A Patient's Guide to Cervical Radiculopathy

Degeneration of the cervical spine can result in several different conditions that cause problems. These are usually divided between problems that come from mechanical problems in the neck and problems which come from nerves being irritated or pinched. A cervical radiculopathy is a problem that results when a nerve in the neck is irritated as it leaves the spinal canal. This condition usually occurs when a nerve root is being pinched by a herniated disc or a bone spur.

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The purpose of this information is to help you understand:

• The anatomy of the cervical radiculopathy
• The signs and symptoms of cervical radiculopathy
• How the condition is diagnosed
• The treatments available for treatment of the condition

Anatomy

In order to understand your symptoms and treatment choices, you should start with some understanding of the general anatomy of your neck. This includes becoming familiar with the various parts that make up the neck and how these parts work together.

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Causes

Cervical Radiculopathy ("Pinched Nerve")

When a nerve root leaves the spinal cord and the cervical spine it travels down into the arm. Along the way each nerve supplies sensation (feeling) to a part of the skin of the shoulder and arm. It also supplies electrical signals to certain muscles to move part of the arm or hand. When a nerve is irritated or pinched -- by either a bone spur or a part of the intervertebral disc -- it causes problems in the nerve and the nerve does not work quite right. This shows up as weakness in the muscles the nerve goes to, numbness in the skin that the nerve goes to and pain where the nerve travels. In the neck, this condition is called cervical radiculopathy. Let's look at the different causes of cervical radiculopathy.

Pinched nerve from a herniated disc

Bending the neck forward and backward, and twisting left and right, places many kinds of pressure on the vertebrae and disc. The disc responds to the pressure from the vertebrae by acting as a shock absorber. Bending the neck forward compresses the disc between the vertebrae. This increased pressure on the disc may cause the disc to bulge toward the spinal canal and the nerve roots.

Injury to the disc may occur when neck motion puts too much pressure on the disc. One of the most painful injuries that can occur is a herniated disc. In this injury, the tear in the annulus portion of the intervertebral disc is so bad that part of the nucleus pulposus squeezes out of the center of the disc. The annulus can tear or rupture anywhere around the disc. If it tears on the side next to the spinal canal, when the nucleus pulposus squeezes out, it can press against the spinal nerves. Pressure against the nerve root from a herniated disc can cause pain, numbness, and weakness along the nerve. There is also evidence that the chemicals released from the ruptured disc may irritate the nerve root, leading to some of the symptoms of a herniated disc -- especially pain.

Herniated discs are more common in early middle-aged adults. This condition may occur when too much force is exerted on an otherwise healthy intervertebral disc. An example would be a car accident where your head hit the windshield. The force on the neck is simply too much for even a healthy disc to absorb and injury is the result. A herniated disc may also occur in a disc that has been weakened by the degenerative process. Once weakened, less force is needed to cause the disc to tear or rupture. However, not everyone with a ruptured disc has degenerative disc disease. Likewise, not everyone with degenerative disc disease will suffer a ruptured disc.

Pinched nerve from degeneration and bone spurs

In middle aged and older people, the degenerative disc disease can cause bone spurs to form around the nerve roots. This usually occurs inside the foramen -- the opening in the cervical spine where the nerve root leaves the spine to travel into the arm. If these bone spurs get big enough they may begin to rub on the nerve root and irritate the nerve root. This causes the same symptoms as a herniated disc. The irritation causes pain to run down the arm, numbness to occur in the areas the nerve provides sensation to and weakness in the muscles that the nerve supplies.

Symptoms

A cervical radiculopathy causes symptoms that radiate out away from the neck. What this means is that although the problem is in the spine, the symptoms may be felt in the shoulder, the arm, or the hand. The symptoms will be felt in the area where the nerve that is irritated travels. By looking at where the symptoms are, the spine specialist can usually tell which nerve is involved. The symptoms include pain, numbness and weakness. The reflexes in the upper arm can be affected.

