Radiculopathy is nerve root compression or inflammation that can cause pain, numbness, and loss of strength in an arm or leg. In case of damage at the root level of the nerves, the complaints spread to the arm or leg where the nerve extends, causing problems such as pain, numbness, weakness, and coordination disorder. Pain caused by nerve root injury is expressed as radicular pain.
Our spine consists of 33 vertebrae from the pelvis to the neck. It is examined in five sections showing different characteristics: neck (cervical), back (thoracic), lumbar (lumbar), rump (sacrum) and tail (coccyx). Between the neck, back and lumbar vertebrae, there are shock-absorbing discs called intervertebral discs, composed of soft, connective and cartilage tissue. The discs may lose their flexibility as a result of wear and damage and may overflow towards the nerve roots. This is called a hernia. Lumbar and neck hernias are the main causes of radiculopathy. However, due to many other reasons, nerve roots can be compressed.
Causes of Radiculopathy
- Disc herniation (herniation)
- degenerative disc disease
- Spinal calcification
- Spinal tumors
- Spinal canal narrowing ( spinal stenosis )
- Compression fractures (spine fractures)
- Lumbar shift ( lumbar spondylolisthesis )
- Radiation (radiotherapy)
- sedentary lifestyle
- being overweight
- Posture disorder
- Wrong training technique
- Carrying loads in the wrong position
- repetitive strains
- Traumas (traffic accident, fall, etc.)
In radiculopathy, the complaints are distributed to the parts of the body where the affected nerve root extends. This is called radicular pain. It should not be confused with referred pain. In reflected pain, a problem in one part of the body gives symptoms in another region (for example, gallbladder inflammation causes right shoulder pain), but the mechanism is different.
Cervical radiculopathy: Neck compression is most common at C5-6 and C6-7 levels. In radiculopathy that occurs at the neck level, neck, shoulder, back or arm pain may be felt. Numbness and weakness may develop in one arm. Certain movements of the neck may increase the complaints.
Thoracic radiculopathy: Radiculopathy in the back region is rarer than in the neck and waist. One side may cause burning or stinging pain in the ribs, side or abdomen. Numbness-tingling may be felt. Its symptoms can be confused with gallbladder problems, other intra-abdominal problems, and heart diseases.
Lumbar radiculopathy: Compression occurs most frequently in the lower back at L4-L5 and L5-S1 levels. It can cause back, hip and leg pain. There may be weakness, numbness, tingling (sciatica) in the leg or foot. Symptoms may be exacerbated by some low back movements, sitting or walking for a long time. If the nerves to the bladder and intestines are compressed, urine or stool control may be impaired.
Other Possible Causes
Some or all of the symptoms seen in radiculopathy may also occur in other problems. Peripheral neuropathy, ligament instability, shoulder problems, thoracic outlet syndrome, brachial plexus injury, Parsonage-Turner syndrome, systemic diseases are some of the diseases that may cause similar complaints.
Diagnosis can be made by medical history and physical examination. Waist/neck examination, muscle strength of the arms and legs, sensory and reflex examination, revealing the complaints with special tests provoking nerve root compression generally provide sufficient information to diagnose radiculopathy. The Spurling test for cervical radiculopathy and the straight leg raise test for lumbar radiculopathy are examples of specific maneuvers that increase or reproduce pain. Laboratory tests and imaging may be done to rule out other possible causes and confirm the diagnosis. X-ray film, MRI, CT are the methods used to view the spine. Nerve functions can be evaluated with an EMG test.
Radiculopathy complaints can often be controlled by methods such as rest, pain relievers, physical therapy applications, manual therapy, and exercise. In the majority of patients, a response is obtained in 1.5 to 3 months with non-surgical treatments. If physiotherapy is not successful, if the back-leg or neck-arm pain continues uninterruptedly for a long time (3-6 months), if there are bladder-intestinal problems associated with radiculopathy, if progressive muscle weakness develops in the arm or leg, surgery may be required. Causes such as hernia and bone protrusion that cause nerve root compression during surgery can be eliminated. For some people, epidural steroid injections (a cortisone injection to the problematic part of the spine with X-ray imaging / fluoroscopy) may be beneficial instead of surgery. Steroids provide relief by rapidly reducing inflammation in the area where they are applied.