Cervical Radiculopathy

The cervical spine is made up of several vertebrae and discs. The vertebrae are the bones that make up the spine itself, and the discs are the cushions between the bones that allow movement. The vertebra has a ring of bone on the back that is made from the lamina and the deicle. When all the vertebrae are stacked on top of each other the rings line up to form the spinal canal. This contains the spinal cord and the nerves that leave to go into the arm.

The disc is made up of two components, an outer ring (anulus fibrosis) and a soft center (nucleus pulposus). The anulus fibrosis is made from lamminated fibers and holds in the soft center contents and this allows movement of the vertebrae on one another. It can be likened to a tube of toothpaste except much thicker.

Radiculopathy is pain that radiates down the arm. It is usually caused by pressure on a nerve in the neck. Each nerve that leaves the spinal cord in the neck leaves through the foramen between the bertebrae in the cervical spine. When a nerve is compressed it give a distinctive pattern of numbness, weakness, and/or pain. Most often your physician can determine which nerve is compressed simply from the symptom patterns. If the seventh cervical nerve root that is compressed, the pain starts in the neck and back of the shoulder, and radiates down along the back of the arm, the side and back of the forearm and into the index and middle fingers. They may go numb, or tingle as if they are alseep. Weakness is usually apparent in the wrist and reflex. The reflex at the back of the elbow may disappear also.

The most common causes of radiculopathy are Disc Prolapse which is pressureon the nerve inside the spinal canal by a ruptured disc before the nerve enters the opening in the vertebrae where it exits the spinal column, or by pressure on the nerve by a rupture inside the foramen, and Foramenal Stenosis. Foramenal Stenosis is a degenerative process in the disc which causes bulging of the disc into the foramen. This is combined with the vertebrae attempting to fuse together by growing osteophytes around the disc. The disc also loses height causing compression of the nerve in the foramen. The facet joint on the back of the vertebra also enlarges further closing off the foramen. All of this combines to seriously compress the nerve at it's root where it comes off the spine.

Your physician usually makes a preliminary diagnosis based on symptomology, and most likely tests will be ordered to confirm the initial diagnosis. In some cases the first test that is ordered is simple Xrays. These will show that the discs have lost height, the possibility of osteophytes, and that the foramen have narrowed. The next test that is usually ordered is an MRI. The MRI produces images using magnetic resonance instead of radiation and the doctor gets a much clearer and detailed picture of what is going on. This test will usually give us the information we ened for a diagnosis. Another test that might also be ordered is a Cervical CT Myelogram. This test involves the injection of contrast into the cerebrospinal fluid around the spinal cord and nearves and this is followed by a CT Scan. The contrast makes it easier to see what is going on. This is sometimes used if the MRI didn't clearly diagnose the problem.

How this problem is treated depends on what type and the severity of your symptoms, what your physician finds upon examination, and the results of the tests. If your symptoms are not too bad, then your physician may recommend analgesia, physiotherapy, anti-inflammatory medication and some gentle exercise hoping that you will get better on your own. If you have Radiculopathy with no numbness/weakness, and your exam shows nothing, the above will also be tried since neck pain is more difficult to treat with surgery. However, if there is evidence upon examination of some nerve damage then it will depend on how bad this is as to whether your physician will recommend surgery. Sometimes the tests reveal that the spine is so bad that surgery will actually make things worse and your physician might advise against it.

Surgery is not always necessary. In most cases the symptoms will resolve on their own. If your MRI shows soft disc prolapse then most of the time you will improve over approximately 6 weeks, and your symptoms may not recur. If the MRI shows that the foramen is narrowed then these symptoms will take longer to improve and may very well recur. If you have numbness and weakness as well as the pain, you can expect these to improve only after the pain has been resolved. The weakness generally improves next and then the numbness last. It could take 6 +/- months for the numbness to improve. In some cases the numbness does not get better. Surgery is suggested when you are not improving after trying other possible treatments, if you have severe weakness/numbness, if you cannot cope with the pain, and/or if you are getting worse in any way.

In order to resolve this problem, your physician has two surgical options. A Cervical Foraminotomy +/- Discectomy is the partial removal of adjacent lamina and part of the facet joint at the back of the foramen. The other option is an Anterior Cervical Discectomy and Fusion where the disc prolapse and any osteophytes are removed from anterior side and the disc replaced with a bone graft.