What Is Radiculopathy and Why Does it Make Your Leg Hurt?

Woman with backache, massaging her back.
Peter Dazeley/Photographer's Choice/Getty Images

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. 

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 symptoms.

Along with herniated disc and bone spurs, tumors, infections, and vasculitis are other causes of radiculopathy. But these are rare.

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. 

The nerve root associated with the larger number is the one that gets compressed.

For example, when the compression occurs at the C5-6 level, the spinal nerve root at C6 is compressed, but the one at C5 is not.

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 for Radiculopathy

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
  • Heavy lifting (routine)
  • Smoking

Radiculopathy Symptoms

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

But the most common include neck and/or 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.

Getting a Diagnosis of Radiculopathy

According to a 2011 review published in the journal Hospital for Special Surgery, about 75 percent 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, i.e., 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/or order tests such as MRI in addition to the physical exam.

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, 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.

And diagnostic tests such as MRIs may help confirm findings from the physical exam, or further pinpoint the area from which your symptoms may be arising.

Non-Surgical Treatment for Radiculopathy

Treatment for cervical and lumbar radiculopathy begins non-invasively. In fact, the Hospital for Special Surgery review mentioned above reports that about 75 percent to 90 percent of people who are diagnosed with cervical radiculopathy improve without surgery. They say that conservative therapies can be either active or passive, but that an aggressive use of an array of active therapies, generally consisting of a multi-disciplinary approach that mainly feature things to do that require 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 PT.
  2. Immobilization of your cervical spine by wearing a collar helps 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: Injection of steroid medication may help reduce swelling and pain, and keep you more comfortable.

Surgery for Radiculopathy

If a non-surgical approach fails to relieve the pain after six to twelve weeks, you may need surgery. The choice of specific 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, which is the most commonly given procedure for radiculopathy due to 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 surgical technique that is not often given. Proponents say its advantage over discectomy with fusion is that it preserves the motion of the spine at the level of the surgery.
  • 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 compared several treatments for radiculopathy and found that surgery, traction and steroid injections yielded the best change in pain status.

Was this page helpful?
View Article Sources