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Radiculopathy

The spine is like a very capable chief executive. The head honcho of the skeleton. Its vertebrae and discs are supported by a loyal, energetic crew of nerves, blood vessels, and ligaments that relay sensory information, supply oxygen, and lend strength and stability. But when one member of this support staff can't perform up to snuff, the whole organization suffers. That's what happens when radiculopathy attempts a hostile takeover. And the boss is not amused.

What is radiculopathy?

Radiculopathy. Even the word sounds painful. It comes from the Latin word radix, meaning “root,” and the Greek word patheia, meaning “suffering.” Radiculopathy (ruh-dik-yoo-LOP-uh-thee) is pain that occurs when a nerve root becomes compressed or irritated. (News flash: A compressed nerve is an unhappy nerve.) Incidentally, the word “pathetic” also derives from patheia—and that’s how radiculopathy can make a patient feel.

What are the symptoms of radiculopathy?

Patients with radiculopathy have varying degrees of back pain that interferes with their quality of life. They may also have weakness, numbness, or a tingling sensation, diminished grip strength or reflexes, limited range of motion, loss of coordination, or pain in the neck, arm, hand, leg, or foot. Radicular pain doesn’t feel like a classic backache. It feels more like a mild electrical shock.

A few lucky (well, lucky-ish) patients have brief periods of pain relief, but many people with radiculopathy find it difficult to focus on anything else.

What causes radiculopathy?

Foramina (singular foramen) are small holes in the vertebrae that allow spinal nerves to enter and exit the spinal column. These openings can narrow, putting pressure on the nerves that pass through them. Each vertebra has two pairs of spinal nerve roots—a pair on the right and a pair on the left. One member of the pair transmits motor information from the brain to the spinal cord. The other carries sensory information back to the brain. The pair join forces outside the spinal canal to form a spinal nerve.

Radiculopathy occurs when one or more of these nerve roots becomes compressed (see What Is Radiculopathy?). The cervical and lumbar spine are the most vulnerable to radiculopathy. It rarely occurs at the level of the thoracic vertebrae.

A variety of injuries and disorders can contribute to radiculopathy. Putting undue strain on the back, such as lifting heavy objects or lifting them incorrectly, can cause radicular pain. Twisting the back and sitting or standing in an unnatural position can also encourage the condition. People with a family history of spinal disorders and those who’ve been injured in a car crash, fall, or other accident are more likely to develop radiculopathy. And sometimes people develop radicular pain related to (doctors say “secondary to”) an otherwise unrelated primary condition, such as a tumor or infection.

But subtle structural problems in the spine are usually the cause of radiculopathy:

Sciatic nerve compression

The sciatic nerve is the largest nerve in the body. It originates in the lower back, extending through the buttocks and into the leg. This mighty nerve supplies sensation to the thigh, lower leg, and foot. Compression of the sciatic nerve is a common type of radiculopathy.

Degenerative disc disease

The spine is made up of alternating vertebrae and intervertebral discs. Each disc is composed of a central core, called the nucleus pulposus, surrounded by a tough, fibrous outer ring, called the annulus fibrosis. As we age, the composition of the disc changes. We call this condition degenerative disc disease. The water content of the nucleus drops, and collagen fibers in the annulus break down. Discs flatten out and may begin to bulge into the spinal canal, compressing nerves exiting the spinal column.

Studies in twins have shown that degenerative disc disease has a strong genetic component. In certain people, the process is accelerated, producing degenerative changes in the spine while the patient is still relatively young. Similarly rapid degeneration is sometimes seen in people who smoke, possibly because smoking causes vascular changes that deprive the disk of an adequate blood supply.

Disc herniation

Eventually the outer ring of a disc can give way altogether, allowing the contents of the nucleus to herniate (spill out) into the spinal canal. Disc contents are usually expelled to the side, where nerves enter and exit the spinal column. Nerves and extruded disc material can’t all fit comfortably in such a small space, and nerve roots in the area end up getting squished.

Spinal stenosis

Spinal stenosis is a condition in which the space within the spinal canal narrows, putting pressure on the spinal cord. Nerves, ligaments, and blood vessels enter and exit the spinal canal through small round openings called foramina (fuh-RAM-in-uh). If disease, inflammation, or age-related degenerative changes narrow these little openings, nerves that pass through them can be constricted. This condition, which is most common among women in their 70s, affects patients’ ability to walk and puts them at a higher risk of falling.

