What is cervical spondylotic radiculopathy. How is selective nerve root block used for diagnosis and treatment. What are the current developments in SNRB for cervical radiculopathy. What are the benefits and risks of this procedure. How effective is SNRB compared to other treatment options. What are the latest research findings on SNRB for cervical radiculopathy. Who is an ideal candidate for SNRB.

Understanding Cervical Spondylotic Radiculopathy

Cervical spondylotic radiculopathy is a condition characterized by compression or irritation of nerve roots in the cervical spine, typically resulting from degenerative changes associated with aging. This condition can cause a range of symptoms, including pain, numbness, tingling, and weakness in the neck, shoulders, arms, and hands.

Why does cervical spondylotic radiculopathy occur? The primary cause is the natural wear and tear of the spine over time, leading to:

• Narrowing of the foraminal spaces where nerve roots exit the spinal column
• Formation of bone spurs (osteophytes)
• Degeneration and herniation of intervertebral discs
• Thickening of ligaments surrounding the spinal cord

These changes can compress or irritate the cervical nerve roots, resulting in the characteristic symptoms of radiculopathy. The C5-C6 and C6-C7 levels are most commonly affected, but any cervical nerve root can be involved.

The Role of Selective Nerve Root Block in Diagnosis and Treatment

Selective Nerve Root Block (SNRB) has emerged as a valuable tool in both the diagnosis and treatment of cervical spondylotic radiculopathy. This minimally invasive procedure involves injecting a local anesthetic and often a corticosteroid medication directly around the affected nerve root.

How does SNRB work for diagnosis? When used diagnostically, SNRB can help pinpoint the exact source of pain by temporarily blocking the sensation from a specific nerve root. If the patient experiences significant pain relief following the injection, it confirms that the targeted nerve root is indeed the source of symptoms.

In terms of treatment, SNRB serves a dual purpose:

1. The local anesthetic provides immediate, short-term pain relief
2. The corticosteroid reduces inflammation around the nerve root, potentially offering longer-lasting relief

Current Developments in SNRB for Cervical Radiculopathy

Recent advancements in SNRB techniques have improved both the safety and efficacy of the procedure. These developments include:

• Enhanced imaging guidance: The use of fluoroscopy and CT guidance has significantly improved the accuracy of needle placement, reducing the risk of complications.
• Particle size optimization: Researchers have been exploring the use of particulate versus non-particulate corticosteroids to minimize the risk of embolic events while maintaining therapeutic efficacy.
• Combination therapies: Some studies have investigated the combination of SNRB with other treatments, such as pulsed radiofrequency, to potentially enhance outcomes.

Are there any new technologies being developed for SNRB? Indeed, there is ongoing research into novel needle designs and drug delivery systems that could further improve the precision and effectiveness of the procedure.

Benefits and Risks of Selective Nerve Root Block

SNRB offers several potential benefits for patients with cervical spondylotic radiculopathy:

• Minimally invasive nature with quick recovery time
• Precise targeting of the affected nerve root
• Dual function as both a diagnostic and therapeutic tool
• Potential to avoid or delay more invasive surgical interventions
• Can be repeated if necessary for ongoing symptom management

However, as with any medical procedure, SNRB is not without risks. Potential complications include:

• Infection at the injection site
• Bleeding or hematoma formation
• Nerve injury or spinal cord injury (rare but serious)
• Allergic reactions to the injected medications
• Temporary increase in pain following the procedure

How can these risks be minimized? Proper patient selection, use of advanced imaging guidance, and adherence to strict sterile technique are crucial in reducing the likelihood of complications.

Effectiveness of SNRB Compared to Other Treatment Options

When evaluating the effectiveness of SNRB for cervical spondylotic radiculopathy, it’s important to consider how it compares to other available treatments. Conservative measures, such as physical therapy, oral medications, and lifestyle modifications, are often the first line of treatment. However, when these fail to provide adequate relief, SNRB may be considered.

How does SNRB compare to epidural steroid injections? While both procedures involve the injection of corticosteroids, SNRB offers more precise targeting of the affected nerve root. This can potentially lead to better outcomes and fewer side effects compared to epidural injections, which deliver medication to a broader area.

