CERVICAL RADICULOPATHY

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Cervical radiculopathy causes symptoms that radiate away from the neck. Although the problem exists in the neck, the symptoms will occur wherever the nerve travels — shoulder, arm, or hand. By locating the symptoms, your doctor can usually identify the affected nerve in the neck. Symptoms generally include pain, numbness, and weakness, with reflexes in the upper sometimes affected. Neck pain and headaches near the back of the head appear common with cervical radiculopathy. The back of the head refers to a medical term called the occiput, which explains why headaches in this area are called occipital headaches.

Diagnosis

Finding the cause of your neck problem begins with a complete history and physical exam. After the history and physical exam, the doctor may recognize the cause of your pain or other symptoms. To make sure of the exact cause of your neck pain, the doctor will perform several diagnostic tests. Doctors use these tests to find the cause of the pain, not make it better. Standard X-rays are usually the first step in looking into any neck problem. These include an oblique (angled) view, along with X-rays taken as you bend forward (flexion) and backward (extension). Your doctor will also determine whether other tests, such as an MRI, are needed.

Physical Examination

After going through your medical history and general well-being, the doctor will inquire about your symptoms. The doctor will then examine your neck, shoulder, arms, and hands. While doing this, he or she will look for muscle weakness, loss of sensation, or changes in your reflexes.

The doctor may ask you to carry out some neck and arm movements to recreate and/ or relieve your symptoms and to confirm problems, the doctor may use imaging to verify problems.

X-rays

X-rays provide images of bone and other dense structures. The X-ray helps the doctor see how the bones align with your neck. It also helps to learn if any narrowing of the foramen occurred and if the discs appear damaged.

Computerized tomography (CT) scans

These appear more detailed than an X-ray. They help the doctor determine if your bone spurs exist near the foramen in your cervical spine.

Magnetic resonance imaging (MRI) scans

These scans create better images of the soft tissues in your body. An MRI scan of the neck helps the doctor know if a neck nerve is compressed as a result of damage to soft tissues (like bulging or herniated discs). MRIs also help the doctor to determine if the spinal cord or cervical nerve roots appear damaged.

Electromyography (EMG)

This measures the electrical impulses of muscles when they appear at rest and while contracting. It helps to know when nerves function properly. By combining EMG with nerve condition studies, the doctor will know if the symptoms you’re feeling result from nerve damage, pressure on nerve roots, or if diabetes and other conditions that damage the nerves cause the condition.

Cervical Radiculopathy (“Pinched Nerve”) Causes

Nerve roots that go from the spinal cord to the cervical spine travel into the arm. Along the way, these nerves supply sensation (feeling) to areas of the skin from the shoulder to the fingers. Additionally, they also carry electrical signals to muscles that move the arm, hand, or fingers. Meanwhile, problems occur when one of these nerves becomes inflamed and pinched by a herniated disc or bone spur.

For example, this may show up as a weakness, numbness, and pain where the nerve travels. To clarify, the pain may feel deep, dull, and achy, or consist of sharp, shooting pain along the path of the nerve. Muscles controlled by the affected nerve root may also weaken. In the neck, this condition refers to a term called cervical radiculopathy.

Bone spurs can develop as a result of various lifestyle factors and spinal trauma. When you experience spinal trauma, whether from a fall, accident, or other injury, your body responds by trying to repair the damage. This process can lead to the formation of bone spurs as a means of stabilizing the spine.

Additionally, certain lifestyle habits can contribute to the development of bone spurs over time.

Key Lifestyle Factors:

• Chronic Poor Posture: Sitting or standing incorrectly can put undue pressure on your spine, leading to wear and tear.
• Carrying Excess Weight: Additional body weight increases the stress on your spinal column, exacerbating the likelihood of bone spurs.
• Improper Lifting Techniques: Regularly lifting heavy objects incorrectly strains your spine and promotes abnormal bone growth.

By understanding these factors, you can take steps to minimize your risk of developing bone spurs and maintain a healthier spine.