When you are suffering from a cervical radiculopathy, there is usually also neck pain and headaches in the back of your head. These are sometimes referred to as occipital headaches because the area just about the back of the neck is called the "occiput."

Diagnosis

Finding the cause of neck pain begins with a complete history and physical examination. After the history and physical examination, your doctor will have a good idea of the cause of your pain. To make sure of the exact cause of your neck pain, your doctor can use several diagnostic tests. These tests are used to find the cause of your pain -- not make your pain better. Regular X-rays, taken in the doctor's office, are usually a first step in looking into any neck problem and will help determine if more tests will be needed.

Complete History

A "complete history" is usually two parts. One part is written; a form that you fill out while you wait to see the doctor. While you fill out the form, take time to think about everything you can remember that relates to your neck pain and write it down. The more you can tell him, the faster he can diagnose the cause and help relieve your pain. The second part of your history will be answering questions. Your doctor will ask you to describe when your neck pain began and the type of pain you are having.

For example, he may ask:

• When did the pain first begin?
• Have you increased your activity level?
• Have you had an injury, or surgery, to your neck at any time?
• Does the pain go down into your arms or legs?
• What causes your neck to hurt more or less?
• Have you had any problems with your bowels or bladder?

Physical Examination

Once most of the information is gathered, your doctor will give you a thorough physical exam. During the exam your doctor will look at your neck to find out how well your neck is functioning. This includes:

• How well you can bend your neck and roll your head in all directions
• How well you can twist your neck
• If there is tenderness around the neck
• If there are muscle spasms around the neck and shoulders

Tests that examine the nerves that leave the spine is also important. This includes:

• Testing for numbness in the arms and hands
• Testing the reflexes
• Testing the strength of the muscles in the arms, hands, and legs
• Testing for signs of nerve irritation

X-rays

X-rays show the bones of the cervical spine. Most of the soft tissue structures of the spine, such as the nerves, discs, and muscles, do not show up on X-ray. X-rays can show problems that affect the bones, such as infection, fractures, or tumors of the bones. X-rays may also give some idea of how much degeneration has occurred in the spine. X-rays alone will not show a herniated disc. The X-rays will be useful in showing how much degeneration and arthritis are affecting the neck. Narrowing of the disc space between each vertebra and bone spurs do show up on X-rays.

Magnetic Resonance Imaging (MRI)

The MRI is the most commonly used test to evaluate the spine because it can show abnormal areas of the soft tissues around the spine. The MRI is better than X-ray because in addition to the bones, it can also show pictures of the nerves and discs. The MRI is done to find tumors, herniated discs, or other soft-tissue disorders. The MRI is painless and lasts about 90 minutes. During the MRI, very detailed computer images of sections of the spine are taken. Unlike most other tests, which use X-rays, the MRI uses magnetic fields and radio waves to see the structures of the neck. Pictures can also be taken in a cross section view. The MRI allows the doctor to clearly see the nerves and discs without using special dyes or needles. In many cases, the MRI scan is the only special test that needs to be done to find what is causing your neck pain.

Before the MRI, you will be asked to remove any metal objects, such as jewelry. You will also be asked if you have metal implants such as a pacemaker or joint replacement. Because of the strong magnetic field, people with certain types of metal implants cannot undergo MRI.

The MRI scanner is a very large machine with a tunnel-like area in the center. While you lay on a table, the table slides into the tunnel of the scanner. Once in position, you will be asked to remain very still for the rest of the test. During the test you will hear the clicking and thumping noises as the scanner moves. While the scanner is taking pictures, the technician can see the pictures on a monitor and record them.

Treatment

Treatment for any spine condition should include two main goals:

• Relieve pain
• Reduce the risk of re-injury

The treatment of neck pain can range from the reassurance that nothing is wrong to very delicate surgery. Treatment is always based on the individual and his symptoms. In general, treatment for neck pain falls into two broad categories: conservative treatment, meaning things you can do short of surgery, and surgical treatment.