In comparison to surgical interventions, such as anterior cervical discectomy and fusion (ACDF) or posterior foraminotomy, SNRB is less invasive and carries a lower risk of complications. However, for patients with severe or progressive neurological deficits, surgery may be necessary.

Studies have shown varying success rates for SNRB in managing cervical radiculopathy, with some reporting significant pain relief in 60-75% of patients. The duration of relief can range from weeks to months, and some patients may experience long-term benefits after a series of injections.

Latest Research Findings on SNRB for Cervical Radiculopathy

Recent studies have provided valuable insights into the efficacy and safety of SNRB for cervical spondylotic radiculopathy. Some key findings include:

• A systematic review published in the Journal of Pain Research found that SNRB can provide significant short-term pain relief and functional improvement in patients with cervical radiculopathy.
• A prospective study in the European Spine Journal demonstrated that SNRB was effective in reducing pain and improving function in over 70% of patients with cervical radiculopathy at 3-month follow-up.
• Research published in the Pain Physician journal suggested that the addition of pulsed radiofrequency to SNRB may enhance long-term outcomes in some patients.

What are the limitations of current research? Many studies on SNRB have relatively small sample sizes and short follow-up periods. Additionally, there is a need for more high-quality randomized controlled trials to definitively establish the long-term efficacy of SNRB compared to other treatments.

Ideal Candidates for Selective Nerve Root Block

Identifying appropriate candidates for SNRB is crucial for maximizing the procedure’s benefits while minimizing risks. Ideal candidates for SNRB typically include:

• Patients with clear radicular symptoms corresponding to a specific cervical nerve root
• Those who have failed to respond adequately to conservative treatments
• Individuals without significant motor deficits or myelopathy
• Patients without contraindications such as active infection, bleeding disorders, or allergies to the medications used

Are there any age restrictions for SNRB? While there are no strict age limitations, the procedure may be more beneficial for younger patients with acute radiculopathy, as older individuals with chronic symptoms may have less dramatic responses.

Factors Influencing SNRB Success

Several factors can influence the success of SNRB in managing cervical spondylotic radiculopathy:

1. Duration of symptoms: Patients with acute or subacute radiculopathy often respond better than those with chronic symptoms.
2. Severity of nerve compression: Mild to moderate compression tends to have a better response compared to severe stenosis.
3. Patient expectations and compliance: Realistic expectations and adherence to post-procedure recommendations can impact outcomes.
4. Technique and expertise of the physician: Proper needle placement and medication delivery are crucial for success.

Future Directions in SNRB for Cervical Radiculopathy

As research in this field continues to evolve, several promising areas of investigation are emerging:

• Biomarkers for predicting SNRB response: Researchers are exploring whether certain biological markers can help identify patients most likely to benefit from the procedure.
• Novel drug combinations: Studies are investigating the potential benefits of combining corticosteroids with other agents, such as platelet-rich plasma or stem cells, to enhance therapeutic effects.
• Advanced imaging techniques: The development of more sophisticated imaging modalities may further improve the precision of needle placement and reduce procedural risks.
• Personalized treatment algorithms: Ongoing research aims to develop better predictive models to guide treatment selection based on individual patient characteristics and imaging findings.

What potential breakthroughs can we expect in the near future? While it’s difficult to predict with certainty, advancements in regenerative medicine and targeted drug delivery systems hold promise for improving the efficacy and durability of SNRB outcomes.

Integrating SNRB into Comprehensive Treatment Plans

As our understanding of cervical spondylotic radiculopathy and the role of SNRB continues to grow, there is increasing emphasis on integrating this procedure into comprehensive, multidisciplinary treatment approaches. This may involve:

• Combining SNRB with structured physical therapy programs
• Incorporating complementary treatments such as acupuncture or chiropractic care
• Addressing psychosocial factors that may contribute to pain perception and treatment outcomes
• Developing individualized, long-term management strategies to prevent symptom recurrence

How can healthcare providers best implement these integrated approaches? Collaboration between pain specialists, neurologists, orthopedic surgeons, and rehabilitation professionals is key to developing and implementing comprehensive treatment plans that incorporate SNRB effectively.

Patient Education and Informed Decision-Making

As with any medical intervention, patient education plays a crucial role in the success of SNRB for cervical spondylotic radiculopathy. Healthcare providers should ensure that patients have a clear understanding of:

• The procedure itself, including what to expect before, during, and after the injection
• Potential benefits and risks associated with SNRB
• Realistic expectations regarding pain relief and functional improvement
• The importance of follow-up care and adherence to post-procedure recommendations
• Alternative treatment options and how SNRB fits into the overall management plan

How can patients actively participate in the decision-making process? Encouraging patients to ask questions, express their concerns, and discuss their treatment goals can lead to more informed decisions and better overall outcomes.

The Role of Shared Decision-Making

Implementing a shared decision-making approach can enhance patient satisfaction and potentially improve treatment outcomes. This involves:

1. Providing patients with clear, evidence-based information about SNRB and alternative treatments
2. Discussing the patient’s values, preferences, and lifestyle factors that may influence treatment choices
3. Collaboratively developing a treatment plan that aligns with both clinical recommendations and patient priorities
4. Regularly reassessing and adjusting the treatment approach based on the patient’s response and evolving needs

By fostering open communication and shared decision-making, healthcare providers can ensure that patients are active participants in their care and that treatment decisions are tailored to individual needs and preferences.

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.  

causes, symptoms, diagnosis and treatment by a rheumatologist at the MCC “Proxima” (Sochi)

Spondylosis is a chronic degenerative process that occurs in the spine and is characterized by deformation of the anterior sections of the intervertebral discs, the appearance of osteophytes on their surface (bone growths) and narrowing of the spinal canal.

Causes of spondylosis

Spondylosis is a pathological disorder that affects the cervical part of the spinal column, vertebrae and adjacent discs between them. The disease is a gradual active degeneration affecting all bone and ligamentous structures of the spine. Spondylosis should not be confused with spondylitis, despite the fact that these two concepts are mistakenly considered synonymous.

Pathologies are characterized by slow destruction of intervertebral discs, vertebral bases, adjacent paravertebral tissues. In most cases, this degeneration of the spine is associated with dehydration of the intervertebral discs and causes wear of the posterior articular processes.

Practitioners believe that the occurrence of this pathology may be due to:

1. Injury to the spinal column.
2. Violation of metabolic processes.
3. Natural aging of the body.
4. Irrational distribution of the load on the spine.
5. Constitutional features.
6. Past infectious diseases.
7. Excessive physical exertion.

Specificity of the disease

Spondylosis is a widespread pathology among elderly and adult patients, as well as persons engaged in heavy physical labor. It has been scientifically proven that the disease is diagnosed in about half of male patients over 50 years of age and in 90% of female patients over 60 years of age. The disease has several varieties, as a result of which its resulting clinical manifestations are very heterogeneous.

Constant stress on the back or neck in daily life aggravates the disease. Due to additional bone growth, the human body tries to counteract the instability of the spine and thus strengthen it. Against this background, bone spurs or spondylophytes develop. They are diagnosed during a lifetime in most people. It is only when they compress blood vessels, nerves, or spinal canal that neurological disorders and neck/back pain occur.

Symptoms

The initial stages of spondylosis proceed without pronounced clinical signs – most patients note the appearance of aching pain and heaviness in the spinal column, stiffness of movements in the area of ​​the affected segment.

Progression of the pathological process accompanied by:

• increased pain;
• tension of the dorsal muscles;
• constant weakness;
• dizziness;
• tinnitus;
• sleep disorder;
• decreased visual acuity;
• difficulty with focus;
• changes in blood pressure;
• restriction of movement;
• false intermittent claudication;
• numbness of the extremities.

How do you know if you have spondylosis?

Spinal changes can be detected by taking a plain X-ray. In the future, in order to see possible compression of the nerve, it is necessary to undergo MRI diagnostics. With a referral from a family doctor / therapist and recent MRI results, you can safely turn to a surgeon for the diagnosis and treatment of spondylosis.

The course of the disease

The onset of spondylosis begins with a degenerative process of the intervertebral disc, which becomes thinner and more fragile, which causes a change in its “shock-absorbing” function.