What Causes Bone Spurs to Develop and Create Pain?

Bone spurs, or osteophytes, are bony projections that typically develop along the edges of bones, often where bones meet each other in the joints. Their formation can be triggered by a variety of factors and conditions.

1. Loss of Normal Cervical Curve

A common cause is the loss of the neck’s natural curvature. This loss, known as lordosis, places additional stress on the vertebrae and intervertebral discs. Over time, this stress can cause the bones and discs to deteriorate, ultimately leading to the development of bone spurs.

2. Degenerative Diseases

Conditions like osteoarthritis play a significant role. Osteoarthritis involves the wear and tear of protective cartilage, which enables smooth joint movements. When cartilage erodes, the body may form new bone growths along joint edges or within the joints to compensate for the damage, leading to bone spurs.

3. Spinal Instability

In response to instability in the spine, the body might produce extra bone around a joint to reinforce it. This is particularly common when joint surfaces are damaged due to conditions such as arthritis. However, this additional bone can sometimes impinge on nearby spinal nerves, causing new complications.

4. Spinal Trauma and Lifestyle Factors

Bone spurs can also result from spinal injuries or chronic lifestyle habits. Factors such as poor posture, excessive weight, and incorrect lifting techniques can cumulatively strain the spine, fostering spur formation.

In summary, bone spurs develop due to a combination of mechanical stress, degenerative diseases, compensatory bone growth in response to instability, spinal trauma, and certain lifestyle factors. Understanding these causes helps in both the prevention and management of this condition.

What Spinal Conditions Are Linked to the Development of Cervical Bone Spurs that Will Cause Radiculopathy?

Cervical bone spurs can develop due to several underlying spinal conditions. Understanding these conditions helps in identifying the root cause and seeking appropriate treatment.

1. Spinal Stenosis
   • Spinal stenosis occurs when the spaces within the spine narrow, leading to pressure on the spinal cord. This often affects the cervical (neck) and lumbar (lower back) areas. The compression can lead to pain, numbness, and other symptoms, possibly contributing to the formation of bone spurs as the body tries to stabilize the affected area.
2. Degenerative Disc Disease
   • Intervertebral discs act as cushions between vertebrae, providing support, flexibility, and shock absorption. Over time, these discs can degenerate, losing their height and effectiveness. Degenerative disc disease not only affects the integrity of the spinal structure but can also lead to the development of bone spurs as the body attempts to compensate for the deteriorating discs.
3. Spondylosis
   • Spondylosis refers to the degenerative changes in the spine, often associated with aging and osteoarthritis. This condition leads to the breakdown of spinal tissues, causing chronic pain and stiffness. As the spine degenerates, bone spurs can form in an attempt to support and stabilize the deteriorating vertebrae and joints.

Each of these conditions involves changes in spinal structure and function that can lead to the development of cervical bone spurs. Monitoring and managing these underlying conditions is crucial for preventing further complications and maintaining spinal health.

What are Bone Spurs in the Neck

Bone spurs in the neck, medically referred to as osteophytes, are bony growths that form on the vertebrae of the cervical spine. These growths often appear between the first seven vertebrae (C1 to C7) and can lead to a variety of symptoms, though some individuals might not experience any at all.

Key Characteristics

• Location: Typically found between the cervical vertebrae.
• Symptoms: Can cause stiffness and pain in the neck area. If a nerve is compressed, pain may radiate into the back, shoulders, and arms.
• Activity Impact: Pain often intensifies with physical activity.
• Additional Symptoms: This may include headaches and reduced mobility in the neck.

How They Affect You

When these bony projections form, they can lead to discomfort and a decreased range of motion. In cases where a nerve is compressed, individuals might experience more severe pain, not just in the neck, but extending to the extremities.

Common Symptoms

• Neck Pain: Typically worsens with movement.
• Radiating Pain: Can extend to the arms and shoulders due to nerve compression.
• Headaches: Often a secondary symptom.
• Reduced Mobility: Difficulty moving the neck freely.

