What is cervical radiculopathy?
The cervical spine is made up of seven vertebral bodies anteriorly with discs between each body. Posteriorly the spinal cord is protected by the lamina which is connected on either side of the spinal cord to the anterior bodies through the pedicles. This forms a protective bony structure around the entire spinal cord. At each level a particular nerve root exits through an opening called the neuroforemen. When a nerve root leaves the spinal cord, it travels down the arm. Along the way, each nerve supplies feeling or sensation to different areas of the upper extremity. It also provides an electrical impulse to particular muscles that move part of the arm. When a nerve becomes pinched by either a spur or a piece of a disc, symptoms are produced within the arm. This shows up as pain, numbness or in severe cases, weakness inn the area supplied by the nerve. These symptoms are know as cervical radiculopathy.
What causes cervical radiculopathy?
Cervical radiculopathy can occur suddenly from an injury leading to a herniation of the disc against the spinal cord. More commonly, as we age, degenerative changes or wear and tear arthritic changes lead to a weakening of the disc causing it to bulge and bone spurs develop causing a progressive narrowing of the foramen putting pressure on the cervical nerves.
What are the symptoms of cervical radiculopathy?
- Pain radiating into the arm or chest.
- Numbness in the fingers.
- Muscle weakness.
- Neck and shoulder pain.
How to diagnose cervical radiculopathy:
In addition to a careful history of the symptoms described above, an examination will reveal
C5 nerve root compression:
Sensory deficit at the upper lateral arm and elbow; deltoid and biceps muscle weakness.
C6 nerve root compression:
Diminished sensation of the lateral forearm, thumb, and index finger; biceps and wrist extensor weakness.
C7 nerve root compression:
Diminished sensation to the middle finger; triceps and wrist flexor muscle weakness.
C8 nerve root compression:
Diminished sensation to the ring, little finger, and ulnar aspect of the palm; weakness of the interosseous and occasionally the finger flexors and flexor carpi ulnaris muscles.
T1 nerve root compression:
Diminished sensation in the medial aspect of the elbow and arm; interosseous muscle weakness.
Cervical spine X-rays:
To evaluate for underlying arthritis, fracture, or subluxations.
Very useful in diagnosing nerve root compression.
CT with myelogram:
Can be beneficial in diagnosing cervical nerve root compression.
Can be beneficial in assessing areas of peripheral nerve entrapment as well as diagnosing cervical radiculopathy.
Non-surgical treatment of cervical radiculopathy:
Mild nerve root compression without weakness can be often treated with therapy, NSAID’s (i.e. Advil), oral steroids or epidural steroid injections.
Surgcial treatmentof cervical radiculopathy?
If significant nerve root compression with weakness or mild nerve root compression refractory to conservative care, then surgical decompression is indicated. This may involve removing the disc from the front of the neck and replacing it with an artificial disc preserving movement or fusing the disc. In many cases, particularly for bone spurs around the nerves a minimally invasive decompression can be done through a 2 cm incision at the back of the neck with quick return to activities.
How can Dr. Knight help you with cervical radiculopathy?
Dr. Knight will rule out all other causes of arm symptoms that are easier to correct such as carpal tunnel syndrome. Once he confirms the diagnosis of cervical radiculopathy, he will begin conservative treatment and then will set up a consultation with one of his partners at DISC which have some of the region’s top spine surgeons. This referral is not to say you are heading to surgery, but merely to have an expert in spine surgery oversee your conservative care initially and be on your case to resolve your symptoms should the need for surgical intervention arise.
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