Radiculopathy Overview: Symptoms, Causes, Treatment

Radiculopathy is a term that refers to diseases of the spinal nerve roots. Radicular is a medical term that means "root," referring to the spinal nerve root.

Woman holding her back
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A common cause of radiculopathy is compression of a spinal nerve root.

Spinal nerve root compression occurs when a structure such as the intervertebral disc or a bone spur, formed as a response to long-term wear and tear, encroaches on the space where the nerve root is located. This encroachment usually results in the structure and the nerve root coming into contact with one another, causing irritation and other symptoms, sometimes including pain.

Other causes of radiculopathy include a herniated disc, bone spurs, infections, vasculitis, and, rarely, tumors.

Compressed spinal nerve roots can occur at any level from C1-2, which is an area designation that corresponds to the top of the neck, all the way down to S4-5, corresponding to the very base of the spine. That said, the most commonly affected areas are L4-5 and L5-S1 in the low back and C5-6 and C6-7 in the neck.

Radiculopathy due to irritated spinal nerve roots in the neck is called cervical radiculopathy; in the low back, it's called lumbar radiculopathy.

Risk Factors

You are at higher risk for radiculopathy if you are sedentary and/or if you drive a lot. Sitting compresses your discs, which may cause herniation and subsequent irritation of the nerve roots.

Other factors that may increase your risk for radiculopathy include:

  • Male gender
  • Chronic cough
  • Pregnancy
  • Routine heavy lifting
  • Smoking

Symptoms

Depending on the cause of your compressed nerve root, along with its location, radicular symptoms may vary.

The most common symptoms include neck and shoulder pain, headache, and sharp pain, weakness, numbness, tingling, or other electrical-type sensations going down the leg (sciatica) or arm. Other symptoms may include impaired reflexes, weakness, muscle stiffness, limited motion, and—with cervical radiculopathy—aching or sharp pain when you extend your neck backward.

Diagnosis

According to a 2011 review published in the journal Hospital for Special Surgery, about 75% of radiculopathy cases can be diagnosed by an M.D. just by taking a patient history. Your doctor will most likely recognize radiculopathy by its most common symptom—pain down one extremity and/or numbness or electrical sensation, also down one extremity, that corresponds to the group of muscles served by the affected nerve. This area is called the nerve's dermatome.

Another symptom that may indicate radiculopathy is weakness in specific muscles of one extremity. In this case, the area served by the specific spinal nerve is called the myotome. Myotomes relate to muscle function, while dermatomes relate to sensation.

Many doctors administer a neurological exam and may order tests in addition to conducting a physical exam. Diagnostic tests, such as an MRI, may help confirm findings from the physical exam, or further pinpoint the area from which your symptoms may be arising.

During your physical exam, the doctor will likely test for pain, loss of feeling, reflexes, and muscle strength in each of the dermatomes and myotomes.

By identifying which dermatome(s) and myotome(s) are affected, he or she can determine which spinal nerve root(s) are damaged. The physical exam may include tests that reproduce your pain to help the doctor determine the nature of the nerve root damage.

Non-Surgical Treatment

Treatment for cervical and lumbar radiculopathy begins non-invasively. In fact, the Hospital for Special Surgery review mentioned above reports that 75% to 90% of people who are diagnosed with cervical radiculopathy improve without surgery. While conservative therapies can be active or passive, an aggressive use of an array of active therapies, generally consisting of a multidisciplinary approach that requires patient participation, tends to get the best results.

This may include pain medication in combination with one or more of the following:

  1. Physical therapy may help you stretch and strengthen your muscles and develop core stabilization. You may also get traction while in physical therapy.
  2. Immobilization of your cervical spine by wearing a collar helps soft tissues to heal properly.
  3. Positioning aids such as a cervical pillow for neck radiculopathy may help you get a good night's sleep.
  4. Injections of steroid medication may help reduce swelling and pain and keep you more comfortable.

Surgical Treatment

If a non-surgical approach fails to relieve the pain after six to 12 weeks, you may need surgery. The choice of procedure will likely depend on the type and location of the spinal nerve root compression, your surgeon's expertise, and if you've previously had spine surgery.

Surgeries your doctor may consider include:

  • Discectomy, the most common procedure for radiculopathy due to a herniated disc, involves surgically removing the disc.
  • Disectomy with fusion adds a spinal fusion to discectomy. The fusion may help stabilize the spinal column. This procedure may require a bone graft.
  • Disc replacement is a relatively new and rarely used surgical technique. Proponents say its advantage over discectomy with fusion is that it preserves the motion of the spine.
  • Posterior cervical laminoforaminotomy is sometimes give when only one herniated disc needs surgery and the disc material is exiting out the side of the vertebra.

A 2018 study published in the journal Molecular Pain that compared several treatments for radiculopathy found surgery, traction, and steroid injections yielded the best change in pain status.

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Article Sources
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  1. American Academy of Physical Medicine and Rehabilitation. Cervical radiculopathy. 2019.

  2. Alexander CE, Varacallo M. Lumbosacral radiculopathy. [Updated 2019 Mar 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.

  3. Caridi JM, Pumberger M, Hughes AP. Cervical radiculopathy: a review. HSS J. 2011;7(3):265–272. doi:10.1007/s11420-011-9218-z

  4. Zhang X, Zhang Z, Wen J, Lu J, Sun Y, Sang D. The effectiveness of therapeutic strategies for patients with radiculopathy: A network meta-analysis. Mol Pain. 2018;14:1744806918768972. doi:10.1177/1744806918768972

Additional Reading
  • AAOS. Cervical Radiculopathy: Surgical Treatment Options. AAOS website.

  • AAOS. Cervical Radiculopathy (Pinched Nerve). AAOS website.

  • Canale, S., Beaty, J. Cervical Disc Disease. Canale and Beaty: Campbell's Operative Orthopaedics. 11th ed.

  • Neuroscience Resource Pages. Radiculopathies.