Conservative Treatment

Medication

Medications are commonly used to control pain, inflammation, muscle spasm, and sleep disturbance.

Some general tips about treatment with medicines:

• Medicine should be used wisely! Take all medications exactly as prescribed by your doctor and report any side effects to him.
• Some pain medicines are highly addictive!
• No pain medicine will control chronic pain if used over a long period of time.
• No medicine will cure neck pain of degenerative origin.

Mild pain medications can reduce inflammation and pain when taken properly. Medications will not stop degeneration, but they will help with pain control.

For a more detailed description of the use of pain medications in back and neck pain, please refer to the document entitled:

Cervical Collar

A cervical collar is often used to provide support and limit motion while an injured neck is healing. It also helps keep the normal alignment. Cervical collars can be soft (made of foam) or hard (made of metal or plastic). Because these collars can restrict the movement of your head, you may need help eating and with other activities. The skin under the collar needs to be checked every day to prevent blisters or sores.

Cervical Pillow

A special pillow may help your pain at night and allow you to sleep better. These cervical pillows are specially designed to place the right amount of curvature in the neck while you sleep and decrease the amount of irritation on the nerve roots. The pillows can be purchased from drug stores and from your therapist.

Epidural Steroid Injection (Nerve Block)

If other treatments do not relieve your back pain, you may be given an epidural steroid injection, or a cervical nerve block. An epidural steroid injection places a small amount of cortisone into the bony spinal canal. Cortisone is a very strong anti-inflammatory medicine that may control the inflammation surrounding the nerves and may ease the pain caused by irritated nerve roots. The epidural steroid injection is not always successful. This injection is often used when other conservative measures do not work, or in an effort to postpone surgery.

Surgery

In some cases, the cervical radiculopathy will not improve with non surgical care. In these cases your surgeon may recommend surgery to treat your cervical radiculopathy. Your surgeon may also recommend surgery if you begin to show signs of:

• Unbearable pain
• Increasing weakness
• Increasing numbness
• Muscle wasting
• The problem begins to affect the legs also

One of the most common operations used to treat a cervical radiculopathy caused by pressure from bone spurs and a herniated disc is the Anterior Cervical Fusion.

For a complete description of the procedure to remove the disc and perform a fusion for neck pain, you may wish to review the document entitled:

After surgery you will probably be placed in some type of brace while healing occurs. Following an anterior cervical fusion it is not unusual to wear a brace for 6 to 12 weeks while the fusion occurs. For a complete understanding of different types of spine braces and to understand what types of braces are used, you may wish to review the document, entitled:

Rehabilitation

Physical Therapy

Whether you have surgery or not, your doctor may have a physical therapist work on an exercise program developed just for you. The physical therapist will teach you ways to prevent further injury to your neck. Many problems in the cervical spine can be improved greatly with a good exercise program and good education on neck mechanics.

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For a complete description of the rehabilitation of neck pain, you may wish to review the document entitled:

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Are you bothered by neck pain that radiates down your arm? Do certain neck movements make your pain worse? Or, maybe you’re worried about that “pins and needles” sensation in your shoulder, arm, or hand?

If so, then you may be dealing with cervical radiculopathy. This neurological condition can be caused by changes in the spine resulting from aging, injury, or damaged discs.

You’re probably wondering what can be done for cervical radiculopathy. Is surgery necessary? Can conservative treatments actually help?

There’s plenty of good news.

Cervical radiculopathy treatment may not require surgery. Allowing your body time to heal and using proven, conservative treatments may be all you need. This, of course, depends on the underlying cause of your neck pain and the severity of your symptoms.

NJ Spine and Ortho is here to help you take a closer look at why you may be experiencing these symptoms.

