How can I treat my cervical radiculopathy
ICD M54.1 - Radiculopathy
What does medicine understand by radiculopathy?
Radiculopathy, also known as root neuritis or root syndrome, refers to irritation or damage to the nerve roots, i.e. those points on the spinal cord where the nerve fibers of the spinal cord enter / exit. It manifests itself in disturbances of sensation, pain or paralysis. Radiculitis is the inflammation of the nerve root itself, but the terms are often used synonymously. If the disorder is not limited to a single root (monoradiculitis), but affects several nerve roots, it is called polyradiculitis. Depending on the nerve fibers affected, this condition can be very serious, or it can remain stable for a long time without treatment, albeit limiting.
What is a nerve root and what is it important for?
Nerve roots emerge from the spine and connect the spinal cord to the rest of the body. So they are the point at which the nerve cord connects through the spine with the spinal cord located in the spine. Depending on the altitude, the nerves lead to different areas of the body. In the lumbar area, for example, at the nerve roots from the vertebrae in the lumbar area, the nerves could lead further towards the legs; the nerves that branch off from the spinal cord at the level of the cervical vertebrae (cervical area) would be responsible for the arms.
More precisely, there are anterior and posterior nerve roots that connect in the spine and then emerge from the spinal canal on the left and right as a so-called spinal nerve. So this happens in pairs over the length of the entire spine with a total of about 31 such paired “branches”. The nerves send and receive (or front and back roots), that is, they transmit signals to the body and organs according to their course, pass on the commands of the brain and, conversely, transmit the sensation of the organs and extremities back again.
This localized supply makes it possible to determine which nerve root is affected. Based on the pain in the back and the affected muscles, the level at which the responsible nerve root is located is assigned.
How does back pain arise?
The nerve roots in the back can, but don't have to, report pain when squeezed or squeezed. There are other ways that pain occurs, such as inflammation or the deposition of metabolic products. Conversely, one can also be ill and have symptoms such as numbness or problems with gross motor skills without feeling any pain.
Pain in the lower back often has a mixture of causes, for example, after a minor, often undiagnosed disc herniation, a nerve can be slightly depressed, and the simultaneous pulling of the posterior longitudinal ligament can lead to inflammation of the nerve.
What types of radiculopathy are there?
Where, which and how many nerve roots are disturbed, as well as the course over time, determine the severity of the disease.
In the case of only a single damaged root, medicine speaks of Monoradiculitis, if there are several of Polyradiculitis.
A classification from top to bottom, according to common diagnostics, begins with what is known as cervical radiculopathy, whereby the affected nerve roots in the cervical spine are meant. Further down, those areas that supply the respiratory muscles or the diaphragm are particularly critical. A thoracic expression at chest level is rare, and finally one speaks of lumbar radiculopathy if the symptoms can be assigned to the nerve roots of the lower back.
The lower back (lumbar to sacral area) is most commonly affected. The cause and location of the nerve damage are closely related. In the upper back it is mostly tumorous or infectious triggers, and only in a quarter of them are herniated discs, which are the main cause in the lower back.
The next delimitation is made in terms of time, whether the occurrence is acute or - from twelve weeks - already chronic.
What are the symptoms of radiculopathy?
The case of radiculopathy often manifests itself in discomfort, pain or even paralysis. In addition, the sensitivity, i.e. the sensitivity, can be restricted, that is, the feeling in or under the skin is lost. On the back itself, radiculopathy can manifest itself as tingling or mild pain, or even numbness. Otherwise, the affected area depends on which area the nerve root supplies, and the pain radiates there. However, not every restriction of the nerves leads to pain, and in particular symptoms may arise that are not accompanied by pain or to an extent that does not immediately sound the alarm bells.
The pain in the nerves can feel like "shooting in" like an electric shock is going down the nerve. In addition, reflexes can be restricted. Depending on the severity of the radiculopathy, it can ultimately also be that the motor skills fail. Along with the pain, the affected patient's freedom of movement is severely restricted. With further movement, especially when moving the spine, the nerve can activate pain.
If one takes a disease in the lumbar region as an example, then the disease does not predominantly affect the lumbar spine, but rather in its supply area: One could expect pain in the legs or no longer perceive touches on one or both legs. But the often much more dangerous thoracic radiculopathy, that is, thoracic radiculopathy should also be mentioned here, which makes breathing difficult. If the nerve fibers that supply the diaphragm are affected, it can even lead to respiratory failure. In another extreme case, mobility can be severely restricted.
