What Is Cervical Radiculopathy?

Due to the stimulation or compression of unilateral or bilateral spinal nerve roots, it manifests as sensory, motor, and reflex disturbances consistent with the distribution area of spinal nerve roots. This disease is more common, and various targeted non-surgical treatments are available. There are obvious curative effects, especially the continuous (or intermittent) traction of the head and neck, the braking of the neck circumference and the correction of bad posture. The prognosis is mostly good.

Basic Information

English name: cervicalspondyloticradiculopathy
Visiting department: orthopedics

Common symptoms: Neck Symptoms, Radical Pain, Radical Dysfunction, Altered Tendon Reflexes, Signs
Contagious: no

Causes of cervical spondylotic radiculopathy

Protrusion or prolapse of the nucleus pulposus, osteoproliferative or traumatic arthritis of the posterior facet joint, spur formation of the hook joint, and loosening of three adjacent joints (intervertebral joint, hook joint, and posterior facet joint) And displacement can cause stimulation and compression on the spinal nerve root. In addition, narrowing of the root canal, adhesive arachnoiditis at the root sleeve, and inflammation and tumors in the surrounding area can also cause symptoms similar to this disease.

Clinical manifestations of cervical spondylotic radiculopathy

Neck symptoms

Depending on the cause of the underlying compression, the severity varies. Mainly caused by nucleus pulposus, because of the direct stimulation of the local sinus vertebral nerves, it is often accompanied by obvious neck pain, paravertebral muscle tenderness and neck standing posture, direct tenderness or ridges in the spinous process or interspinous process of the cervical spine. Pain is mostly positive, and these manifestations are particularly pronounced in the acute phase. If it is caused by simple degenerative joints of the vertebrae and bone hyperplasia, the symptoms of the neck are relatively mild and may not even be found.

2. Radical pain

It is most common and its range is consistent with the distribution of the spinal nerve roots of the affected vertebral segment. Accompanied by root pain are other sensory disturbances in this nerve root distribution area. Among them, numbness of fingers, hypersensitivity of fingertips, and hypodermatosis are common.

3. Radical Dysfunction

In the past, the root pressure was obvious. The muscle tension increased in the early stage, but it soon weakened and muscle atrophy appeared. The affected area is also limited to the muscle group dominated by the spinal nerve root. In the hands, the large and small fish muscles and interosseous muscles are obvious.

4. Changes in tendon reflexes

That is, the reflex arc involved in the affected spinal nerve root is abnormal. It is active early, but decreases or disappears in the middle and late stages. The examination should be compared with the contralateral side. Root involvement alone should not have pathological reflexes. If accompanied by pathological reflexes, it indicates that the spinal cord is also involved.

5. Signs

Most traction tests that increase the spinal nerve root tension are mostly positive, especially those with root compression in the acute phase and later. Positive cervical compression tests are more common in cases with prominent nucleus pulposus, prolapse of nucleus pulposus, and instability of the vertebral segment.Most of those who are caused by hooked hyperplasia are weakly positive, and are caused by mass lesions in the spinal canal. Mostly negative.

Nerve root cervical spondylosis

Depending on the cause, the plain X-ray films are different, and generally show one or more of abnormal changes such as vertebral instability (trapezoidal change), disappearance of cervical physiological curvature, intervertebral foraminal stenosis, and hyperplasia of the unclamped vertebra. MRI can show disc degeneration and nucleus pulposus, and the nucleus pulposus can even protrude into the root canal and spinal canal, and most of them are inclined to the affected side.

Diagnosis of cervical spondylotic radiculopathy

The main basis is:

1. Has more typical root symptoms

Including numbness and pain, and its scope is consistent with the area dominated by the cervical spine nerves.

2. Neck compression test and upper limb pull test

Most of them are positive, and the pain point closure is not effective, but those who have a clear diagnosis do not need to do this test.

3. Imaging examination

X-ray films can show abnormal changes in cervical curvature, vertebral instability, and bone spur formation. MRI can clearly show the local pathological anatomy, including the protrusion and prolapse of the nucleus pulposus, and the location and extent of spinal nerve root involvement. Wait.

Differential diagnosis of nerve root type cervical spondylosis

There are 8 pairs of cervical spine nerves, and they dominate different parts. Therefore, when they are affected, the distribution and difference of symptoms are different depending on the affected parts. In clinical practice, cervical spine nerve roots involving 5 to 8 are more involved, so it is important to identify confusing diseases.

This disease should be related to parenchymal lesions of the cervical spine (tuberculosis, tumors, etc.), thoracic outlet syndrome, carpal tunnel syndrome, ulnar, radial and median nerve injuries, periarthritis, tennis elbow and biceps tendonitis. Distinguish the main diseases of limb pain.

Radical and dry pain (mainly radial, ulnar and median), and plexus (mainly cervical, brachial, and axillary plexus) must be distinguished from this disease.

It is also necessary to distinguish the root dysfunction of the disease from dry and plexus atrophy, and to distinguish it from changes in muscle strength caused by spinal cord disease. If necessary, examinations such as electromyography or cortical evoked potentials can be performed for identification.

Nerve root cervical spondylosis treatment

Non-surgical therapy

Various targeted non-surgical therapies have obvious effects. Among them, continuous (or intermittent) traction of the head and neck, braking around the neck, and correction of poor posture are effective. Manual massage also has a certain effect, but it should be gentle, and accidents caused by rough operation should not be avoided, and massage should not be used.

2. Surgery

Consider surgery if you have:

(1) It is ineffective for more than 3 months after regular non-surgical treatment, and the clinical manifestations, imaging findings and neurological location are consistent.

(2) Progressive muscle atrophy and severe pain.

(3) Although non-surgical treatment is effective, it affects work, study and life due to recurrent symptoms.

The anterior cervical decompression is appropriate, which not only has good curative effect, but also has little effect on the stability of the cervical spine. For those with vertebral instability or root canal stenosis, intervertebral interfacial internal fixation can also be used at the same time to spread and fixate the vertebrae. Although the posterior neck approach to achieve decompression by incision of the small joints is effective, it is easy to cause cervical vertebra angulation deformities after surgery, which has gradually been abandoned by everyone. The laminae can also be removed or scraped from the posterior side of the vertebral body through the lamina.

Prognosis of nerve root type cervical spondylosis

1. Due to simple cervical nucleus pulposus, the prognosis is mostly good, and few patients have recurrence after cure.

2. The prolapse of nucleus pulposus has easily formed residual symptoms.

3. For prognosis caused by hook joint hyperplasia, early and timely treatment is more satisfactory. If the course of the disease is long and the subarachnoid space adhesion has formed at the root canal, the effect is likely to be unsatisfactory due to the delay of symptoms.

4. Radical pain due to extensive bone hyperplasia is not only complicated to treat, but also has a poor prognosis.