Radiculopathy: What You Need to Know

Radiculopathy is pain, tingling, numbness or weakness down the length of a nerve, caused by a compressed nerve root in the spine.

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What does your neck have to do with your arms? When it comes to radiating nerve pain, quite possibly everything. 

Man experiencing cervical radiculopathy down left armSpine issues can cause pain to radiate down an arm or leg.

Most people have heard of pinched nerves. These occur when the tissues, muscles, bone or cartilage in or around your spine compress a nerve root. Pinched nerves can cause pain, weakness, or feelings of tingling and even numbness down the length of the nerve. These symptoms are particularly common with herniated discs. This radiating pain is known as radiculopathy. 

Radiculopathy: How Does It Happen?

According to Dr. Daniel Paull, orthopedic surgeon and founder and CEO of Easy Orthopedics in Colorado Springs, CO, “Radiculopathy is when the nerves that are coming out of your spinal cord are pinched. This often results in a burning pain, numbness, or tingling that runs down your arms or legs, depending on which spinal nerve is irritated.”

Each of your vertebrae has a mostly hollow space called the spinal canal that allows the spinal cord to pass through. Anything that causes spinal stenosis—a general term for the crowding of the spinal canal—can also radiculopathy if the nerve roots branching off the spinal cord become compressed. 

Dr. Paull notes that “A disc herniation can be a particular injury that can cause radiculopathy, as the herniated disc will press directly on the nerve.” Other causes of stenosis and nerve root compression can include bone spurs (most often brought on by osteoarthritis, the most common form of arthritis), inflammation of tendons or ligaments due to an injury, or thickening of the ligaments in the spine, known as ossification. In rare cases, a mass on the spinal column can also cause this problem. 

Radiculopathy can happen anywhere in the spine and the specific problem is named for the location. Cervical radiculopathy involves the nerves that come from the neck. Sacral and lumbar radiculopathy involves the nerves that come out of the lower back. Sciatica—when nerve roots that become the sciatic nerve get compressed—is perhaps the most infamous form of lumbar and sacral radiculopathy.

Radiculopathy Risk Factors

Acute injuries, some chronic conditions, and certain lifestyle choices can all increase your risk of radiculoptahy. Injury resulting in a pinched nerve and osteoarthritis in the spine (aka spondylosis) are two of the most common. People with jobs involving a lot of heavy manual labor are at higher risk, mainly because this kind of job puts people at higher risk of spine injury overall. 

Smoking is a risk factor, as is being overweight, pregnancy, and having a family history of disc disease. Men are at a slightly higher risk than women. Interestingly, both working a highly labor-intensive job and living a sedentary lifestyle are both considered risk factors. 

Diagnosing and Treating Radiculopathy

If you are experiencing radiculopathy and other symptoms, your doctor will do a physical examination to determine if you have some nerve compression. Some simple physical and neurological tests may be performed to check reflexes and muscle strength. 

These may be followed by imaging studies, such as X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans. Your doctor may also want to do a nerve conduction study in order to determine exactly where the pain is coming from and whether the injury is muscular or neurological. 

If your doctor diagnoses you with radiculopathy, there is good news. “In most cases, it will go away with physical therapy and time,” says Dr. Paull. “80-85 percent of lumbar disc herniations will resolve without surgery.”

Nonsurgical treatments are the most common. These may include: 

  • Rest
  • Physical therapy
  • Changing lifestyle habits (quitting smoking, modifying activity levels, losing weight)
  • Medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxers
  • Epidural steroid injections 

If non-surgical treatment isn’t helping the problem, there are surgeries that can help, including:

  • Discectomy: removing all or parts of the herniated disc
  • Foraminotomy: widening the spaces where the nerves exit the spine (the foramina)
  • Spinal Fusion: fusing segments of vertebrae together in order to stabilize the spine overall

Most people with radiculopathy will improve; the condition has a favorable prognosis overall. Non-surgical treatments are the most common, but patients who require surgical intervention also have an extremely positive outcome. 

A 2010 study published in American Family Physician states, “t final follow-up, however, nearly 90 percent of patients were asymptomatic or only mildly incapacitated by the pain.” A 2016 study published in the same journal reiterated positive outcomes, regardless f surgical or non-surgical treatment: “Most patients with cervical radiculopathy will improve regardless of treatment modality. In fact, roughly 88% will improve within four weeks of nonoperative management.”

Don’t hesitate to see your doctor if you are having symptoms of radiculopathy, especially if you have already been diagnosed with disc herniation or arthritis in your spine. Once diagnosed and treated, chances are you will live a pain-free life for years to come. 

Updated on: 05/10/21
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Anatomy of a Herniated Disc
Joshua M. Ammerman, MD
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