Cervical radiculopathy is a condition resulting from a compressed nerve in the cervical spine or neck.
The usual cause of cervical radiculopathy is progressive wear or tear in the disc. This results in a disc prolapse that causes compression on the nerve. Cervical radiculopathy can also result from osteoarthritic bone spur. This narrows the foramina canals through which the nerves exit the cervical spinal cord.
The symptoms are usually neck pain and sharp pain down the arm. These symptoms can be of gradual onset or come on quite quickly. It is not unusual for the symptoms of neck pain and arm pain to come on together or one symptom to proceed the other. The duration of symptoms is also variable.
The distribution of pain depends on the nerve root or roots that are being compressed. Other more severe symptoms like numbness, tingling, or pins and needles may occur. This relates to the severity of the nerve compression.
Diagnosis is made by analysing the history and clinical examination of the patient. We then correlate this with diagnostic imaging. The imaging test of choice is the MRI scan.
The majority of patients find that the condition does resolve by itself overtime. During this period, the type of treatment is pain-relieving medication and gentle physiotherapy. However, surgery becomes the treatment option for:
The treatment options for cervical disc prolapse are either anterior or posterior surgery. The selection of the type of surgery would depend on the location where the nerve is compressed and also the findings of the scan.
The types of surgeries are:
This is a surgery to remove disk herniation. In the surgery, the disc is removed by making an incision in the throat.
Disc replacement surgery is a type of back or spine surgery in which a worn or degenerated disc is replaced. It is replaced with an artificial disc made of metal or a combination of plastic and metal.
Young patients who have a disc prolapse without any significant bony changes can undergo a cervical disc replacement. This treatment is thought to be beneficial as it addresses the symptoms and also helps to avoid accelerated wear and tear in adjacent discs. Patients who have cervical fusion see more wear and tear at the adjacent segment.
Some of the causes of Cervical Radiculopathy include:
Factors that raise the risk of cervical radiculopathy include:
Some of the complications associated with Cervical Radiculopathy include:
Not all cases of cervical radiculopathy need surgery. The majority can be treated through non surgical means. This includes the use of appropriate analgesic medications and medications for neuropathic pain. This is usually combined with activity modification and physiotherapy.
The condition needs to be carefully monitored for response. In situations there is lack of adequate response, progression of worsening pain or development of neurological signs such as weakness or numbness, the treatment plan will need to be changed to a surgical plan.