Cervical radiculopathy (radiculitis)

What is cervical radiculopathy?

Your skull is connected to your upper back by a series of 7 small bones, known as vertebrae. This is known as your cervical spine. Cervical radiculopathy, also known as radiculitis, occurs when the nerve root, the initial segment of a nerve leaving your central nervous system, of the cervical spine becomes compressed, damaged or inflamed. 

This is a relatively rare condition. For example, a study conducted in the USA showed that there were an estimated 85 cases of cervical radiculopathy per 100,000 population [1]. 

Cervical radiculopathy vs Cervical stenosis vs Cervical myelopathy

Cervical radiculopathy should not be confused with cervical stenosis or cervical myelopathy. 

Cervical radiculopathy occurs when the nerve roots are compressed or damaged  

Cervical stenosis occurs when space within your spine narrows and as a result, puts pressure on the nerves that run through your spine

Cervical myelopathy occurs when the spinal cord itself is compressed

How will having cervical radiculopathy affect me?

There are ways in which having cervical radiculopathy may affect you in your daily life. You may find it difficult and painful to move, especially at your upper body region such as your neck, shoulders and arms. As a result, this may bring discomfort and inconvenience to your life, especially if there is a job or event that requires you to move around often.

What does having cervical radiculopathy feel like?

Pain and discomfort. With cervical radiculopathy, you may experience a burning or shock-like pain in your neck and upper back that shoots down your shoulders, arms, fingers and chest. 

Weakness and tingling. Besides pain, you may also experience muscle weakness or a tingling pins-and-needles sensation in your arms and fingers. You may also find yourself having a lack of coordination or being more clumsy than usual. 

What are the causes of cervical radiculopathy?

Medical conditions. Cervical radiculopathy can be a result of underlying medical conditions, such as: 

A herniated disc 

  • Your spine is made up of 24 small bones, known as vertebrae, stacked on top of each other. In between each vertebrae, there is a rubbery pad known as a disc that acts as a cushion and prevents the vertebrae from rubbing against each other. Each disc has a harder exterior, known as the annulus, which surrounds an inner core, known as the nucleus. The nucleus contains loose fibers that are suspended in a gel-like substance. 
  • A herniated disc occurs when a fragment of the nucleus pushes out through the annulus as it is weak or torn
  • When a herniated disk happens in your upper back, it could compress on the nerves roots, resulting in cervical radiculopathy 

Spinal stenosis 

  • Spinal stenosis occurs when spaces within your spine, known as the foramen, begin to narrow, thus putting pressure on the nerves that run through your spine. 
  • When stenosis occurs in your upper back, this could once again place pressure on the nerves roots, resulting in cervical radiculopathy 

Spinal injuries. Trauma and injury to the cervical spine may fracture or displace a bone in the spine, damaging the surrounding nerve roots. In addition, swelling of tissues near the cervical spine may also press on nearby nerve roots, causing cervical radiculopathy.  

Tumours. Abnormal growths such as tumours within or near the cervical spine may also press on and damage the spinal nerve roots.

What are the risk factors of cervical radiculopathy?

Some risk factors of cervical radiculopathy include: 

Heavy manual labor

Smoking

Previous spinal nerve injury 

How is cervical radiculopathy diagnosed?

Medical examination. When visiting a doctor, your doctor will most likely conduct a thorough medical examination and several tests before definitively diagnosing you with cervical radiculopathy. Your doctor may ask you about your medical history, family history and test your strength and reflexes. 

The spurling test. The foraminal compression test, also known as the Spurling test, is probably the best test for your doctor to confirm a diagnosis of cervical radiculopathy. The Spurling test is performed by positioning your neck so that it is extended and your head so that it is rotated. Your doctor will then apply a downward pressure on your head. If pain is felt radiating from your neck down to your shoulders and arms, this is a likely confirmation that you have cervical radiculopathy. 

Imaging. Your doctor may also make use of spinal imaging such as X-Ray, MRI and CT scans to have a detailed look at the cervical spine and surrounding nerve roots.

How do I prevent myself from developing cervical radiculopathy?

There is no certain way to completely prevent cervical radiculopathy. However, some ways to reduce your risk of developing cervical radiculopathy include:

Exercising regularly. Exercising helps to strengthen your back muscles and keep your spine flexible. Some sports that are good for the spine include swimming and yoga.

Maintaining a good posture. Bad postures can create gradual changes to the natural curves of your spine. Thus, keeping your back straight while sitting down and sleeping on a firm mattress that adequately supports your spine may help to reduce your risk of developing cervical radiculopathy. 

How is cervical radiculopathy treated?

Rest. For some patients, cervical radiculopathy can go away on its own. Resting in bed, restricting physical activity and icing or heating the affected area may help to relieve some of your pain and accelerate the healing process. 

Physiotherapy. For this, your doctor will likely refer you to a physiotherapist. Although not a cure, physiotherapy is important in helping you to remain active and build strength in your neck and back. 

Cervical epidural steroid injections. Alternatively, your doctor may make use of epidural steroid injections. This is a minimally invasive procedure whereby your doctor, with the guidance of X-ray imaging, will first carefully insert a needle into a fat-filled area between the bone and the protective sac of the spinal nerves within your cervical spine. Your doctor will then inject a medicine to help reduce pain and inflammation in your cervical spine. 

Surgery. Lastly, your doctor may opt to treat your sciatica surgically by removing whatever is compressing on your nerves roots in your cervical spine. 

If you are currently experiencing any upper back and neck pain or think that you may have cervical radiculopathy, visit a doctor and seek medical attention immediately.

References

  1. A Malanga, G. (2019). Cervical Radiculopathy: Background, Epidemiology, Functional Anatomy. EMedicine. https://emedicine.medscape.com/article/94118-overview 
  2. Iyer, S., & Kim, H. J. (2016). Cervical radiculopathy. Current Reviews in Musculoskeletal Medicine, 9(3), 272–280. https://doi.org/10.1007/s12178-016-9349-4 
  3. Radiculopathy. (2019). Johns Hopkins Medicine Health Library. https://www.hopkinsmedicine.org/health/conditions-and-diseases/radiculopathy