Whether you’re experiencing mild symptoms or more severe pain, consulting a healthcare professional is advised for appropriate diagnosis and treatment options.

Bone Spurs that Don’t Cause Problems

Bone spurs often remain asymptomatic because they develop gradually and don’t always interfere with surrounding tissues or structures. These bony projections may form in areas where they cause no discomfort, such as along the edges of bones or in less sensitive areas of the body. Consequently, they often go unnoticed until an X-ray for a different health issue reveals their presence.

However, when bone spurs do become symptomatic, they can provoke pain, inflammation, and reduced mobility, necessitating medical treatment. Factors that can trigger symptoms include irritation of nearby nerves, tendons, or joints. In such cases, intervention is necessary to alleviate discomfort and prevent further complications.

Key Points:

• Gradual Development: Bone spurs form slowly and don’t always affect nearby tissues.
• Detection: Often identified incidentally during X-rays for other conditions.
• Symptomatic Triggers: When symptoms arise, they typically involve pain, inflammation, or mobility issues.
• Necessity for Treatment: Symptomatic bone spurs may require medical intervention to manage discomfort and prevent further issues.

Understanding Osteophytes: What Are They?

Osteophytes, also known as bone spurs, are bony projections that develop along the edges of bones, particularly where bones meet at the joints. These overgrowths can form in various parts of the body, including the hands, feet, shoulders, hips, knees, and spine.

Key Characteristics of Osteophytes:

• Location: Often found at joint edges or within the joint itself, particularly in weight-bearing joints and the spine.
• Occurrence in Spine: Common between the first seven cervical vertebrae (C1 to C7), leading to potential neck stiffness and pain.

While some individuals with bone spurs experience no symptoms, others can suffer from a range of discomforts:

• Spinal Osteophytes: These can result in stiffness and back pain, especially if they compress nearby nerves, leading to pain radiating into the extremities.
• Cervical Bone Spurs: Often associated with neck pain, which can worsen with physical activity. Additional symptoms may include headaches, reduced neck mobility, and arm pain due to nerve compression.

These symptoms and their severity can vary significantly based on the location and size of the osteophytes.

Symptoms of Osteophytes:

• Pain and Stiffness: Especially noticeable in the neck and back.
• Radiating Pain: Nerve compression can cause pain to extend into the arms or legs.
• Headaches: In cases involving the cervical spine.
• Mobility Issues: Decreased range of motion in affected joints.

Understanding these characteristics and symptoms can help in identifying and managing osteophytes, ensuring that individuals receive appropriate medical attention and treatment.

How the Cervical Spine’s Function and Structure Contribute to Its Vulnerability to Bone Spurs

The cervical spine, located in the neck, is tasked with a dual role: supporting the weight of the head and allowing a wide range of movements. This structural and functional flexibility makes it more susceptible to wear and tear over time.

First, let’s consider the support aspect. The cervical spine bears the constant load of the head, which typically weighs around 10-12 pounds. This continuous pressure can lead to strain and stress on the vertebrae and intervertebral discs.

Additionally, the cervical spine’s ability to enable a broad degree of motion—turning, nodding, and tilting—requires it to be both strong and flexible. This constant movement, coupled with the weight-bearing function, sets the stage for potential degeneration.

Over time, this can result in:

• Disc Degeneration: The cushioning discs between vertebrae lose hydration and elasticity, compromising their ability to absorb shock.
• Facet Joint Stress: The small joints that connect the vertebrae can undergo wear, leading to arthritis and inflammation.

Degeneration in these areas often triggers the body’s protective mechanisms, one of which is the formation of bone spurs, or osteophytes. These bony projections form as a response to increased friction and pressure, aiming to stabilize the affected area. However, they can sometimes lead to further complications like nerve compression and pain.

In summary, the cervical spine’s essential functions—bearing the head’s weight and facilitating neck mobility—make it inherently prone to degenerative changes and subsequent formation of bone spurs.

