Cervical Radiculopathy: A Pain in the Neck

What is it?

Cervical radiculopathy is the medical term that doctors use to describe an abnormality in the function of a spinal nerve root in the neck.

The most common symptoms from this are neck pain and/or pain in the arm and hand. This pain can be excruciating. Sometimes it occurs along with muscle weakness and/or numbness and tingling in the arm and hand, but in actuality any of the three symptoms: pain, muscles weakness, or numbness can occur in isolation or in combination with any of the others. People may also complain of a loss of range of motion or an increase in their pain when they look upwards.

Why does it happen?

Cervical radiculopathy is commonly referred to as a “pinched nerve” because the most common thing that causes it is something that is physically putting pressure on the nerve roots in and around the cervical vertebrae, like a bone spur or a herniated intervertebral disc.

Sometimes symptoms come on slowly, other times symptoms occur all of the sudden. Patients with cervical radiculopathy often look for a “reason” why this is happening to them–an accident or injury in the remote past or a particular physical act the recent past–, but most of the time it occurs due to aging of the spine, what doctors call a degenerative process, that occurs over a long period of time. Even symptoms that are severe and seem to have appeared out of nowhere reflect the final stage in a gradual process, like the proverbial “straw that broke the camel’s back.”

How do I know I have a cervical radiculopathy?

A lot of the time, a diagnosis can be made “clinically” which means on the basis of symptoms alone.

If you have pain that shoots from your neck down to your fingers, it is most likely a cervical radiculopathy and doctors will often provide an initial treatment plan without ordering any tests. If symptoms persist, however, it makes sense to find out what is going on with an imaging study of the cervical spine.

An MRI is the best study to confirm the diagnosis and will typically show something putting pressure on the nerve root where the nerve root exits the spine after coming off the spinal cord. Sometimes another kind of test called an electromyogram (EMG) is performed as well to measure nerve function to determine if they are being injured or irritated and, if so, give some indication of where in the body the insult is coming from.

Nonsurgical Treatment

Most cases of cervical radiculopathy will get better with nonsurgical treatment.

This typically consists of taking medicines, pursuing physical therapy, and, if needed, receiving a direct injection of a steroidal anti-inflammatory into the cervical spine. Medicines can help limit the sensation of pain and reduce inflammation. The first line of medical therapy usually involves a two to three week course of a non-steroidal anti-inflammatory (NSAID) like Ibuprofen or Naproxen. Doctors will also sometimes use a short course of a steroidal medication like prednisone or Solumedrol (often called by its brand name “Medrol Dosepak”). Another class of medicines called “membrane stabilizers” like Gabapentin/Neurotin or Lyrica may also be used. These act by reducing the firing of hyperactive nerves. Muscle relaxants are also appropriate in some cases. Opioids are also sometimes used, but they are currently out of favor because of concerns over addiction and use tolerance.

Physical therapy can help cervical radiculopathy in numerous ways. Physical therapy exercises can increase flexibility and reduce pain by decreasing soft tissue tension and spasm. Traction can relieve pain by immediately reducing pressure on nerves. With behavior modification, you can reduce movements during your daily routine that might be aggravating your symptoms. Strengthening exercises can treat any muscle weakness you may have.

If oral medicines and physical therapy don’t work, an injection of steroid directly into the neck, known as a cervical spine epidural steroid injection, can be beneficial. This can get a concentrated amount of medicine directly to the area in need and therefore can be effective when oral medicines fail.

Surgical Treatment

Although everyone would like to avoid surgery, it is nice to know that surgery for cervical radiculopathy is safe, routine, and, in the vast majority of cases, highly effective.

The surgery usually involves removing the bone spur or piece of herniated intervertebral disc that is pushing on the nerve. There are three common types of surgery that are done for this. One is a surgery from the back of the neck called a posterior cervical foraminotomy or microdiscectomy, that involves a small incision in the back of the neck, drilling a small hole in the spine and removing bone, ligament and/or disc material. The advantage to this approach is that it does not involve an implant or bone fusion.

The disadvantage is that sometimes, for technical, anatomic reasons, the material putting pressure on the nerve root cannot be completely removed from this approach. Indeed some studies have shown a higher failure rate with posterior cervical foraminotomy/microdiscectomy than the other surgeries. The other surgeries both involve coming from the front of the neck. The advantage to coming from the front of the neck is that the material (disc, bone spur) can almost always be removed. The disadvantage is that is order to get to this material, the entire intervertebral disc (not just the herniated part) has to be removed which creates a gap between the cervical vertebra that ,ust be filled.

There are two options to fill the gap, replacing the removed disc with an artificial one or performing a fusion which results, over time in two separate cervical vertebra growing together into one single bone. The first option is called a cervical arthroplasty; the second is called an anterior cervical discectomy and fusion. Figuring out which surgery may be best for you among the three is a process that depends upon the nuances of your particular case and requires a detailed conversation with your surgeon.