Cervical Radiculopathy

THE CLINICAL SYNDROME

Cervical radiculopathy is a constellation of symptoms consisting of neurogenic neck and upper extremity pain emanating from the cervical nerve roots. In addition to the pain, the patient with cervical radiculopathy may experience associated numbness, weakness, and loss of reflexes. The cause of cervical radiculopathy include herniated disk, foraminal stenosis, tumor, osteophyte formation, and rarely infection.

SIGNS AND SYMPTOMS

The patient suffering from cervical radiculopathy will complain of pain, numbness, tingling, and paresthesias in the distribution of the affected nerve root or roots.

Patients may also note weakness and lack of coordination in the affected extremity. Muscle spasms and neck pain as well as pain referred into the trapezius and intrascapular region are common (Fig. 12-1). Decreased sensation, weakness, and reflex changes are demonstrated on physical examination. Patients with C-7 radiculopathy will commonly place the hand of the affected extremity on top of their head to obtain relief (see Fig. 12-1). Occasionally, a patient suffering from cervical radiculopathy will experience compression of the cervical spinal cord, resulting in myelopathy. Cervical myelopathy is most commonly due to midline herniated cervical disk, spinal stenosis, tumor, or, rarely, infection. Patients suffering from cervical myelopathy will experience lower extremity weakness and bowel and bladder symptomatology. This represents a neurosurgical emergency and should be treated as such.

Figure 1. Patients with C-7 radiculopathy will often place the hand of the affected extremity on the head to obtain relief.

Figure 2. Disk herniation at C5-6 level. Sagittal T1-weighted spin-echo image showing a herniated fragment (arrows) extending below the disk space level.

TREATMENT

Cervical radiculopathy is best treated with a multilmodality approach. Physical therapy including heat modalities and deep sedative massage, combined with nonsteroidal anti-inflammatory drugs and skeletal muscle relaxants, represents a reasonable starting point. The addition of cervical steroid epidural nerve blocks is a logical next step. Cervical epidural blocks with local anesthetic and steroid has been shown to be extremely effective in the treatment of cervical radiculopathy. Underlying sleep disturbance and depression are best treated with a tricyclic antidepressant compounded such as nortriptyline, which can be started at a single bedtime dose of 25 mg.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.