Why It’s Crucial to Identify the Underlying Cause of Cervical Bone Spurs for Treatment

Understanding the root cause of cervical bone spurs is essential for effective treatment. Cervical bone spurs often arise as a secondary symptom of an underlying spinal condition. Addressing only the bone spurs without targeting the primary issue can lead to incomplete or ineffective treatment.

Key Reasons to Identify the Underlying Cause:

• Targeted Treatment: By pinpointing the specific spinal condition responsible, treatment can be customized to address both the spur and the root issue, ensuring a more comprehensive solution.
• Prevention of Recurrence: Treating the underlying condition can prevent new bone spurs from forming, reducing the need for repeated treatments and interventions.
• Enhanced Symptom Relief: Addressing the primary cause can alleviate a wider range of symptoms associated with the condition, not just those caused by the bone spur.
• Improved Outcomes: Long-term health and mobility are better preserved when the core issue is treated, leading to a higher quality of life for the patient.

In summary, focusing on the underlying cause of cervical bone spurs allows for more effective and thorough treatment, enhancing patient outcomes and preventing future complications.

Untreated Bone Spurs

Untreated bone spurs in the neck can lead to a series of complications. These bony projections can impinge on nerves and surrounding tissues, causing persistent pain. Over time, this irritation may result in muscle weakness and a limited range of motion. Additionally, sufferers might experience joint stiffness in the affected area, further restricting movement and potentially impacting daily activities.
By not addressing bone spurs promptly, there is a risk of exacerbating these symptoms and worsening the overall quality of life. Seeking early medical intervention can help manage and mitigate these adverse effects.

How Cervical Bone Spurs Are Treated

The cervical spine has the crucial task of supporting the head and allowing neck flexibility, making it susceptible to degenerative changes. When it comes to treating bone spurs, a customized approach is essential. Factors to consider include:

• Forward head posture
• Loss of the cervical curve
• History of untreated spinal trauma

Often, bone spurs are asymptomatic and discovered incidentally during an X-ray for another issue. However, if they become symptomatic, causing pain or other discomforts, treatment becomes necessary.

A conservative, non-surgical treatment approach is highly effective for managing cervical bone spurs. This method focuses on addressing the underlying causes of the condition. Once the causation is determined, a treatment plan can be designed accordingly. Chiropractic care plays a key role in this approach, helping to address vertebral subluxation and other spinal issues that contribute to the development of bone spurs.

Conservative treatment plans often integrate multiple disciplines, including:

• Condition-specific exercises and stretches
• Stem cell injections to reduce inflammation
• Rest and physical therapy
• Lifestyle and ergonomic guidance

These treatments aim to alleviate symptoms while supporting the spine’s natural design and function. If a bone spur affects the surrounding tissue, it can lead to pain, limb weakness, reduced range of motion, and joint stiffness. Addressing these symptoms through a holistic, non-invasive treatment plan can significantly improve a patient’s quality of life.

Nonsurgical Treatment of Cervical Radiculopathy

The initial treatment for cervical radiculopathy is nonsurgical. The non-surgical treatment options for cervical radiculopathy include:

• Condition-Specific Exercises and Stretches: Tailored exercises and stretches can help maintain flexibility and reduce pressure on the affected nerves.
• Stem Cell Injections: These can be used to reduce inflammation and promote healing in the affected area.
• Rest: Adequate rest is essential to allow the body to heal and reduce inflammation.
• Physical Therapy: Physical therapy can strengthen the muscles around the spine, providing better support and reducing symptoms.
• Lifestyle Guidance: Making lifestyle changes, such as improving posture and ergonomics, can help prevent further degeneration and alleviate symptoms.

More specifically, nonsurgical treatments include the following:

Soft cervical collar

The cervical collar supports and limits motion while an injured neck heals. It also helps keep the proper alignment. Cervical collars can be soft (made of foam) or hard (plastic). Because these collars can restrict head movement, you may need help with eating or other activities. The skin under the collar needs checking every day to prevent blisters or sores.

