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cervical_radiculopathy

Cervical radiculopathy

Cervical radiculopathy is a clinical diagnosis defined by the presence of sensory or motor deficits and complaints caused by mechanical compression of the corresponding cervical nerve root.

Epidemiology

Cervical radiculopathy is a common diagnosis with a peak onset in the fifth decade.It is most prevalent in persons 50 to 54 years of age.

The most commonly affected nerve root is C7, C6, and C8.

Etiology

The etiology is often compressive, but may arise from noncompressive sources.

Cervical radiculopathy most often stems from degenerative disease in the cervical spine.

Damage can occur as a result of pressure from material from a ruptured disc, degenerative changes in bones, arthritis or other injuries that put pressure on the nerve roots. In middle-aged people, normal degenerative changes in the discs can cause pressure on nerve roots. In younger people, cervical radiculopathy tends to be the result of a ruptured disc, perhaps as a result of trauma. This disc material then compresses the nerve root, causing pain.

Cervical radiculopathy is caused by a combination of compression and inflammation of a spinal nerve. These can be caused by decreased disc height and degenerative changes in the uncovertebral and facet joints (i.e., cervical spondylosis).

Cervical disc herniation is a relatively rare cause of cervical radiculopathy, which usually occurs in younger age groups than cervical spondylosis 1) 2).

Special Types

Although midcervical (C5-C7) radiculopathy is common and well recognized, high cervical (C3 and C4) radiculopathy is relatively rare and can be missed clinically.

C4 radiculopathy.

Left C6 radiculopathy.

C7 radiculopathy.

C8 radiculopathy.

T1 radiculopathy.

Clinical features

Patients commonly complain of pain, weakness, numbness, and/or tingling.

Cervical radiculopathy describes pain in one or both of the upper extremities, often in the setting of neck pain, secondary to compression or irritation of nerve roots in the cervical spine. It can be accompanied by motor, sensory, or reflex deficits

Damage to nerve roots in the cervical area can cause pain and the loss of sensation in different parts of the upper extremities, depending on where the damaged roots are located.

The main symptom of cervical radiculopathy is pain that spreads into the arm, neck, chest, upper back and/or shoulders. A person with radiculopathy may experience muscle weakness and/or numbness or tingling in fingers or hands. Other symptoms may include lack of coordination, especially in the hands.

Diagnosis

Scales

Neck Disability Index

Anxiety due to neck/arm pain, distress (Distress And Risk Assessment Method, DRAM)

Self efficacy (Self Efficacy Scale, SES)

Health status (EQ-5D).

Differential diagnosis

Referred pain may arise from several structures in the cervical spine including the facet joint, intervertebral disc, periosteum, ligaments, and fascia. Some conditions, such as subacromial bursitis, bicipital tendinitis, rotator cuff tendinitis or tear, and myofascial pain syndromes, may mimic the pain of cervical radiculopathy. Various neurologic disorders, such as idiopathic brachial plexitis, radiation or neoplastic plexopathy, entrapment neuropathy, intramedullary spinal cord lesion, motor neuron disease, and multifocal motor neuropathy, may also cause sensory or motor disturbances that are at times difficult to distinguish from cervical radiculopathy.

Outcome

Cervical radiculopathy remains a potentially disabling disease with a significant impact on the patient’s quality of life. Despite adequate conservative non-operative therapy, a large number of patients will require surgical treatment. Widely used options in this setting include anterior cervical discectomy and fusion, cervical arthroplasty, and posterior cervical foraminotomy. Moreover, a significant increase in the frequency of surgical treatment has been reported within the past decade. From 1999 to 2008, the annual number of cervical discectomies with subsequent fusion for degenerative disc diseases in the USA increased by 67% 3).

Treatment

Case series

1)
Lunsford LD, Bissonette DJ, Jannetta PJ, Sheptak PE, Zorub DS. Anterior surgery for cervical disc disease. Part 1: Treatment of lateral cervical disc herniation in 253 cases. J Neurosurg. 1980;53:1–11.
2)
Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117(Pt 2):325–335.
3)
McGuire KJ, Harrast J, Herkowitz H, Weinstein JN. Geographic variation in the surgical treatment of degenerative cervical disc disease: American board of orthopedic surgery quality improvement initiative; Part II candidates. Spine (Phila Pa 1976) 2012;37:57–66. doi: 10.1097/BRS.0b013e318212bb61.
cervical_radiculopathy.txt · Last modified: 2019/07/18 11:34 by administrador