Injuries of the spine are more or less serious and depend primarily on the work that the patient has done in the past (for example, masons, porters and builders subject their spine to a greater or lesser degree of constant stress), and the intensity that can ” felt” in old age, provoking sclerosis, bone irregularities, compaction of intervertebral discs, their wear at the level of cartilage between the joints, osteophytes.

With the development of spondylosis, the formation of a hard disc herniation, also called a disc-osteophyte beam, is possible, which is responsible for the progressive narrowing of the spinal canal.

Forms of spondylosis

According to the criterion of damage, the following types of spondylosis are distinguished:

1. Compression syndrome of the vertebral artery essential nutrients and oxygen and they die; scientists call this type of spinal cord injury myelopathy).
2. Spondylogenic compression (medical doctors understand this type of pathology as a narrowing of the spinal canal due to bone deformation; this so-called spinal canal stenosis presses directly on the spinal cord and regularly causes neurological complaints and constant severe back pain).
3. Spondylosis with radiculopathy (this form, known as radicular syndrome, refers to direct injury to the nerve root).
4. Spondylosis deformans (the process of forming a single structure as a result of connecting the bone processes of different vertebrae to each other, which limits the mobility of the spine).
5. Hyperostotic spondylosis (the form caused by the metabolic disease diabetes).

If neither myelopathy nor radiculopathy nor neurological disorders occur, the disease is classified as one of the other types of spondylosis.

Increased load or external impact on the spine in the form of violence or falls are other causes of spondylosis. In some cases, a genetic (hereditary) predisposition plays a certain role.

Diagnosis of spondylosis

The main method of differential diagnosis of spondylosis is x-ray examination , which allows to detect the presence of:

• osteophytes, having the appearance of a sharp point resembling a bird’s beak;
• neo-arthrosis – counter growths on the vertebral bodies;
• bone staples connecting the vertebrae and blocking movement in the affected area.

In contrast to osteochondrosis, there is no fusion of the spinous processes and their pain on palpation, the height of the intervertebral discs is preserved, no more than 2-3 motor segments are affected.

The results of electroneuromyography and dopplerography of cerebral vessels are used to detect neurological disorders.

Treatment of spondylosis

In spondylosis, therapeutic measures are aimed at preventing the progression of the degenerative process, the relief of the pain syndrome and strengthening the back muscles – the patient is recommended:

1. Correlation of lifestyle .
2. Physical activity restriction .
3. Elimination of permanent static loads .
4. Regular change of posture during sedentary work.
5. The use of vitamin-mineral complexes , chondroprotectors and non-steroidal anti-inflammatory drugs.
6. Physiotherapeutic procedures – electrophoresis, diadynamic therapy, ultrasound.
7. Therapeutic exercise , regular exercise of which improves the blood supply to the muscles and intervertebral discs.
8. Acupuncture .
9. Therapeutic massage with gentle osteopathic techniques.
10. Hirudotherapy .

Manual therapy, spinal traction and intensive massage are contraindicated for spondylosis!

Spondylosis Rehabilitation

Physiotherapy is almost always the best option for increasing spinal mobility. An individually designed training plan aims to stabilize the weakened intervertebral disc and stop or at least delay its further wear.

Where none of the therapeutic approaches work, sometimes only surgery remains. In order to relieve symptoms, the surgeon creates enough space for the affected intervertebral discs and nerves. Sometimes this requires strengthening individual vertebrae. Due to the risks (for example, in patients with osteoporosis) and possible side effects, such an operation is considered the last option of the decision made by the most reputable doctors.

Where outpatient treatment is insufficient or surgery is required, inpatient rehabilitation is recommended. Specialist clinics or rehabilitation centers with respective orthopedic specialists offer a wide range of therapy concepts.

In the case of conservative treatment methods (without surgery), the family doctor initiates orthopedic rehabilitation through authorized institutions or health insurance companies. In the rehabilitation center, as part of the treatment, an individual and intensive program is developed, designed for several weeks.

The chances of rehabilitation increase with the patient’s personal willingness to participate in it (for example, with the normalization of body weight). In most cases, conservative methods can achieve good results in terms of long-term improvement in the course of spondylosis.

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) foramina

• protrusions and herniations of 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 area 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):

• intense pain in the foot, thigh and buttock 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.

Unfavorable factors:

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

Prevention and advice

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, she 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.