Radiculopathy
Commonly asked questions about Radiculopathy:
What is a radiculopathy?
A radiculopathy is the irritation of a nerve root as it exits the spine. An example of a radiculopathy you may have heard of is "sciatica". Radiculopathies typically occur for two reasons. Most commonly, a disc herniation that pushes out toward the exiting nerve root can compress and irritate the nerve root. Another common reason is when arthritis may narrow the hole where the nerve exits, causing irritation. Of course, sometimes a little of both disc irritation and arthritis contribute. Occasionally, there is no evidence of narrowing or disc herniation, but there is still pain. We think that the chemicals the body releases during injury may be the source of the pain in these cases.
What are the symptoms of a radiculopathy?
Typically, a radiculopathy feels like neck or low back pain that travels into the arm or leg. Because the nerves involved are capable of transmitting almost any sensation when they are irritated, so can the pain in the arm or leg vary. It may be stabbing, burning, tingling, aching, throbbing, numbness, and anything in between. Also, it may be constant or may be worse with certain movements.
What types of treatment options are available for a radiculopathy?
Just as in patients with a herniated disc, the most important initial treatment for a patient with a radiculopathy is pain control. Often, Tylenol or anti-inflammatory medications, like ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), or ketoprofen (Orudis KT) are used first. Usually modification of activity is also needed, such as work restrictions. Bed rest is generally not a good idea, and it is important to stay as active as possible. Sometimes, exercise can decrease symptoms significantly, and physical therapy may be started. Most of the time, within a few weeks, the pain will get better with these modest treatments. If these strategies fail, or the pain is bad enough, a patient may get the best relief with an epidural steroid injection. This involves using x-ray guidance to place anti-inflammatory medication in the back near the level where the nerve is irritated.
How is a radiculopathy diagnosed?
As in disc herniations, radiculopathy is suspected based upon the patient's clinical history and physical examination. If further diagnostic testing is needed, a CT scan, MRI scan or special nerve and muscle testing, called electrodiagnostic testing (or EMG), may be ordered. Occasionally, a selective epidural steroid injection can help to pinpoint which nerve root is irritated and help treat it. When a selective epidural injection is performed, cortisone is placed where the nerve comes out of the spinal canal. If the nerve root is not irritated, this just feels like a shot. However, if the nerve is inflamed, the injection may cause brief pain like the radiculopathy. This helps us to know the right place to put the cortisone.
What is the role of surgery in this condition?
Surgery is only required when there is progressive loss of strength in the affected limb, loss of bowel and bladder control such as soiling or wetting clothing, or loss of sensation in the groin. One might also consider surgical intervention if severe pain affects a patient's lifestyle and has been present for 3 months or more. Otherwise, surgery is voluntary, and should only be considered if all other methods have been unsuccessful.
Note the following articles for more information: "Disc Herniations", "Lumbar Disc Disease"
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