Radiculopathies

Question 1

Definition

Answer 1

Condition where the nerve root in the spinal column becomes inflamed or compressed, causing, pain, numbness or weakness radiating due to herniated discs, spinal stenosis or degenerative disc disease.

Question 2

Classification

Answer 2

Cervical radiculopathy: affects the neck and upper limbs
Thoracic radiculopathy: affects the mid-back and torso
Lumbo-sacral radiculopathy: affects the lower back and lower limbs

Question 3

Epidemiology and risk factors

Answer 3

Age - 30-50
Sex: men
Occupational factors: jobs involving heavy lifting or repetitive movements
Osteoarthritis: cervical radiculopahy can arise from osteoarthritic changes in the c-spine

Question 4

Pathophysiology

Answer 4

Nerve roots arise from individual level of the spine cord, with most roots interconnecting at plexi (e.g brachial plexus, lumbosacral plexus) before forming district peripheral nerves.
A peripheral nerve may have multiple nerve root contributions.
Delineating between a radiculopathy and a peripheral neuropathy

Question 5

Signs

Answer 5

• Positive straight leg raise test: places tensile stress on the L2-4 + sciatic nerve
• Sensory deficits in a dermatomal distribution
• Reduced muscle power

Question 6

Symptoms

Answer 6

• Radiating pain : may originate in neck or back, depending on site of pathology
• Paraesthesia or numbness
• Muscle weakness

Question 7

Dermatomes definition

Answer 7

Skin that receives sensory nervous supply from a single spinal nerve root (e.g. T1)

Question 8

Ddx

Answer 8

Peripheral neuropathy

Question 9

L5 radiculopathy clinical features

Answer 9

• Weakness of foot dorsiflexion
• Weakness of toe extension
• Weakness during foot inversion
• Lower limb tendon reflex changes present
• L5 dematomal distribution of sensory loss

Question 10

Common perioneal nerve injury clinical features

Answer 10

• Weakness of foot dorsiflexion
• Weakness of toe extension
• Weakness during foot eversion
• No changes to lower limb reflexes
• Sensory loss over the anterior aspects of foot and leg

Question 11

What common condition can L5 nerve root radiculopathy and common peroneal nerve

Answer 11

Foot drop

Question 12

Diagnosis

Answer 12

• MRI: to identify the level and cause of nerve root compression = for persistent or severe symptoms
• Nerve conduction studies: assess speed of nerve signal transmission.
• Electromyography (EMG): evaluate electrical activity in muscles and identify the affected nerve root.

Question 13

Treatment

Answer 13

FIRST LINE:
- NSAIDs: ibuprofen
- Physical therapy
Second-line:
- Epidural steroid injections: (severe) to reduce inflammation around the nerve root
- Surgery: laminectomy or discectomy may be considered for persistent, severe symptoms not responsive to conservative treatment

Question 14

Complications

Answer 14

Chronic pain
Motor weakness
Sensory loss