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Cervical Radiculopathy
A Comprehensive Look At Cervical Nerve Root Compression
By Genevieve V. Walton
Overview●A radiculopathy is a peripheral neurologic
syndrome resulting from mechanical injury and chemical irritation of the spinal nerve roots.
●May involve a single, or multiple nerve roots. ●Two most common types: lumbosacral & cervical
oLumbosacral type can occur in the L2-S1 nerve roots, and account for 60-90% of all radiculopathy cases
oCervical type typically occur in the C5-T1 nerve roots, and account for 5-30% of all radiculopathy cases
Cervical Spine Anatomy
●Vertebral Body●Intervertebral disk●Intervertebral
foramina●Nerve Roots●Brachial Plexus
Classification
●AcuteoRecent Trauma
●ChronicoLongstanding Trauma
●ActiveoCurrent Reinnervation
Epidemiology
●Rate of Occurrence:o83.2 per 100,000
●Age related peaks in early 50’s●Foraminal Encroachment ocauses 70-75 % of cases
Epidemiology
●Instance by Nerve RootoC7 70 %oC6 19 - 25 %oC8 4 - 10 %oC5 2 %
Causes
●Spondylosis
●Cervical Disk Disease
●Disk Herniation
●Biochemically Induced Radiculopathy
Spondylosis
●Abnormal fixation of the spine●Umbrella term for:ohypertrophy of the facet jointsonarrowing of neural foraminaoformation of osteophytes
●Spondylolisthesis●Spinal Stenosis
Cervical Disk Disease
●Process:oDisk degrades from repetitive useoIt loses integrity and bulgesoWater leaks out of disk
●Causes:oVertebral SclerosisoOsteophytes
Disk Herniation
●A: Normal disc anatomy●B: Disc protrusion
oNP penetrating asymmetrically through annular fibers but confined within the AM
●C: Disc extrusion oNP extending beyond the
AM
●D: Disc sequestrationonuclear fragment separated
from extruded discNP = Nucleus Pulposus AM = Annular Margin
Biochemically Induced
●Occurs without compression●Malfunction of enzyme in nucleusoInflammatory Response
●When nuclear material leaves diskoAutoimmune Inflammatory Response
Common Compressions
Symptoms
●SubjectiveoPain, Weakness, Numbness, TinglingoCan be felt from neck, down through the
hands
●ObjectiveoChanges in:
Reflexes Range of Motion Motor Control Postural Positioning
Waiters Tip Posture●Caused by a C5-C6 root
avulsion, or upper trunk lesion●The effected arm hangs at the
side●Arm is rotated inward at the
shoulder.●Elbow is fully extended●Forearm is pronated
Claw Hand●Caused by a C8-T1
root avulsion , or ulnar nerve lesion above the elbow
●Metacarpal joints are hyperextended
●Interphalangeal joints are flexed
Diagnostic Tests
●ManualoSpurling Maneuver
●ElectrodiagnosticoSomatosensory Evoked PotentialsoElectromyography
●ImagingoX-ray, CT, MRI, Myelogram
Spurling Maneuver●Patients neck is
extended●Head rotated to
symptomatic side●Axial pressure applied
to head●May reproduce or
worsen radicular pain
Electrodiagnostic
●Somatosensory Evoked Potential (SEP) Evaluates the Afferent Sensory Pathway
●Electromyography (EMG)oNerve Conduction Studies
Evaluates Peripheral Nerves
oNeedle Electrode Examination Evaluates motor portion of nerves/muscles
Imaging
●X-RayoJumped Facets
C4 onto C5
●CToCervical Disk Herniation
Imaging
●MRIoCervical Disk Herniation.
●MyelogramoCervical Stenosis
Treatments
●Conservative
●Surgical
Conservative Treatments
●Medication●Rest●Physical Therapy
Surgical Treatments
●DiscectomyoWith or Without Fusion
●Micro-Discectomy●Laminectomy
Prognosis
●Good to Excellent●Almost 90% of Patients are successfully
treated without surgery.●Over 95% success rate when caused by
disk herniation.●Chance of reoccurrence regardless of
treatment type.
Case Study
●68 year old right handed male ●Presented with “clumsiness” and
weakness in his right hand for the past month.oDifficulty writing, holding things, and pinching
●Pt has a known history of degenerative joint disease of the left hip with a mild limp.
●Doctor noted slowness of AMR's of the fingers on the right hand as compared to the left
Case Study
●Tests ordered by Doctor:oEMG oSEPoMRIoMyelogram
Case Study
Case Study
EMG Report Continued
Case Study●SEP results:
oNormal Study
●MRI results:oSpondylosis at all levels between C2-C3 through T1-
T2. Severe at left & moderate at right C3-C4. Moderate at C4-C5. Moderate to severe at right T1-T2.
●Myelogram resultsoVarying degrees of cervical spondylosis. It did not
show any foraminal narrowing or disk protrusion affecting the C8 or T1 roots which would explain his syndrome.
Case Study
●The Doctor associated his recent problems to a C8-T1 Radiculopathy. The chronic radicular problems were attributed as residuals from a spinal surgery 25 years ago.
●Conservative treatment measure are being pursued.
Conclusion●Cervical Radiculopathies are most
commonly:oCaused by compression of the nerve rootoTypical symptoms include pain, weakness,
numbness, and tingling in the shoulder, arm, and hand.
oDiagnostic testing combines electrodiagnostic & radiographic studies.
oConservative treatments tried prior to surgical intervention
oVery Good Prognosis
Questions?