Stenosis of the lumbar spine can cause bilateral radicular pain—in other words, pain on both sides of the body radiating from the lower back into the buttocks, leg, and foot. Stenosis of the cervical spine can limit range of motion and cause weakness, tingling, loss of sensation, and pain radiating to the shoulder arm, or hand.

How common is radiculopathy?

In any given year, up to one-third of Americans have sciatic pain—a type of radiculopathy caused by compression of the sciatic nerve—making it the most common back pain syndrome in the United States. Sciatica causes pain that radiates down into the leg and foot. Radiculopathy of the cervical spine (the upper portion of the spine) is also common, particularly among white people in their 40s and 50s. Those who smoke are at greater risk of developing cervical radiculopathy, and having had lumbar radiculopathy makes subsequent cervical radiculopathy more likely.

How is radiculopathy diagnosed?

The cause and origin of back pain are always hard to nail down, so your doctor will need to gather information from a number of different sources. He or she will ask when and how your pain began, whether it’s constant or intermittent, how intense it is, and whether there are positions (such as a stooped posture) or activities that either relieve or aggravate the pain.

Your physician or surgeon will also want to know about your general health and current lifestyle habits, such as your exercise routine and any use of tobacco products. Those who smoke are more likely to have back pain and may not recover as well after surgery. The doctor may also discuss your weight, since some studies have found that people with a high body mass index (BMI) are at greater risk of having back pain. It’s important to tell your doctor if you have diabetes, since peripheral nerve pain can mimic the pain of radiculopathy.

The doctor may also want to perform imaging studies, such as a CT or MRI scan. Needle electromyography (EMG) is a scary-sounding but harmless test in which a technician applies a mild electrical stimulus to small needles placed at strategic points near the presumed origin of your pain. The test is positive if the stimulus reproduces your pain. CT and MRI scans can reveal stenosis, nerve compression, disc degeneration, or disk herniation.

How is radiculopathy treated?

Treatment of radiculopathy is aimed at restoring lost functionality (grip strength, for example), reducing pain, and preventing progression of the disorder. Before deciding on a specific treatment, your doctor will explain your options and help you choose the interventions that fit your lifestyle and pain management goals.

Nonsurgical treatments
Spinal decompression

Placing the spine in traction by means of a system of weights and pulleys can relieve pressure and encourage blood flow to compromised areas.

Physical therapy

Physical therapy for radiculopathy focuses on strengthening the muscles that support the back, stretching to promote flexibility and range of motion, and improving posture to distribute body weight more evenly. A physical therapist can also apply interventions such as hot or cold packs.

In some patients, range of motion in the neck is so limited that it’s disabling. Restoring range of motion can not only diminish pain, but also improve the patient’s ability to care for him- or herself, which in turn improves social interaction and boosts emotional health.

Medication

Over-the-counter or carefully prescribed pain medication might offer some relief as other therapies are initiated. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Aleve) and ibuprofen (Advil) can be extremely effective in reducing radicular pain. Muscle relaxants, opioid medications, and short-term oral corticosteroids can help as well.

Injections

Injections are both a treatment and a diagnostic tool: if injection of an anesthetic (or an anesthetic mixed with a corticosteroid) relieves your pain, it probably originates in the nerve that was blocked by the anesthetic.

Surgery

If pain persists despite lifestyle changes, medications, and other interventions, you and your physician might decide to proceed with surgery. Not surprisingly, patients who are younger, who don’t smoke, and whose pain is relatively mild are the best candidates for surgery, but older patients and those with more severe pain can benefit as well. The type of surgery the surgeon performs depends on the underlying cause of the radiculopathy. For example, in a patient with cervical disc herniation, the disc might be removed and replaced with a bone graft, followed by fusion of that segment of the spine. A patient with lumbar radiculopathy caused by a calcified ligament might have part of a vertebra removed to give the offending ligament a little elbow room, so to speak.

Inspired Spine is a leader in minimally invasive keyhole surgery. We offer a full range of treatments, beginning with more conservative measures and advancing to surgical options in patients with persistent pain. Call (727) MY-SPINE to schedule a consultation with an Inspired Spine provider near you.

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