Cervical Radiculopathy Flashcards
When were ruptured cervical discs first recognized as a cause of radicular symptoms in the arm in the absence of myelopathy?
in the 1940’s
What is the most common cause of cervical radiculopathy?
compression
What 2 derangements can cause compression on nerve roots?
- cervical spondylosis
- disc herniation
Define spondylosis
general term for nonspecific, degenerative changes of spine
Bony growths at which joints typically result in the neural foramina narrowing, causing compression of the nerve roots and radicular symptoms?
Zygapophyseal and uncovertebral joints
Radicular symptoms tend to arise following a ____ disc herniation
lateral
What are some examples of diseases/disorders that can cause noncompressive radiculopathy?
- diabetes
- vasculitis with nerve root infarction
- infections (herpes, Lyme disease, TB, syphilis, etc.)
- infiltration
- acute demyelination (GB)
Noncompressive causes of radiculopathy affect the ventral and dorsal roots more _____.
diffusely, meaning they may span multiple myotomes and dermatomes
What is the mean age at diagnosis of cervical radiculopathy?
47.9
What is the incidence ratio of men to women?
1:1.7
Incidence rates are highest for which age group?
50-54 years age group
What is the most frequently affected nerve root? It accounts for what percentage of patients?
C7
70%
C6 root involvement was found in approximately __%
20%
Involvement of which nerve roots accounted for the remaining 10%?
C5, C8, and T1
Typically if symptom onset is acute what is the cause? If onset is indolent?
herniated disc
spondylosis
Where is pain experienced?
In the neck, arm, shoulder, interscapular region, chest, breast, and face
What is a danger sign associated with cervical radiculopathy?
Lhermitte’s phenomenon
If there is associated fever, chills, and/or unexplained weight loss what might the cause be?
tumor or infection
What type of events may trigger cervical radiculopathy?
- Physical exertion in the form of golf, shoveling snow, diving from a board, etc.
- Trauma
- Motor vehicle accident
Is sensory loss common or not? Explain…
It is frequently mild or absent due to an extensive overlap of dermatomes
What special test screens for cervical radiculopathy?
the Spurling maneuver
When are neuroimaging and electrodiagnostic testing indicated for diagnosis?
When…
- localizing signs and symptoms suggest a nerve root injury
- there are there are persistent symptoms that do not resolve with conservative therapy
If a noncompressive radiculopathy is suspected, what type of imaging should be performed?
imaging with contrast
What is the imaging study of choice for diagnosing cervical radiculopathy?
MRI
What are 4 other possible diagnoses that must be ruled out first?
- Pain arising from the zygapophyseal or uncovertebral joints
- Orthopedic problems of the neck or shoulder
- Entrapment neuropathy
- Brachial plexopathy
What does prognosis depend upon?
Whether the cause is compressive or noncompressive
What type of therapy is preferred when compressive radiculopathy is suspected?
conservative
What are some examples on conservative therapy?
- Oral analgesics
- A short course of oral corticosteroids
- Avoidance of provocative activities
- Cervical traction
- Short-term neck immobilization with the use of a hard or soft cervical collar
- Use of a cervical pillow
- Physical therapy with exercise and gradual mobilization
What may patients with persistent cervical radicular pain, with or without radiculopathy (inspite of conservative therapy) benefit from?
Epidural glucocorticoid injections
What are the criteria for surgery?
- Symptoms and signs of cervical radiculopathy
- Evidence of cervical nerve root compression by MRI or CT myelography
- persistence of radicular pain despite nonsurgical therapy for at least six to 12 weeks or progressive motor weakness that impairs function
What are 3 types of surgeries that cervical radiculopathy patients may benefit from?
- Anterior cervical discectomy and fusion
- Posterior laminoforaminotomy
- Artificial disc replacement