If the condition is chronic, this also has psychological effects due to the reduced quality of life, and the muscles that can no longer be used are reduced.
How common is radiculopathy and who does it affect?
Radiculopathy can actually be described as a widespread disease. Since a herniated disc is usually the trigger for radiculopathy, which occurs most frequently between the ages of 30 and 50, this age group is also the most susceptible. If you take the number of herniated discs as an indication, more than a fifth of those under 60 and more than half of those over 60 are affected.
The symptoms usually occur in the second half of life, but almost never in children and adolescents. With other causes, or more unusual herniated discs in higher vertebrae, younger people can also be affected. In addition to the medical damage, there is also economic damage, especially in physically demanding industries. According to different calculations, back pain causes 15–30% of the days of incapacity for work and 18% of all early retirement.
What are the underlying causes of radiculopathy?
The most common cause of the disease is caused by a herniated disc (on the other hand, however, radiculopathy is often wrongly diagnosed as a herniated disc!). More precisely, one speaks of a disc herniation, whereby the nerve is pinched by the damaged intervertebral disc. The nerves can also be damaged or “pinched” in other ways, for example through forms of arthritis or other weakening of the bones, with the nerve being damaged again indirectly through a disruption of the bones or the spinal cord. This is more common in worn spinal columns, but also in younger patients.
Pathogens such as viruses and bacteria
It is also less common that other tissue uses the nerves, for example in the context of a cancerous tumor or an abscess, an accumulation of pus in the skin of the spinal cord itself, or a hematoma. Bacteria, fungi or viruses that can cause the disease or carry it as a complication are also possible. For example tuberculosis or some herpes infections that affect the nerve roots. Borreliosis, which is transmitted by ticks, can cause the nerve bundles to constrict.
Other diseases (e.g. diabetes mellitus)
Last but not least, the diabetes mellitus can cause the disease, as it can disrupt the blood flow to individual parts of the body and also that of the nerve roots.
What is pseudoradicular syndrome?
"Radicular" means "concerning the root", from the Latin "radix" - "root" (compare "radishes"). So radiculopathy is radicular because it starts from the roots of the nerves. Pseudoradicular syndromes, on the other hand, initially appear to come from the nerve roots, although they have a different cause. For example, similar discomfort could arise in the muscles or bones of the painful and restricted areas. It is often difficult to distinguish, but the exact cause can be diagnosed clinically.
When should I see a doctor if I suspect radiculopathy?
If you have chronic back pain, it is always advisable to see a doctor. Back pain is a very common complaint with age, as the intervertebral discs and spine deteriorate with age. Symptoms of a disease of the root nerves include back pain, radiating pain or numbness, especially if it is accompanied by paralysis or discomfort in other parts of the body.
You should immediately seek (emergency) medical treatment in an acute case. You can recognize this by the following points:
The “Red Flags” are often used as a clue.
- If the above symptoms preceded an accident, for example a fall. In seniors in particular, even slight trauma on the surface can cause damage to the spine
- Symptoms that appear suddenly or that are increasingly paralyzing
- Paralysis in certain parts of the body, especially if you feel little or less pain at the same time
- Fever or chills
- When the pain increases at night
- In connection with weight loss, drug abuse (including nicotine) or a weakened immune system, extreme caution is advised, as these promote the disease.
How does the doctor diagnose lumbosacral radiculopathy?
This expression, which affects the lower back and is usually also noticeable in the legs, is the most common, and a herniated disc is almost always the trigger. While the situation is quite clear in the case of a herniated disc, in the case of more general back pain it is important for the doctor to first determine whether there is any radiculopathy and what the cause is. In old age, damage to the spine is more or less normal and does not necessarily indicate a radiculopathy.
Specifically, the diagnosis begins with an anamnesis, i.e. your medical history is discussed and in particular the occurrence and course of the symptoms. It is important to know since when and what caused the pain, where and what exactly the problem is, whether the pain occurs at rest or when moving, and whether it increases with pressure. In particular, checking the reflexes and motor skills helps with an accurate diagnosis. The doctor will also examine whether there are any injuries or infections.
Further investigations can follow. With various imaging methods, it is possible to find the cause of the back pain or other complaints, especially if there is uncertainty. However, this only makes sense if it is necessary for further therapy or if no other causes for the pain could be identified. If in doubt, there are other diagnostic methods: In order to determine radiculopathy and rule out pseudoradicular syndrome, the doctor would have to perform a clinical neurological examination. In the worst case, a so-called lumbar puncture is carried out, in which the specialist takes nerve water with a needle.