Causes of Cervical Radiculopathy

Your brain is the hub of your central nervous system. It relays messages throughout your body with the help of the spinal cord and a network of nerves. Consider your neck (i.e. the cervical spine) to be the bridge between your brain and the rest of your body.

A column of seven vertebrae originates at the base of the skull and connects to the thoracic spine (or upper back) area. Your cervical spine serves to protect the spinal cord and also supports the head. In addition, nerve roots branch out from these vertebrae through openings known as foramina. Between each of these vertebrae, flexible discs reside, absorbing the shock of our everyday movements.

How do all of these complex structures contribute to your radiculopathy pain?

The short answer is: it depends.

Cervical radiculopathy is caused by a compressed or irritated nerve. Sometimes, considered a “pinched” nerve, this compression usually occurs where a nerve root branches out from the spinal column. Structural changes affecting the spine can injure a nerve and cause radiating pain as well as other issues.

Common causes of structural nerve compression include:

• Degenerative changes in the spine: As we age, the spine changes because of wear and tear, personal habits, and disease. Sometimes, the discs protecting the spine can lose their shape and structure. Also, osteoarthritis can cause bone spurs to grow in or around the foramina. Foraminal stenosis is a blanket term for changes in the cervical spine that involve narrowing of the foramina. It is the most common cause of cervical radiculopathy.
• Herniated disc: Sometimes, the inner layer of a disc can rupture and push through its tough outer layer. It can be due to repeated, strenuous activity, a car accident, or other trauma. The damaged disc can then press against a nerve causing radiculopathy.
• Less common causes: Fractures to the spine—such as spondylolisthesis—tumors, or infections may also injure the nerves exiting the spinal cord.

Cervical Radiculopathy Symptoms

Neck pain can result from a variety of factors. Cervical radiculopathy, however, has some tell-tale symptoms. These often depend on the particular nerve root which is affected.

Here’s what you need to look out for:

• Varying levels of pain, starting at the neck and radiating into the shoulders, arms, hands, or fingers. Pain may be dull and aching or a sharp and burning.
• Numbness or reduced sensation in the neck, arm, and fingers. Sometimes, this can be experienced as a “pins and needles” sensation.
• Muscle weakness or reduced coordination in the arms or hands.
• Changes in how you respond to hot and cold stimuli.
• Changes in your reflexes when your doctor uses a rubber mallet
• Your pain decreases when hands are placed on the top of the head.

In general, these symptoms typically occur on only one side of the body. There are times, however, when both sides may be affected.

What is the Best Treatment for Cervical Radiculopathy?

You want relief from your radiculopathy symptoms. You want to stop worrying if things will continue to get worse. But, most importantly, you want to know how to reverse your condition. Some home remedies are effective for symptom management. In fact, many nonsurgical treatments can even address the underlying cause.

Of course, this all depends on the severity of your condition and how the individual nerves are affected.

What’s the best thing you could do?

Get checked out by your physician or an orthopedic doctor. Diagnosing the problem is fairly straightforward. Your doctor will conduct a physical exam and gather information about your medical history. In some cases, imaging and electrodiagnostic testing may be ordered to confirm a cervical radiculopathy diagnosis.

Is it worth the time and money for an accurate diagnosis?

Definitely, it is!

Take this example: a person with carpal tunnel syndrome may be scouring the web, looking for an accurate diagnosis. Since some of the symptoms of carpal tunnel syndrome are similar to cervical radiculopathy, one may misdiagnose his or her condition. Instead of taking steps to improve the condition, the individual then works hard to treat a condition that he or she doesn’t have.

Don’t waste any more time: contact a doctor, confirm your condition, and start the healing process today!

Cervical Radiculopathy Home Remedies

Home remedies may not address the underlying cause of your cervical radiculopathy. These treatments can, however, provide symptom relief and hasten your recovery process.