This padded ring wraps around the neck and stays in place with Velcro. The doctor may ask you to wear it to allow the neck muscles to rest and reduce the rate at which you move your neck. This decreases pinching of the cervical nerve roots that are associated with neck motion. You should only wear a soft collar for a short period because wearing it for a long time can weaken the muscles in your neck.

Cervical Pillow

A special pillow may help ease your pain at night and allow you to sleep better. Cervical pillows are specially designed to place the right amount of curvature in the neck while you sleep and to decrease the amount of irritation on the nerve roots. Patients can purchase these pillows from drug stores or a physical therapist.

Physical therapy

You can relieve pain, strengthen the muscles in your neck, and improve the range of moving the neck through some exercises.

Your doctor may recommend that you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.

Therapists use cervical traction to gently stretch the neck and relieve pressure on the irritated nerve root. Electrical stimulation eases muscle spasms and pain. Exercises focus on improving the strength and coordination of the neck, shoulders, and upper back. Patients should schedule therapy sessions two to three times each week for up to six weeks.

The goals of physical therapy help you:

• Learn correct posture and body movements to reduce neck strain
• Maintain appropriate activity levels
• Maximize your neck range of motion and strength
• Learn ways to manage your condition

Medications

In some cases, the following medications can be administered to improve the symptoms:

• Non-steroidal anti-inflammatory drugs (NSAIDs): These include ibuprofen, aspirin, and naproxen. They may provide relief if the pain is caused by inflammation or irritation of the nerve.
• Oral corticosteroids: This helps to relieve pain by reducing inflammation and swelling around the nerve.

Medications provide pain relief resulting from inflammation, muscle spasms, and sleep disturbance.

Steroid injection

If other treatments do not relieve your neck pain, you may be given an epidural steroid injection (ESI), also called a nerve block. An ESI places a small amount of cortisone into the bony spinal canal. Cortisone may control the inflammation surrounding the nerves and may ease the pain caused by irritated nerve roots. This injection works when other conservative measures do not. This treatment does not always provide a successful remedy but may provide short-term help.

This injection reduces local inflammation. In this case, steroids become injected near the affected nerve. The injection may be introduced between the laminae (epidural injection), in the foramen (selective nerve injection), or into the facet joint. Steroid injection reduces the swelling and also relieves the pain caused by a bulging or herniated disc long enough to aid the nerve’s recovery.

Narcotics

Doctors prescribe narcotics sparingly and only for those who experience severe pain that does not go away by other treatment options. Doctors usually prescribe them for a limited time only.

Personalized Treatment Plans

A proactive approach involves first determining the underlying cause of the bone spurs. Once identified, a customized treatment plan is designed to address the specific needs of the patient. This may include lifestyle changes to prevent further complications and promote overall neck health.

Holistic Care

In addition to the listed treatments, incorporating holistic methods such as chiropractic care and physical therapy can be beneficial. These therapies work in tandem with traditional treatments to provide a comprehensive care plan, enhancing recovery and maintaining neck mobility.

By understanding that each case is unique, these conservative treatments offer a range of options that can be tailored to individual circumstances, ensuring the most effective and personalized care for managing bone spurs in the neck.

Learn more about spinal rehabilitation.

Surgical Treatment for Cervical Radiculopathy

Cervical radiculopathy doesn’t always improve with conservative care. When the following conditions become noticeable, your doctor may recommend surgery:

• Unbearable pain that doesn’t respond to medical management
• Unacceptable weakness
• Weakness that is progressing
• Evidence of spinal cord compression
• Bowel or bladder concerns

Surgery for cervical radiculopathy is typically considered when conservative treatments—such as physical therapy, medications, or lifestyle modifications—fail to alleviate symptoms. Cervical radiculopathy occurs when a nerve root in the cervical spine (neck) is compressed or irritated, leading to symptoms such as pain, numbness, or weakness radiating into the arms or hands.