How does the doctor diagnose cervical radiculopathy?
This diagnosis is often purely clinical. In addition to the above-mentioned anamnesis and the necessary clinical neurological examinations, there are the following peculiarities:
Since the cause is rarely found in a disc injury, especially in older people, and is often chronic, doctors use more advanced methods such as CT or magnetic resonance imaging to find the cause. Blood samples or samples may also be taken from the affected area to diagnose inflammation, autoimmune disease, or other disease.
How can radiculopathy be treated?
Lumbar sacral radiculopathy
It depends heavily on what is causing the nerve crush and how acute treatment is needed. Since lumbosacral (that is, lower spine, belonging to the loin and sacrum) radiculopathy is usually caused by a herniated disc, the therapies associated with it will be discussed here.
It's about relieving the nerve and relieving pain for the person affected. This can first be achieved through physiotherapy. Almost all typical procedures that stretch and strengthen the muscles are used. This has been proven to bring short-term pain relief and improved mobility.
In the presence of red flags, failure of physiotherapy (after about six weeks), acute symptoms and corresponding findings from further diagnostics, for example in the MRI, a specialist must decide whether an operation is possible.
If the therapy is successful, you may also need physiotherapy to train the muscles that have been paralyzed by the radiculopathy to be resilient again.
If the disorder is cervical, i.e. in the cervical spine, the cause is often something other than a herniated disc. Here, too, conservative therapy aimed primarily at pain relief is the first choice in non-acute cases. In the physiotherapy used here, a neck brace is often used, which must be worn for two weeks. Then you have to do exercises here for at least six weeks for mobilization. In the following, we will go into the therapy that reacts to causes such as inflammation.
Since the problem is that there is often a chronic bruise of the nerve, it is also a matter of alleviating this bruise or the pain it causes. This happens with infections, for example with anti-inflammatory drugs, or an antiviral or immunosuppressive therapy, complemented with painkillers and bed rest. Most cases can be treated sufficiently successfully with conservative therapy. If this does not work and if treatment is assessed as possible in the MRI, surgical intervention may also be indicated in the end.
In most of the chronically painful cases, you can get the symptoms under control with conservative pain therapy, and the disease can be effectively combated with physiotherapeutic measures.
Surgical intervention is a form of therapy used in around 20% of all cases of radiculopathies. However, it is not possible to determine right from the start for whom an operation makes sense. The doctor generally only chooses it if the case is either very acute or if conservative therapy is unsuccessful. Above all, it is necessary because permanent neurological damage can be sustained in the event of a longer illness, but it also has its own risks, since the spine plays a sensitive and central role in the body.
While acute back pain can be effectively treated with surgery, it has been shown that pain in the extremities can be treated just as well with physiotherapy.
During the operation, the spine is relieved. Options are:
- Surgical removal of the compression by what is known as an open microsurgical discectomy
- Plating, in which the spine is supported by means of a kind of splint
- Intervertebral disc prosthesis
- A so-called cervical laminoforaminotomy, in which the doctor removes the compression in a minimally invasive manner
In any case, regardless of the treatment approach, behavioral and pain therapy can also be prescribed by the doctor, as can antidepressants.
What can I do myself?
Especially when you are in pain, you can try to relax and, despite pain or restrictions, find ways to maintain your quality of life. Meditation, yoga or other relaxation methods are therefore recommended.
Can I prevent radiculopathy?
To protect the spine, you have to protect your back.So long before the spine shows signs of wear and tear, you should positively influence risk factors such as obesity, stress at work and fitness. Smoking and substance abuse also increase the risk of illness.
Do the health insurance companies cover the costs of treating a radiculopathy?
The initial visit to the general practitioner for diagnosis and therapy are usually covered by health insurance. You may be able to apply for some services such as occupational therapy or adjustments in the apartment to enable independent mobility. For the individual services and provisions, you should find out more from your insurance company and the doctor treating you.
About the author: Dr. Simone Hermanns
Female medical specialist for gynaecology and obstetric
Dr. med. Simone Hermanns works as a specialist at the University Hospital Zurich and has been supporting MOOCI as a medical expert in the field of gynecology and obstetrics since February 2020.
For 7 years she has been working full of energy and zest for life as a doctor in various clinical departments in Germany and Switzerland. She discovered her love for medicine especially in the operational area, as the diversity of this area is always fascinating.
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