

Diagnosis

The diagnosis of cervical spondylosis requires a differential diagnosis from other conditions with similar symptoms. Diagnosis of the disease is based on physical examination data, imaging findings and neurophysiological studies.

Physical examination

First, the doctor finds out the presence of symptoms, their intensity, location, history of the disease. A neurological examination is then performed, which includes examining reflexes, testing muscle strength, determining sensory deficits and determining range of motion in the neck. Your doctor may do a walking test to determine how much damage your spinal cord has.

If the doctor suspects cervical spondylosis, he will order imaging tests and neurophysiological studies to verify the diagnosis.

Imaging

• Radiography can be used to visualize bone spurs and other abnormalities.
• CT can provide more detailed images of the neck.
• An MRI scan that creates images using radio waves and a magnetic field helps the doctor detect compression of nerve structures.
• Myelogram – this procedure uses the injection of contrast into certain areas of the spine. A CT scan or X-ray is then used to obtain more detailed images of these areas.
• EMG (ENMG) is used to check the functionality of nerve fibers, the method checks the electrical activity of the nerves and the conduction of impulses to the muscles.
• ENMG determines the speed and strength of the signals that the nerve sends. This allows you to determine the presence and level of damage to nerve fibers.

Cervical spondylosis treatment

Treatment of cervical spondylosis is aimed at reducing pain symptoms, reducing the risk of permanent damage and restoring the patient’s normal lifestyle. Non-surgical methods are usually very effective and avoid surgery.

Treatments for cervical spondylosis include neck immobilization, pharmacological treatment, lifestyle modifications, and physical modalities (eg, traction, manipulation, exercise).

• neck immobilization (using a soft collar or rigid brace) is often used as a non-surgical treatment for neck pain and/or suboccipital pain syndromes caused by spondylosis and cervical radiculopathy.

As symptoms improve, the collar should only be worn during strenuous work. In the end, you can stop wearing the collar.

Stiffer orthoses and devices may better restrict movement of the cervical spine, but they may decrease muscle tone and cause neck stiffness. The use of a daily neck exercise program can limit the loss of muscle tone.

Pharmacological treatment includes several options.

• NSAIDs are the basis of pharmacological treatment. They are effective in reducing the biological effects of inflammation and pain. Their use should be monitored for adverse effects such as gastropathy, renal toxicity, hypertension, liver damage and bleeding. Selective cyclooxygenase-2 (COX-2) inhibitors such as celecoxib may reduce the risk of gastrointestinal toxicity, but they increase the risk of cardiovascular complications.
• Antidepressants. These medicines are indicated in the presence of chronic pain syndromes
• Muscle relaxants such as carisoprodol and cyclobenzaprine may also be effective in patients with neck spasm.
• Opioids – These drugs may be given to patients with severe pain. In addition, for elderly patients with contraindications to the use of NSAIDs, opioids may be a reasonable alternative, but given the development of dependence, they must be used with caution.
• Steroids. The use of steroids is controversial. In some patients with severe radiculopathy, oral steroids can rapidly relieve pain and symptoms. Steroids may also be beneficial in patients with progressive cervical spondylogenic myelopathy. Epidural steroid injections may help patients with radicular symptoms.
• Preparations for the treatment of neuropathic pain. Drugs such as gabapentin can be quite effective for chronic pain associated with cervical spondylosis.

• lifestyle modifications (eg, body mechanics training, relaxation techniques, posture awareness, ergonomics, and/or workplace changes) may relieve symptoms.

Physical therapy is one of the oldest methods of treatment for diseases of the spine.

• Traction therapy. M Mechanical stretching of the neck using specialized equipment allows you to increase the distance between the vertebrae, reduce root compression and improve circulation in the epidural space.

• Manual therapy. Manipulations used by chiropractors and osteopaths were described 4000 years ago. This method remains a popular treatment for back pain.

Techniques vary and include low-speed, high-amplitude manipulations; high-speed, low-amplitude manipulations (eg, jolts or impulse manipulations) and maneuvers.

Contraindications for manual therapy are: vertebral fractures, dislocations, infections, malignant tumors, spondylolisthesis, myelopathy, various rheumatological and connective tissue disorders and the presence of objective signs of nerve root compression.

• Exercise therapy. Exercises that are used to treat neck pain include isometric exercises to strengthen the neck, stretching and flexibility of the neck and shoulders, physical activity to strengthen the back, and aerobic exercises.

Other commonly used treatments include heat, cold, acupuncture, massage, trigger point injections, transcutaneous electrical nerve stimulation, and low-intensity cold laser. Most of the passive modalities used to treat osteochondrosis of the cervical spine are performed by physiotherapists and exercise therapy doctors and are most effective in combination with other treatment methods.

surgical>

If there are severe symptoms that are resistant to current conservative treatments, surgery may be required. Surgical procedures include the removal of bone spikes (osteophytes), parts of the bones of the vertebrae, or a herniated disc in order to eliminate the mechanical effect of these formations on the nerve structures.