Spine Information
Cervical Radiculopathy
Table of Contents
Cervical radiculopathy occurs when a nerve in the neck is irritated
as it leaves the spinal canal. Commonly thought of as a "pinched
nerve," cervical radiculopathy is generally from a herniated disc or a
bone spur that is pressing against an inflamed nerve root. Most often
these are a result of degenerative changes in the neck.
Learn about cervical radiculopathy including
how the cervical spine is affected
what symptoms accompany the condition
how the condition is diagnosed
what treatment options are available
In order to understand your symptoms and treatment choices, it is
helpful to start with a basic understanding of the anatomy of the neck.
This includes becoming familiar with the various parts that make up the
cervical spine and how they work together.
Cervical Radiculopathy ("Pinched Nerve")
Nerve roots that go from the spinal cord in the cervical spine
travel into the arm. Along the way, these nerves supply sensation
(feeling) to areas of the skin from the shoulder to the fingers. They
also carry electrical signals to muscles that move the arm, hand, or
fingers. Problems occur when one of these nerves becomes inflamed and
is pinched by a herniated disc or bone spur. This may show up as
weakness, numbness, and pain where the nerve travels. The pain may feel
deep, dull, and achy. Or you may have sharp, shooting pain along the
path of the nerve. Muscles controlled by the affected nerve root may
also weaken. In the neck, this condition is called cervical
radiculopathy.
Disc Herniation
The neck is subject to tension and pressure when the neck moves. The
disc between each vertebra responds by acting as a shock absorber.
Bending the neck forward compresses the discs between the vertebrae and
tends to bulge the discs backward toward the spinal canal and nerve
roots.
Problems may occur when the center part of the disc, the nucleus
pulposus, squeezes out of the disc and puts pressure on nerves in the
neck. This condition, called disc herniation,
can happen when a tear in the outer ring of the disc (the annulus)
allows the nucleus to squeeze through. The annulus can tear or rupture
anywhere around the disc. If it tears next to the spinal canal, the
nucleus can squeeze out and put pressure on the spinal cord or spinal
nerves. Pressure against the nerve root from a herniated disc can cause
numbness and weakness along the nerve. When the nerve root is inflamed,
the added pressure from the disc may also cause vague, deep pain in the
neck, shoulder, and upper arm. It can also cause sharp, shooting pain
to radiate along the pathway of the nerve.
This condition may occur when too much force is exerted on an
otherwise healthy intervertebral disc. Heavy forces on the neck may
simply be too much for even a healthy disc to absorb.
Herniated discs are more common in middle-aged adults. This is
because the natural process of aging causes the discs to become
weakened from degeneration. Less force is needed to cause the
degenerated disc to herniate. Not everyone with a herniated disc has
degenerative problems. Likewise, not everyone with degeneration will
suffer a herniated disc.
Bone Spurs
In older people, degenerative disc disease can cause bone spurs to
form near the nerve roots. If these bone spurs get big enough, they may
begin to rub on the nerve root and irritate it. This usually occurs
inside the foraminae, which are small openings on each side of the
spinal column where the nerve roots leave the spine. An irritated nerve
root that is squeezed by a bone spur can cause the same symptoms as a
herniated disc in the neck-pain, numbness, and weakness in the arm.
Cervical radiculopathy causes symptoms that radiate away from the
neck. Although, the problem is in the neck, the symptoms will be felt
wherever the nerve travels-shoulder, arm, or hand. By locating the
symptoms, your doctor can usually tell which nerve in the neck is
having problems. Symptoms generally include pain, numbness, and
weakness. The reflexes in the upper arm can also be affected.
Neck pain and headaches near the back of the head are common with
cervical radiculopathy. The back of the head is called the occiput,
which is why headaches in this area are called occipital headaches.
Finding the cause of your neck problem begins with a complete history and
physical exam.
After the history and physical exam, the doctor may have a good idea of
the cause of your pain or other symptoms. To make sure of the exact
cause of your neck pain, several diagnostic tests can be used. These
tests are used to find the cause of the pain, not make it better.
Standard X-rays,
are usually a first step in looking into any neck problem. These
include an oblique (angled) view, along with X-rays taken as you bend
forward (flexion) and backward (extension). Your doctor will also
determine whether other tests, such as an MRI, are needed.
Conservative Treatment
Medication
Medications are commonly used to control pain, inflammation, muscle spasm, and sleep disturbance.
Cervical Collar
A cervical collar is often used to provide support and limit motion
while an injured neck is healing. It also helps keep the proper
alignment. Cervical collars can be soft (made of foam) or hard
(plastic). Because these collars can restrict head movement, you may
need help with eating or other activities. The skin under the collar
needs to be checked every day to prevent blisters or sores.
Cervical Pillow
A special pillow may help ease your pain at night and allow you to
sleep better. Cervical pillows are specially designed to place the
right amount of curvature in the neck while you sleep and to decrease
the amount of irritation on the nerve roots. These pillows can be
purchased from drug stores or from a physical therapist.
Physical Therapy
Your doctor may have you work with a physical therapist. A
well-rounded rehabilitation program assists in calming pain and
inflammation, improving your mobility and strength, and helping you do
your daily activities with greater ease and ability.
Therapists use cervical traction to gently stretch the neck and to
relieve pressure on the irritated nerve root. Electrical stimulation
eases muscle spasm and pain. Exercises focus on improving strength and
coordination of the neck, shoulders, and upper back. Therapy sessions
may be scheduled two to three times each week for up to six weeks.
The goals of physical therapy are to help you
- learn correct posture and body movements to reduce neck strain
- maintain appropriate activity levels
- maximize your neck range of motion and strength
- learn ways to manage your condition
ESI
If other treatments do not relieve your neck pain, you may be given an epidural
steroid injection
(ESI), also called a nerve block. An ESI places a small amount of
cortisone into the bony spinal canal. Cortisone is a strong
anti-inflammatory medicine that may control the inflammation
surrounding the nerves and may ease the pain caused by irritated nerve
roots. This injection is often used when other conservative measures do
not work, or in an effort to postpone surgery. This treatment is not
always successful but may provide short-term help. Learn more about
spinal injections.
Surgical Treatment
Cervical radiculopathy doesn't always improve with conservative
care. Surgery may be recommended when the following conditions are
present:
- unbearable pain that doesn't respond to medical management
- unacceptable weakness
- weakness that is progressing
- evidence of spinal cord compression
- bowel or bladder concerns
One of the most common operations used to treat a cervical
radiculopathy caused by pressure from bone spurs and a herniated disc
is an anterior cervical fusion.
After surgery, you may be placed in some type of neck brace for up to 12 weeks while healing.
Learn more about braces used to treat neck problems.
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