Radiculopathies

Question 1

What is radiculopathy?

Answer 1

Pinched nerve root - one or more nerves are affected and do not work properly

Question 2

What are the different types of radiculopathies?

Answer 2

The most common types are lumbar and cervical radiculopathy – thoracic radiculopathy can also occur

Question 3

What causes radiculopathy?

Answer 3

Arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.
causes:
- Herniated disc
- Spinal stenosis
- Degenerative disc disease
- Osteoarthritis
- Facet joint degeneration/hypertrophy
- Ligamentous hypertrophy
- Spondylolisthesis - when a vertebra moves and rests on the vertebra below
- Rarer: radiation, DM (caused by altered nerve blood flow), neoplastic disease, Lyme meningitis

Question 4

What are the risk factors for radiculopathy?

Answer 4

• Age
• Overweight
• Poor posture
• Improper lifting technique
• FH of degenerative bone conditions

Question 5

What are the presenting symptoms and signs of radiculopathy?

Answer 5

1. Pain = often starts from area where spinal nerve roots are dysfunctional and radiates down to dermatome (shooting pain)
2. Motor ⇒ LMN symptoms for muscles innervated by this spinal root (eg. hyporeflexia)
3. Sensory ⇒ dermatomal pattern of pain and numbness

• Cervical Radiculopathy → neck pain commonly associated. May also be accompanied by headache and shoulder pain.
• Lumbosacral Radiculopathy → lower back pain and leg pain, characteristically worse on sitting.
  *Foot Drop (L5 Radiculopathy) ⇒ weakness/paralysis of dorsiflexion and eversion of foot. L5 root lesion (radiculopathy) is most common cause due to lumbosacral disc herniation. Sensory loss over L5 dermatome (big toe). May also be caused by common peroneal nerve lesion (secondary to compression at neck of fibula). Lower back pain that will shoot down the leg.
• Nerve Root Pain ⇒ dermatomal distribution and associated neurological defect(ie. sensory changes and weakness) 

Question 6

What investigations are used to diagnose/ monitor radiculopathy?

Answer 6

● Full neurological exam (Positive straight leg raise test)
● MRI spine- if symptoms don’t improve with conservative treatment
● X-ray and MRI
● EMG to test nerve function
● Nerve conduction studies

Question 7

How is radiculopathy managed?

Answer 7

1. Conservative Treatment → NSAIDs, Steroid Injections, Physiotherapy
   - If no improvement of symptoms in 4-6 weeks, refer for MRI
2. Surgery → if significant neurological defects

Question 8

What are some complications that may arise from radiculopathies?

Answer 8

• Incomplete neurologic recovery
• loss of full cervical range of motion (ROM)
• chronic neck pain
• headaches.
• Sciatica
• Cauda equina syndrome

Question 9

What is sciatica?

Answer 9

MOST COMMON TYPE OF RADICULOPATHY:
- Compression of lumbosacral nerve roots forming sciatic nerve (L4, L5, S1)
- Most commonly due to herniated intravertebral disc
- Pain and tingling radiating from lower back to ipsilateral leg
- Weakness in calf muscles
- Clinically diagnosed using straight leg raise test (pain on passive flexion of leg = lasegue’s sign)
- Mx ⇒ physiotherapy and analgesia (NSAIDs)
- If symptoms persist after 4-6 wks of conservative treatment, MRI referral should be done
[SCIATICA IS OFTEN NAMED AS ONE OF THE SYMPTOMS OF CAUDA EQUINA SYNDROME]

Question 10

What is cauda equina syndrome?

Answer 10

• Lumbosacral nerve root compression at L4/L5 or L5/S1.
• Most common cause is central disk prolapse.
• Features include lower back pain, bilateral sciatica, reduced perianal sensation, decreased anal tone, urinary dysfunction.
• Needs urgent MRI and possible surgical decompression.