Radiculopathy, also commonly referred to as pinched nerve,is related tocompression of the nerve roots by the surrounded tissues, disc prolapsed, at the exit point from the spinal column or just before. The most common cause of radiculopathy is the intervertebral disc herniation or protrusion. Less common causes are arthritis of the spine (wear and tear), spondylolisthesis, trauma, tumor, infection and other inflammatory process like multiple sclerosis.
Clinical Features and presentation of Radiculopathy:
Radiculopathy features are depending on the underlying cause of compression of one or multiple nerve roots. Usually, it is presented as an acute onset sciatica or brachialgia in case of acute disc herniation of the lumbo-sacral or cervical spine. However insidious symptoms are not uncommon. In a radiculopathy, the problem occurs at or near the root of the nerve, shortly after its exit from the spinal cord. However, the pain or other symptoms often radiate to the part of the body served by that nerve. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the foot. When the nerve roots are compressed, they may become inflamed. Symptoms can range from mild to severe, include, but not limited to pain, numbness, weakness, sensory changes, wasting and fasculation of the muscles. Sometimes it cause severe back pain and neck pain related to paraspinal muscles spasms.
The location of symptoms depends on which nerve root is affected at the cervical, lumbar or less common at the thoracic spine.
Diagnosis and investigations
MRI scan is the gold standard investigation for radiculopathy. It is diagnostic for the underlying cause of the nerve compression and irritation in more than 90% of cases. Neurophysiological studies are of great value in differentiating radiculopathy from peripheral senserio-motor or entrapment neuropathy which may give similar symptoms.
Management
Depend on the underlying causes of the radiculopathy, if the underlying cause is degenerative disc herniation, surgical treatment is usually the last resort of treatment of this condition. First step of management is through Conservative treatment, which is the gold standard, unless there are any of the red flag features that necessitate urgent or expedited surgical intervention. Conservative treatment in form of short period of rest, avoid physical activities that aggravate the symptoms. Start a course of simple, and if necessary neuropathic, pain killers to control the pain and numbness. Physiotherapy exercises are usually when the pain and symptoms improve and these exercises are very crucial in improvement the core muscles support of the spine and improve the long term outcome.
Red flag features that indicate a significant compression of multiple roots or spinal cord, includes, but not limited to intractable severe pain that the patient cannot coupe even with strong pain killers, weakness or paralysis of limbs, loss of sphincter control or impairment of sexual function, if the features are suspected cord compression(myelopthy) or cauda equine compression (manifested by loss of bladder or bowel control, paresthesia, numbness or sensory changes of the genitalia and the back passages and decrease anal tone).
Types of surgery:
Surgery is the last resort in treatment of radiculopathy related to degenerative disc herniation: