CERVICAL RADICULOPATHY

Cervical Radiculopathy often refers to a “pinched nerve”. To frequently, this condition can cause pain to radiate away from the neck. Furthermore, disc herniation, bone spurs can also cause cervical radiculopathy.

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Cervical Radiculopathy

Cervical X-ray Pre SurgeryCervical radiculopathy occurs when a nerve root in the cervical vertebrae becomes damaged or irritated as it leaves the spinal canal. Commonly thought of as a “pinched nerve,” cervical radiculopathy stems from a herniated disc or a bone spur that presses against an inflamed nerve root. Unfortunately, this problem occurs as a result of degenerative changes in the neck. Some symptoms of cervical radiculopathy include weakness, numbness, and/ or pins-and-needles tingling.

By reading further down this page, you can learn about cervical radiculopathy including:

  • The effects of cervical radiculopathy
  • What symptoms accompany the condition
  • How doctors diagnose the condition
  • The non-surgical and surgical treatment options

Anatomy

To understand your symptoms and treatment choices, patients should learn and understand the anatomy of the neck. In addition, this includes becoming familiar with the various parts that make up the cervical spine and how they work together. Learn more about the anatomy of the cervical spine.

Cervical Radiculopathy (“Pinched Nerve”) Causes

Nerve roots that go from the spinal cord in 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.

Disc Herniation

When the neck moves, it generates tension and pressure on the spine. Therefore, the disc between each vertebra responds by acting as a shock absorber. Additionally, bending the neck forward compresses the discs between the vertebrae and tends to bulge the discs backward toward the spinal canal and nerve roots.

Problems may occur when the center part of the disc, the nucleus pulposus, squeezes out of the disc and puts pressure on nerves in the neck. To explain, this condition, called disc herniation, can happen when a tear in the outer ring of the disc (the annulus) allows the nucleus to squeeze through.

For example, the annulus can tear or rupture anywhere around the disc. If it tears next to the spinal canal, the nucleus can squeeze out and put pressure on the spinal cord or spinal nerves. To further explain, pressure against the nerve root from a herniated disc can cause numbness and weakness along the nerve. When the nerve root becomes inflamed, the added pressure from the disc may also cause vague, deep pain in the neck, shoulder, and upper arm. It can also cause sharp, shooting pain to radiate along the pathway of the nerve.

This condition may occur when excessive force gets exerted on an otherwise healthy intervertebral disc. Heavy forces on the neck may injure healthy discs.

Herniated discs appear more common in middle-aged adults because of the natural process of aging. Unfortunately, this causes the discs to become weakened from degeneration, and less force causes herniation. Although, not everyone with a herniated disc possesses degenerative problems. Likewise, not everyone with degeneration will suffer a herniated disc.

Bone Spurs

In older people, degenerative disc disease can cause bone spurs to form near the nerve roots. If these bone spurs get big enough, they may begin to rub on the nerve root and irritate it. This usually occurs inside the foramina, which are small openings on each side of the spinal column where the nerve roots leave the spine. An irritated nerve root, squeezed by a bone spur, can cause the same symptoms as a herniated disc in the neck pain, numbness, and weakness in the arm.

Symptoms

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. The reflexes in the upper arm can also be 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 a 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.

Treatment for Cervical Radiculopathy

Note that most patients with cervical radiculopathy feel better over time and may not need treatment. In some patients, the pain fades away quickly (within days or weeks) while it takes longer in other patients.

Cervical radiculopathy that has improved may return at a particular point in the future. Even when it happens, it eventually gets better without using any treatment. If cervical radiculopathy does not improve, then the patients will need evaluation and treatment.

Nonsurgical treatment

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

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. These pillows can be purchased from drug stores or from 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. Therapy sessions may be scheduled 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

Learn more about spinal rehabilitation.

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 to 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 spasm, 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 that experience severe pain that does not go away by other treatment options. Doctors usually prescribe them for a limited time only.

Surgical Treatment 

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

One of the most common operations used to treat cervical radiculopathy caused by pressure from bone spurs and a herniated disc is an anterior cervical fusion.

After surgery, you may be placed in some type of neck brace for up to 12 weeks while healing. Learn more about braces used to treat neck problems.

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. Schedule your pain relief appointment with the spine care specialists at Southwest Scoliosis and Spine Institute by calling 214-556-0555.

 

If you or a loved one suffers from spinal pain, you owe it to yourself to call Southwest Scoliosis and Spine Institute at 214-556-0555 to make an appointment.