Cervical Radiculopathy

What is a cervical radiculopathy?

A radiculopathy refers to symptoms that develop due to irritation of a spinal nerve root. It is common for this clinical scenario to result in pain that radiates from the neck into the upper limb. When accompanied by weakness, numbness, tingling, or change in reflex, this is referred to as a cervical radiculopathy. A radiculopathy can also be diagnosed via a nerve test called an electromyography and nerve conduction study (EMG/NCS). If the only symptom is the radiating pain from the neck into the upper limb without accompanying weakness, numbness, tingling, or change in reflex, this is referred to as cervical radicular pain or radiculitis.

What causes a cervical radiculopathy?

A radiculopathy or radiculitis can occur due to a variety of causes. The most common causes are irritation of the nerve root by a disc herniation or narrowing (stenosis) within the spinal column. When the nerve root becomes irritated or inflamed, this can lead to a patient experiencing neck pain with radiation to the upper limb with or without accompanying weakness, numbness, tingling, or reflex changes.

How is a cervical radiculopathy diagnosed?

A diagnosis of radiculopathy or radiculitis is primarily based on a patient’s symptoms and physical examination findings. Typical symptoms and signs of cervical radiculopathy include neck pain with radiation of pain to the upper trapezius, scapula (shoulder blade), shoulder, or upper limb. Additionally, there may be associated weakness, numbness, tingling, or reflex changes. Finally, advanced imaging (MRI or CT) and/or electrodiagnostic testing (EMG/NCS) may help to further solidify the diagnosis.

How is a cervical radiculopathy treated?

Initial treatment options for management of pain due to cervical radiculopathy/radiculitis may include medications, physical therapy, and/or chiropractic. In many cases, these conservative measures will allow for good recovery. If a patient is still experiencing significant pain despite the aforementioned treatment options, a cervical epidural steroid injection (ESI) can be considered as the next step in the treatment pathway. Finally, when all typical non-operative treatments have been exhausted and a patient is still experiencing significant pain, a referral to spine surgery may be considered for further evaluation and possible surgical intervention.

Epidural Steroid Injection

When patients with cervical radiculopathy/radiculitis have not significantly improved with conservative treatments such as medications, physical therapy, or chiropractic care or are unable to tolerate their rehabilitation due to severe pain, an epidural steroid injection (ESI) can be considered. Using x-ray (fluoroscopic), a needle is carefully and precisely guided to the epidural space. Once the epidural space has been accessed, a steroid solution is instilled through the needle and coats the inflamed and painful disc herniation and nerve(s). This helps to decrease inflammation and, subsequently, decreases pain and improves function.