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Cervical Radiculopathy

Cervical Myelopathy

Cervical radiculopathy is the scientific term for a pinched nerve in the neck. This pinched nerve can cause neck pain, arm pain, and/or a combination of both neck and arm pain. This condition is seen in both younger patients (age 18 to 50) as well as older patients (>50 years of age). The typical cause of cervical radiculopathy is younger patients is a herniated disc in the neck while is older patients it is more commonly a combination of disc degeneration and neck arthritis.

Most patients who present to a physician for cervical radiculopathy will describe neck and/or arm pain on one side more than the other. They may describe a tight, cramping feeling in their neck with 'shooting pain' down the arm, which typically feels like a 'lightning bolt' or 'pins/needles' type of pain/sensation. Rarely will someone notice weakness of the arm and/or diffculty with walking or balance. A thorough physical examination will allow a trained physician to make the proper diagnosis and usually identify which nerve is compressed in the neck and if there is any signifciant degree of spinal cord compression. This can be confirmed with advanced imaging studies (such as an MRI) if necessary.

The treatment for an overwhelming majority of patients with cervical radiculopathy is non-operative. Some studies have suggested that 75-90% of patients can avoid cervical spine surgery for this condition. Usually, the pinched nerve calms down and heals over time, returning to its normal, pain-free state. To make the patient comfortable while time heals the nerve, the he/she is typically given oral medications for nerve pain, muscle spasms, and inflammation. The patient is also usually prescribed a gentle physical therapy program under the guidance of a spine-trained therapist. If these non-invasive treatments do not provide the patient with adequate relief over time, an MRI is performed to confirm the location of the pinched nerve in the neck. Based on the MRI and the patient's symptoms, cervical epidural injections can be used to confirm the source of the pain and to help alleviate the pain. These injections are technically challenging and should only be performed by a trained rehabilitation physician or a trained anesthesia pain specialist.

Surgery on the cervical spine should be considered if any of the following three conditions are met: 1) if the patient also has spinal cord compression with symptoms of spinal cord dysfunction, such as difficulty with balance, heaviness in the legs, bowel/bladder issues, etc. 2) Progressive weakness of the affected upper extremity. For example, if the pinched nerve is on the right side at C7, then the patient may develop weakness in the tricep and have progressive weakness with right elbow extension. 3) If the patient has continued neck and/or arm pain after months of exhausting all non-operative treatment options. The pain from a pinched nerve can be very severe, and - if the patient does not get adequate lasting relief from oral medications, physcial therapy, and epidural injections - then surgery can reliably relief the patient's pain and discomfort.

The proper surgical technique for the treatment of cervical radiculopathy is based on many factors (the patient's age, medical/surgical history, body type, spinal alignment, degree of spinal cord compression, degree of neck pain versus arm pain, pain in one arm versus both arms, etc.) The recommendation of surgery and the type of surgery should be discussed with the spine surgeon and be viewed on a case by case basis.

For more information and/or more specific questions, please consult a fellowship-trained orthopedic spine surgeon.