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.

Signs and Symptoms

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

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.

Treatment of cervical radiculopathy

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:

• Patients who do not respond to this initial line of treatment
  
• Patients who have a large disc bulge with the potential of causing nerve or spinal canal damage
  
• Patients who have numbness or weakness secondary to nerve injury
  

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:

Anterior Cervical Discectomy and Fusion

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

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.

Patients who have cervical canal stenosis or compression from bone spurs may be candidates for cervical laminectomies or cervical foraminotomies. 

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.

Causes of cervical radiculopathy

Some of the causes of Cervical Radiculopathy include:

• Degenerative changes: Normal age related changes, happening in middle age, can create some pain in the disc. These changes make the opening of the vertebrae narrower. As such, the nerve root gets compressed resulting in the pain or radiculopathy.
• Injury: Cervical radiculopathy can be caused due to a ruptured disc, as a result of an injury. When we perform activities such as bending, lifting, twisting or pulling, the disk often gets herniated. This can compress the nerve root and cause pain.
• Tumours in the spine caused by cancer, can lead to this conditions
• Infections in the spine
• Sarcoidosis  

Risk Factors

Factors that raise the risk of cervical radiculopathy include:

• Smoking cigarettes
  
• Driving equipment that vibrates
  
• Prior radiculopathy
  
• Lifting heavy equipment
  
• Playing golf
  
• Diving injuries
  

Progression and complications of untreated cervical radiculopathy

Some of the complications associated with Cervical Radiculopathy include:

• Loss of full cervical range of motion(ROM)
  
• Incomplete neurological recovery including persistent weakness or numbness.
  
• Headache
  
• Neck pain and ongoing arm pain
  
• Persistent loss of normal cervical lordosis
  
• Disc space narrowing
  
• Osteophyte formation
  

Conservative (non surgical) treatment for cervical radiculopathy

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.