Here are some things you could try to soothe a pinched nerve in the neck:

• Resting and/or activity modification: Limiting strenuous activities or heavy lifting can allow your body time to heal. In addition, paying better attention to your posture while sitting, walking, and performing everyday activities may put less strain on your neck.
• Ice and/or heat therapy: If you experience pain or other symptoms after performing tasks, you may want to apply a cold pack to soothe the area. Heat can also be effective in speeding up the healing process and in reducing inflammation. Try to use ice or heat for up to 20 minutes a session. Then, wait a couple of hours before repeating.
• Over-the-counter medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen can relieve pain and reduce inflammation. Consider trying these medications before moving on to more powerful (and potentially more addictive) prescription drugs.
• Cervical radiculopathy exercises: There are some easy exercises you can do every day to strengthen the neck and restore movement. While it is certainly easy to find these exercises on the web, you want to check with your physician before starting any new exercise routine. This is especially true if you recently suffered an accident or have worsening weakness/numbness in the arm.

What if these home remedies don’t work? Don’t worry: Other non-surgical treatments may help!

Looking Beyond Home Remedies for Relief

Sometimes you need the help of a professional to treat your cervical radiculopathy symptoms. Here are a couple of useful options:

• Physical therapy: A physical therapist can assess your condition and prescribe strengthening and stretching exercises based on your individual needs. Also, the physical therapist may suggest cervical traction or a soft cervical collar to improve your posture and soothe inflammation.
• Chiropractic care: A chiropractor or other health professional can manually adjust the cervical spine. Manual manipulation can improve mobility, reduce symptoms, and create a better healing environment.
• Prescribed medications: Sometimes, over-the-counter medications don’t provide sufficient relief. A doctor may prescribe muscle relaxants or stronger pain medications if your pain limits you from completing everyday activities. Always make sure you take these medications as directed. Some drugs may be habit-forming, especially if you have a history of substance abuse.
• Cervical epidural steroid injection: A doctor may choose to inject steroids near the affected nerve to reduce inflammation. Steroid injections do not treat the cause of the problem. They do, however, lessen the swelling and pain to allow the nerve a chance to heal.

When Should Surgery Be Considered?

If your symptoms haven’t improved after 2 to 3 months of conservative treatment, you may want to consider consulting with an orthopedic surgeon.

Sound scary?

Surgery may not be as bad as you think.

Many surgical procedures for cervical radiculopathy employ minimally invasive techniques that improve surgical outcomes. What does this mean for you? Less damage to surrounding tissues, minimal scarring, and quicker recovery times. During spinal decompression, a surgeon uses a tiny camera and surgical tools to access the area and create more space for the nerve roots. If you experience arm pain or numbness, minimally invasive neck surgery boasts a success rate between 80 and 90 percent.

What happens during cervical radiculopathy surgery? It depends on your particular condition. In some cases, the surgeon may remove the damaged intervertebral disc and fuse the affected vertebrae with a bone graft and other instrumentation. Sometimes, a surgeon replaces a damaged disc with an artificial one. This allows for more mobility than one would experience with typical fusion surgery.

Another surgery used for a pinched nerve in the neck is a posterior cervical foraminotomy. In a nutshell, this procedure makes more room for the pinched nerve to pass through the foramen. Using a small incision in the back of the neck, precision instruments carefully remove pieces of bone that may be compressing the nerve.

Physical therapy and other rehabilitation may be necessary after surgery to achieve a full recovery.

Ready to Feel Relief?

You don’t want to be in pain anymore. Why not schedule a consultation with experienced professionals who know how to fix cervical radiculopathy?

NJ Spine & Orthopedic uses the latest technology and proven treatments to help you get your life back. We won’t pressure you for surgery. In fact, we want to make sure that you know all the conservative treatment options out there.

If surgery is your best option, however, you have the comfort of knowing that our team has decades of experience in treating a variety of simple and complicated spinal conditions.

Call our pinched nerve doctors at (855) 586-2615 today to set up an appointment!

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