Here’s a comprehensive description of the surgical approach to treating cervical radiculopathy:

Understanding Cervical Radiculopathy

• Cervical Radiculopathy: As previously discussed, this condition is often caused by conditions such as cervical disc herniation, cervical spondylotic myelopathy, or spinal stenosis. The nerve root can become compressed due to a bulging or herniated disc, bone spurs (osteophytes), or narrowing of the spinal canal.

Indications for Surgery

Surgery may be recommended for cervical radiculopathy if:

• Symptoms persist despite non-surgical treatments.
• There is significant pain, numbness, or weakness affecting daily activities.
• Diagnostic imaging shows clear evidence of nerve root compression.
• There is a risk of progressive neurological deficits.

Types of Surgery for Cervical Radiculopathy

• Anterior Cervical Discectomy and Fusion (ACDF):Procedure:
• Anesthesia: Performed under general anesthesia.
• Incision: A small incision is made in the front (anterior) of the neck.
• Discectomy: The surgeon removes the damaged intervertebral disc that is pressing on the nerve root.
• Debridement: Any bone spurs or herniated disc material is also removed.
•  Anterior cervical fusion.: A bone graft or synthetic spacer is placed in the disc space to promote fusion between adjacent vertebrae.
• Stabilization: Sometimes, a metal plate and screws are used to stabilize the spine during the healing process.

Benefits:

• Effective relief of nerve compression symptoms.
• Good outcomes for reducing pain and improving function.

Risks:

• Infection
• Bleeding
• Damage to surrounding structures (e.g., esophagus, trachea)
• Nonunion or failure of the bone graft to fuse properly

Cervical Artificial Disc Replacement (ADR):Procedure:

• Anesthesia: Performed under general anesthesia.
• Incision: A similar approach is used as with ACDF, with an incision in the front of the neck.
• Discectomy: The affected disc is removed to relieve nerve compression.
• Disc Replacement: An artificial disc is inserted into the disc space to maintain motion and spacing between vertebrae.

Posterior Cervical Foraminotomy:Procedure:

• Anesthesia: Performed under general anesthesia.
• Incision: A posterior (back) approach is used, with an incision made along the back of the neck.
• Foraminotomy: The surgeon removes bone or tissue from the foramen (the bony canal through which the nerve root exits the spinal canal) to relieve nerve root compression.
• Decompression: Any additional sources of compression, such as herniated disc material or bone spurs, are also addressed.

Postoperative Care and Recovery

• Hospital Stay: Most patients can expect to stay in the hospital for 1-2 days, depending on the type of surgery and individual recovery.
• Pain Management: Postoperative pain is managed with medications and may include muscle relaxants or narcotics as needed.
• Activity Restrictions: Patients are typically advised to avoid heavy lifting, strenuous activities, and extreme neck movements for several weeks.
• Physical Therapy: Rehabilitation often includes physical therapy to improve neck strength, flexibility, and overall function.
• Follow-Up: Regular follow-up appointments are necessary to monitor healing, assess surgical outcomes, and adjust treatment as needed.

Outcomes and Considerations

• Success Rates: Surgery for cervical radiculopathy generally has high success rates in relieving symptoms and improving function.
• Long-Term Care: Maintaining a healthy lifestyle, engaging in regular exercise, and following medical advice are crucial for long-term success and spinal health.

Conclusion

Surgery for cervical radiculopathy is a viable option when conservative treatments fail to provide relief. The choice of procedure depends on various factors, including the specific cause of nerve compression, patient health, and surgical goals. Understanding the types of surgery, potential risks, and postoperative care is essential for achieving the best outcomes and managing expectations. Always consult with a qualified spine specialist to determine the most appropriate treatment plan based on individual needs and conditions.

Get the Help You Need at Southwest Scoliosis and Spine Institute

As spine care and rehabilitation experts, we treat patients with cervical radiculopathy. Once we detect the source of the pain, our experienced and fellowship-trained physicians will actively treat the condition. Finally, schedule your pain relief appointment with the spine care specialists at Southwest Scoliosis and Spine Institute with offices in Dallas, Plano, and Frisco, Texas, by calling 214-556-0555.

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Spine Health: Cervical Radiculopathy