Definition and Overview
Cervical radiculopathy is a disease that causes pain, paresthesia, and muscle weakness in the dermatome and myotome areas due to compression, traction, or inflammatory stimulation of the cervical spinal nerve roots (C1-C8). Although it is commonly called 'cervical disc', there are various causes other than intervertebral disc herniation, such as cervical spondylosis, osteophyte, and posterior longitudinal ligament ossification.
It has an annual incidence of approximately 83 cases per 100,000 people, is somewhat higher in men, and is most prevalent in people in their 40s and 50s. The C6 and C7 nerve roots are most commonly involved, accounting for approximately 70% of all cervical radiculopathy.
cause
Causes related to intervertebral discs
Herniated nucleus pulposus is the most common cause of radiculopathy in young people. As the nucleus pulposus protrudes through the annulus fibrosus, it puts pressure on adjacent nerve roots and causes chemical inflammation.
degenerative changes
In people over 50 years of age, the main cause is degenerative changes such as bone spur formation due to cervical spondylosis, intervertebral foraminal stenosis, and yellow ligament thickening. Degenerative changes progress slowly, so the onset of symptoms is often gradual.
Other causes
Trauma, tumor, infection, ossification of the posterior longitudinal ligament (OPLL), and atlantoaxial instability due to rheumatoid arthritis rarely cause radiculopathy.
symptoms
Main symptoms by cervical spine level
Symptoms vary in distribution depending on the level of the nerve root being compressed.
- C5 nerve root: pain in the deltoid area, weakness in shoulder abduction, paresthesia on the lateral side of the upper arm.
- C6 nerve root: Numbness in the thumb and index finger, weakness in wrist dorsiflexion (extension), decreased biceps reflexes.
- C7 nerve root: numbness in middle finger, triceps weakness, decreased triceps reflexes.
- C8 nerve root: numbness in the ring and small fingers, weakness of the intrinsic muscles of the hand, decreased grip strength
Pain characteristics
It is characterized by pain that starts in the neck and radiates to the shoulders, between the shoulder blades, and along the arms to the fingers. It worsens when the neck is tilted back or rotated to the affected side, and can be relieved by raising the arm on the affected side above the head (shoulder abduction relief sign).
diagnosis
physical examination
- Spurling test: Radiating pain is reproduced by tilting the head to the affected side and applying axial pressure. With a specificity of about 93%, it has high diagnostic value when positive.
- Shoulder abduction test: Pain is relieved by raising the arm above the head.
- Upper extremity muscle strength test and deep tendon reflex evaluation
imaging test
- Cervical spine MRI: This is the most useful test because it can directly check soft tissue (disc, ligament) and nerve root compression.
- Cervical spine X-ray: To evaluate bony changes, including osteophytes, foraminal narrowing, and misalignment
- CT: Used as an auxiliary method when precise evaluation of osseous lesions is required.
electrophysiological test
Nerve conduction studies (NCS) and electromyography (EMG) are useful for objective confirmation of radiculopathy, determination of the level of involvement, and differentiation from peripheral nerve entrapment. Because denervation appears 3 to 4 weeks after the onset of symptoms, the timing of the test must be considered.
treatment
conservative treatment
Approximately 80-90% of patients improve with conservative treatment.
- Drug treatment: NSAIDs, muscle relaxants, gabapentin or pregabalin are effective for neuropathic pain.
- Physical therapy: Includes cervical traction, manual therapy, and neck strengthening exercises.
- Cervical braces: Short-term (1 to 2 weeks) use of a cervical collar during the acute phase may help relieve pain.
- Epidural steroid injection: Consider cervical epidural steroid injection if the patient does not respond to conservative treatment.
surgical treatment
Surgery is considered if there is no improvement even after 6 to 12 weeks of conservative treatment, or if there is progressive muscle weakness or findings of myelopathy (gait disturbance, hand fine motor impairment, bladder dysfunction).
- Anterior cervical discectomy and fusion (ACDF): This is the most commonly performed surgical method.
- Artificial disc replacement: An alternative method that allows preservation of motion segments.
- Posterior foraminal expansion: Applicable for single-segment soft disc herniation.
Progress and prognosis
Overall, it is a disease with a good prognosis. Conservative treatment alone results in significant symptom improvement in most patients within 4 to 6 months. Even when surgery is performed, pain reduction and functional recovery are reported in more than 90% of patients.
The recurrence rate is approximately 25-30%, and new nerve root compression may occur as degenerative changes in adjacent segments progress.
life guide
- Regularly perform exercises to strengthen the deep neck flexors around the neck.
- Avoid being in a fixed position for a long time and stretch your neck every 30 to 60 minutes.
- Use a pillow of an appropriate height that maintains the natural lordosis of the cervical spine.
- Avoid lifting heavy objects with one hand.
- When using a smartphone, raise the screen to eye level to reduce cervical spine curvature.