Radiculopathy is a condition that results from an injury or irritation to a nerve root as it leaves the spinal canal through the neuroforamen (intervertebral foramen). Radiculopathy is usually due to the nerve root being "Pinched" or compressed. Radiculopathy usually occurs in the neck (cervical spine) or the lower back (lumbar spine). Even though the injury or irritation to the nerve root occurs at the spine, the symptoms of Radiculopathy are experienced at a distant site. This is known as referred pain. Cervical Radiculopathy symptoms are felt in the shoulders, arms, and/or hands. Lumbar Radiculopathy symptoms are felt in the buttocks, leg, and/or feet.
The spine is made up of 33 vertebrae. These bones are stacked, one on top of the other, to form the spine or spinal column. The individual vertebrae are donut shaped with an opening in the middle (the spinal canal).
The vertebrae surround and protect the spinal cord which lies in the spinal canal.
Positioned between almost every vertebra are the intervertebral discs. The discs function as the spine's shock absorbing system; they protect the vertebrae, spine, brain, and the nerves as they leave the spinal column. The discs also allow movement between the vertebrae. This movement enables the spine to move. The discs are composed of a central soft gel-like tissue surrounded by a tough cartilaginous outer ring. Bands from this cartilaginous ring anchor the discs in place between the vertebrae.
The intervertebral foramen (Neuroforamen) are the openings between two adjacent vertebra (there are two of these openings, one on each side of the vertebrae). These openings allow the nerve fibers (nerve roots) in the spinal cord to exit the spinal canal and travel to their specific body parts. The nerves that leave the spinal cord to co-ordinate and control the body's organs and parts are the motor nerves. The sensory nerves are those nerves which carry signals and information back to the brain. The sensory nerves enter the spinal canal through the neuroforamen.
Cervical Radiculopathy symptoms may include:
- Pain that radiates from the back into the shoulders, and down the arms to the hands. The pain can vary from dull-aching, to sharp and burning.
- Muscle weakness is usually a sign that the compression on the nerve root is severe.
- Abnormal feelings such as tingling, burning, and numbness may be felt in the arms and hands.
Lumbar Radiculopathy symptoms are similar to those as described above, except that they are caused by compression of a nerve root in the lower back region of the spine. Symptoms radiate from the lower back to the buttocks, thigh, leg, and foot. When we bend forward or to the side, the symptoms of Lumbar Radiculopathy may become worse.
Radiculopathy is due to a pinching of a nerve root as it leaves the spinal canal. The three most common causes of nerve root pinching or compression are:
- Herniated (Intervertebral) Discs. The intervertebral discs lie between two adjacent vertebrae, and they cushion and protect the ends of the vertebrae (they are filled with a soft, gel-like substance). By the time we hit 30, these discs may start to show sings of deterioration. They develop small leaks, and begin to lose their jelly-like material, becoming flatter and more brittle. When this occurs, these discs are said to have ruptured or herniated. Flatter and weaker discs may lead to compression of the nerve root as it passes through the neuroforamen.
- Degenerative Disc Disease. As we age, the intervertebral discs begin to shrink or flatten. This is caused by an absorption of the water content in the discs. The result is a thinner intervertebral disc. Without sufficient thickness, the discs can no longer cushion or properly separate the vertebrae. This allows the vertebrae to rub against each other and pinch the nerve root as it travels through the neuroforamen.
- Osteoarthritis. This disease is due to the normal wearing down of the body's joint cartilage that we experience with age. As we age, the cartilage throughout our entire body begins to deteriorate and become thinner. If it wears down completely, bone may rub painfully on bone. In an attempt to repair and replace the cartilage, the body may produce bony growths called bone spurs. When bone spurs form on the vertebrae in the spine, they narrow the spinal canal, and the neuroforamen, causing nerve root compressions.
The old adage, "An ounce of prevention is worth a pound of cure," is true when it comes to our spines. We cannot totally prevent the onset of Radiculopathy any more than we can stop the aging process. However, we can limit the damage caused by the aging process if we do just a few things, such as exercising, maintaining good posture, and watching our weight. For more information about these preventive measures, please see the next section Self-Help and Exercises
Treatment for the symptoms of Radiculopathy can be divided into non-surgical treatments and surgical treatments. The "Gold Standard" of medical care for Radiculopathy is to exhaust all possible non-surgical treatments before any surgical procedures are performed.
The following non-surgical treatments. have been found to be the most successful in keeping people comfortable:
- Physical Therapy may include exercise, the use of modalities to limit muscle spasm, and working with gait training.
- Maintain good posture at all times....walking, sitting, and sleeping. Good posture reduces abnormal pressure on the spinal cord and the nerve roots; this should help to reduce pain. We have found that the Walpilo and Mediflow Pillow will provide your neck with the proper support, while comfortably maintaining it in a neutral position. Click her for information about these uniquely effective pillows. For those with Lumbar Radiculopathy, we recommend a Knee Elevator. The unique shape of this product helps to provide true pain relief.
- Nonsteroidal Anti-Inflammatory Drugs (NSAID) include the following over-the-counter medications: Advil, Motrin, and Ibuprofen. Indomethacin is an example of a prescription NSAID. All of these medications can cause various side effects, some very severe. While they may help reduce the symptoms of Radiculopathy, we highly recommend that you discuss these medications (including the over-the-counter ones) with your doctor before taking them.
- Rest and restricted activities are a must until symptoms subside. Once your symptoms have subsided, you should gradually return to those activities that you can comfortably tolerate
- Epidural steroid injections, while invasive, are still considered to be conservative treatments. During these injections your doctor will inject corticosteroid medications into the spinal fluid around your spinal cord and nerve roots. These injections help to suppress inflammation of the nerves. When the nerves are no longer inflammed, patients usually experience a decrease in the symptoms of Radiculopathy. Due to the possibilities of side effects that corticosteroids may produce, you must ask your doctor if this treatment is right for you.
Good common sense is the best medicine that one can use in the self-treatment and prevention of Radiculopathy. Here are several "to do things" which may make you more comfortable, and keep you more active:
- Regular exercise helps to maintain the strength and flexibility of all your muscles, ligaments, and joints...including those in our spines. Regular exercising may reduce your chances of developing the symptoms of Radiculopathy. Before beginning any exercise program, you must consult with your family doctor. The most common exercises suggested for this condition include: walking, riding a bicycle, and swimming. If you begin to experience pain with these activities, stop immediately and call your doctor.
- Use good posture at all times. You should try to do this even when sitting or lying down in bed. Good posture reduces the stress placed on the spinal cord by the vertebrae. This in turn will help to alleviate the pain of spinal stenosis, along with its other symptoms.
- Proper positioning of the neck is very important. A cervical pillow that provides a comfortable night's sleep, while positioning the neck in a neutral position should be used. These are the two cervical pillows that we recommend Walpilo and Mediflow Pillow. For those of small stature, or those who have a short neck, a Junior Size Pillow is available, as is a Travel Size Walpilo. Please click here to see our full line of recommended cervical pillows.
- Maintain a healthy weight. Extra weight will place excessive stress on our back and abdominal muscles, and on the joints between the vertebrae. The results are an unstable and weakened spinal column, which in turn sets the stage for the onset of spinal stenosis. A healthy weight helps to keep the spinal column straight and strong. This will help to prevent compression of the spinal cord and nerve roots, thus reducing the chances of spinal stenosis occurring.