Cervical Radiculopathy

A Comprehensive Look At Cervical Nerve Root Compression

By Genevieve V. Walton

Overview●A radiculopathy is a peripheral neurologic

syndrome resulting from mechanical injury and chemical irritation of the spinal nerve roots.

●May involve a single, or multiple nerve roots. ●Two most common types: lumbosacral & cervical

oLumbosacral type can occur in the L2-S1 nerve roots, and account for 60-90% of all radiculopathy cases

oCervical type typically occur in the C5-T1 nerve roots, and account for 5-30% of all radiculopathy cases

Cervical Spine Anatomy

●Vertebral Body●Intervertebral disk●Intervertebral

foramina●Nerve Roots●Brachial Plexus

Classification

●AcuteoRecent Trauma

●ChronicoLongstanding Trauma

●ActiveoCurrent Reinnervation

Epidemiology

●Rate of Occurrence:o83.2 per 100,000

●Age related peaks in early 50’s●Foraminal Encroachment ocauses 70-75 % of cases

Epidemiology

●Instance by Nerve RootoC7 70 %oC6 19 - 25 %oC8 4 - 10 %oC5 2 %

Causes

●Spondylosis

●Cervical Disk Disease

●Disk Herniation

●Biochemically Induced Radiculopathy

Spondylosis

●Abnormal fixation of the spine●Umbrella term for:ohypertrophy of the facet jointsonarrowing of neural foraminaoformation of osteophytes

●Spondylolisthesis●Spinal Stenosis

Cervical Disk Disease

●Process:oDisk degrades from repetitive useoIt loses integrity and bulgesoWater leaks out of disk

●Causes:oVertebral SclerosisoOsteophytes

Disk Herniation

●A: Normal disc anatomy●B: Disc protrusion

oNP penetrating asymmetrically through annular fibers but confined within the AM

●C: Disc extrusion oNP extending beyond the

AM

●D: Disc sequestrationonuclear fragment separated

from extruded discNP = Nucleus Pulposus AM = Annular Margin

Biochemically Induced

●Occurs without compression●Malfunction of enzyme in nucleusoInflammatory Response

●When nuclear material leaves diskoAutoimmune Inflammatory Response

Common Compressions

Symptoms

●SubjectiveoPain, Weakness, Numbness, TinglingoCan be felt from neck, down through the

hands

●ObjectiveoChanges in:

Reflexes Range of Motion Motor Control Postural Positioning

Waiters Tip Posture●Caused by a C5-C6 root

avulsion, or upper trunk lesion●The effected arm hangs at the

side●Arm is rotated inward at the

shoulder.●Elbow is fully extended●Forearm is pronated

Claw Hand●Caused by a C8-T1

root avulsion , or ulnar nerve lesion above the elbow

●Metacarpal joints are hyperextended

●Interphalangeal joints are flexed

Diagnostic Tests

●ManualoSpurling Maneuver

●ElectrodiagnosticoSomatosensory Evoked PotentialsoElectromyography

●ImagingoX-ray, CT, MRI, Myelogram

Spurling Maneuver●Patients neck is

extended●Head rotated to

symptomatic side●Axial pressure applied

to head●May reproduce or

worsen radicular pain

Electrodiagnostic

●Somatosensory Evoked Potential (SEP) Evaluates the Afferent Sensory Pathway

●Electromyography (EMG)oNerve Conduction Studies

Evaluates Peripheral Nerves

oNeedle Electrode Examination Evaluates motor portion of nerves/muscles

Imaging

●X-RayoJumped Facets

C4 onto C5

●CToCervical Disk Herniation

Imaging

●MRIoCervical Disk Herniation.

●MyelogramoCervical Stenosis

Treatments

●Conservative

●Surgical

Conservative Treatments

●Medication●Rest●Physical Therapy

Surgical Treatments

●DiscectomyoWith or Without Fusion

●Micro-Discectomy●Laminectomy

Prognosis

●Good to Excellent●Almost 90% of Patients are successfully

treated without surgery.●Over 95% success rate when caused by

disk herniation.●Chance of reoccurrence regardless of

treatment type.

Case Study

●68 year old right handed male ●Presented with “clumsiness” and

weakness in his right hand for the past month.oDifficulty writing, holding things, and pinching

●Pt has a known history of degenerative joint disease of the left hip with a mild limp.

●Doctor noted slowness of AMR's of the fingers on the right hand as compared to the left

Case Study

●Tests ordered by Doctor:oEMG oSEPoMRIoMyelogram

Case Study

Case Study

EMG Report Continued

Case Study●SEP results:

oNormal Study

●MRI results:oSpondylosis at all levels between C2-C3 through T1-

T2. Severe at left & moderate at right C3-C4. Moderate at C4-C5. Moderate to severe at right T1-T2.

●Myelogram resultsoVarying degrees of cervical spondylosis. It did not

show any foraminal narrowing or disk protrusion affecting the C8 or T1 roots which would explain his syndrome.

Case Study

●The Doctor associated his recent problems to a C8-T1 Radiculopathy. The chronic radicular problems were attributed as residuals from a spinal surgery 25 years ago.

●Conservative treatment measure are being pursued.

Conclusion●Cervical Radiculopathies are most

commonly:oCaused by compression of the nerve rootoTypical symptoms include pain, weakness,

numbness, and tingling in the shoulder, arm, and hand.

oDiagnostic testing combines electrodiagnostic & radiographic studies.

oConservative treatments tried prior to surgical intervention

oVery Good Prognosis

Questions?