Radiculopathy
Radiculopathy | |
---|---|
C5-C6, followed by C6-C7, is the most common location for radiculopathy in the neck. | |
Specialty | Neurosurgery |
Radiculopathy (from
In a radiculopathy, the problem occurs at or near the root of the nerve, shortly after its exit from the spinal cord. However, the pain or other symptoms often radiate to the part of the body served by that nerve. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the foot.
The radicular pain that results from a radiculopathy should not be confused with
Causes
Radiculopathy most often is caused by mechanical compression of a
Repeated, longer term exposure (5 years or more) to certain work-related activities may put people at risk of developing lumbosacral radiculopathy.[5] These behaviours may include physically demanding work, bending over or twisting at the trunk, lifting and carrying, or a combination of these activities.[5]
Less common causes of radiculopathy include injury caused by tumor (which can compress nerve roots locally) and diabetes (which can effectively cause ischemia or lack of blood flow to nerves).[medical citation needed]
Diagnosis
Signs and Symptoms
Radiculopathy is a diagnosis commonly made by physicians in primary care specialties,
Diagnosis typically involves
Although most cases of radiculopathy are compressive and resolve with conservative treatment within 4–6 weeks, guidelines for managing radiculopathy recommend first excluding possible causes that, although rare, require immediate attention, among them the following.
Investigations
If symptoms do not improve after 4–6 weeks of conservative treatment, or the person is more than 50 years old, further tests are recommended.
Treatment
Ideally, effective treatment aims to resolve the underlying cause and restores the nerve root to normal function. Conservative treatment may include
Rehabilitation
With a recent injury (e.g. one that occurred one week ago), a formal physical therapy referral is not yet indicated. Often mild to moderate injuries will resolve or greatly improve within the first few weeks. Additionally, patients with acute injuries are often too sore to participate effectively in physical therapy so soon after the insult. Waiting two to three weeks is generally recommended before starting formal physical therapy. In acute injury resulting in lumbosacral radiculopathy, conservative treatment such as acetaminophen and NSAIDs should be the first line of therapy.[1]
Therapeutic exercises are frequently used in combination with many of the previously mentioned
Surgery
While conservative approaches for rehabilitation are ideal, some patients will not improve and surgery is still an option.[23] Patients with large cervical disk bulges may be recommended for surgery; however, most often, conservative management will help the herniation regress naturally.[24] Procedures such as foraminotomy, laminotomy, or discectomy may be considered by neurosurgeons and orthopedic surgeons. Regarding surgical interventions for cervical radiculopathy, the anterior cervical discectomy and fusion procedure is more commonly performed than the posterior cervical foraminotomy procedure.[25] However, both procedures are likely equally effective and without significant differences in their complication rates.[25]
Epidemiology
Cervical radiculopathy has an annual incidence rate of 107.3 per 100,000 for men and 63.5 per 100,000 for women, whereas lumbar radiculopathy has a prevalence of approximately 3-5% of the population.
See also
References
- ^ a b "Cervical Radiculopathy (Pinched Nerve)". OrthoInfo by American Academy of Orthopaedic Surgeons. June 2015. Retrieved 22 September 2017.
- ^ "Pinched Nerve Symptoms & Treatment | Advanced Neurosurgery". Advanced Neurosurgery Associates. Retrieved 2020-12-14.
- ^ S2CID 15518713. Archived from the original(PDF) on 2019-02-20.
- PMID 27250042.
- ^ PMID 30120136.
- PMID 27175952.
- PMID 28231784.
- S2CID 10894629.
- ^ PMID 24785207. Archived from the original(PDF) on 19 October 2016.
- ^ "Lyme Disease Data and surveillance". Lyme Disease. Centers for Disease Control and Prevention. 2019-02-05. Retrieved April 12, 2019.
- ^ "Lyme Disease risk areas map". Risk of Lyme disease to Canadians. Government of Canada. 2015-01-27. Retrieved May 8, 2019.
- PMID 27161773.
- ^ Malanga GA. "Cervical Radiculopathy Workup". Retrieved 2017-06-29. Updated: Dec 14, 2016
- PMID 16921635. Archived from the original(PDF) on 2016-08-20. Retrieved 2015-08-25.
- S2CID 14391502.
- ^ "American Association of Neuromuscular & Electrodiagnostic Medicine". Choosing Wisely. 2015-02-10. Retrieved 2018-04-05.
- ^ PMID 21292148.
- S2CID 23757555.
- PMID 27008296.
- PMID 16848101.
- PMID 19468883.
- S2CID 12334905.
- S2CID 249709589.
- PMID 10549703.
- ^ PMID 28032703.
- PMID 31788391.
- S2CID 1017140.
- PMID 8186959.
Further reading
- Pachner AR (1989-10-01). "Neurologic manifestations of Lyme disease, the new "great imitator"". Reviews of Infectious Diseases. 11 (Suppl 6): S1482-6. S2CID 3862308.
- Chou R, Hashimoto R, Friedly J, Fu R, Bougatsos C, Dana T, et al. (September 2015). "Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis". Annals of Internal Medicine. 163 (5): 373–81. S2CID 25696028.
- Bakalar, Nicholas (August 24, 2015). "Steroid Shots No Better for Back Pain Than Placebo". The New York Times.
External links
- Radiculopathy at the U.S. National Library of Medicine Medical Subject Headings (MeSH)