The spine is like a very sound structure and stabilizes the skeleton. Its vertebrae and discs are supported by a robust array of nerves, blood vessels, and ligaments that relay sensory information, supply oxygen, and lend strength and stability. But when one of these bodily tissues isn’t performing as it should, the entire spine suffers for it.
Radiculopathy comes from the Latin word radix, meaning “root,” and the Greek word patheia, meaning “suffering.” Radiculopathy occurs when one or more of the Foramina nerve roots becomes compressed. The cervical and lumbar spine are the most vulnerable to radiculopathy. It rarely occurs at the level of the thoracic vertebrae.
Foramina (singular foramen) are small holes in the vertebrae that allow spinal nerves to enter and exit the spinal column. These openings can narrow, putting pressure on the nerves that pass through them.
Each vertebra has two pairs of spinal nerve roots—a pair on the right and a pair on the left. One member of the pair transmits motor information from the brain to the spinal cord. The other carries sensory information back to the brain. The pair join forces outside the spinal canal to form a spinal nerve.
In any given year, up to one-third of Americans have sciatic pain—a type of radiculopathy caused by compression of the sciatic nerve—making it the most common back pain syndrome in the United States.
Sciatica causes pain that radiates down into the leg and foot. Radiculopathy of the cervical spine (the upper portion of the spine) is also common, particularly among white people in their 40s and 50s. Those who smoke are at higher risk of developing cervical radiculopathy and having had lumbar radiculopathy makes subsequent cervical radiculopathy more likely.
Patients with radiculopathy have varying degrees of back pain that interferes with their quality of life. They may also have weakness, numbness, or a tingling sensation, diminished grip strength or reflexes, limited range of motion, loss of coordination, or pain in the neck, arm, hand, leg, or foot.
Radicular pain doesn’t feel like a classic backache. It feels more like a mild electrical shock. A few lucky (well, lucky-ish) patients have brief periods of pain relief, but many people with radiculopathy find it challenging to focus on anything else.
A variety of injuries and disorders can contribute to radiculopathy. Putting undue strain on the back, such as lifting heavy objects or lifting them incorrectly, can cause radicular pain. Twisting the back and sitting or standing in an unnatural position can also encourage the condition.
People with a family history of spinal disorders and those who’ve been injured in a car crash, fall, or other accident are more likely to develop radiculopathy. And sometimes, people develop radicular pain related to (doctors say “secondary to”) an otherwise unrelated primary condition, such as a tumor or infection.
Sciatic Nerve Compression
The sciatic nerve is the largest in the body. It originates in the lower
back, extending through the buttocks and into the leg. This mighty nerve
supplies sensation to the thigh, lower leg, and foot. The compression
of the sciatic nerve is a common type of radiculopathy.
Degenerative Disc Disease
The spine is made up of alternating vertebrae and intervertebral discs.
Each disc is composed of a central core, called the nucleus pulposus,
surrounded by a tough, fibrous outer ring, called the annulus fibrosis.
As we age, the composition of the disc changes. We call this condition
degenerative disc disease.
The water content of the nucleus drops, and collagen fibers in the annulus
break down. Discs flatten out and may begin to bulge into the spinal canal,
compressing nerves exiting the spinal column.
Studies in twins have shown that degenerative disc disease has a strong
genetic component. In certain people, the process is accelerated, producing
degenerative changes in the spine while the patient is still relatively young.
Similarly, rapid degeneration is sometimes seen in people who smoke, possibly because smoking causes vascular changes that deprive the disk of adequate blood supply.
Herniated Disc
Eventually, the outer ring of a disc can give way altogether, allowing
the contents of the nucleus to
herniate (spill out) into the spinal canal. Disc contents are usually expelled
to the side, where nerves enter and exit the spinal column. Nerves and
extruded disc material can’t all fit comfortably in such a small
space, and nerve roots in the area end up getting squished.
Spinal Stenosis
Spinal stenosis is a condition in which the space within the spinal canal narrows, putting
pressure on the spinal cord.
Nerves, ligaments, and blood vessels enter and exit the spinal canal through the foramina (fuh-RAM-in-uh). If disease, inflammation, or age-related degenerative changes narrow these little openings, nerves that pass through them can be constricted.
This condition, which is most common among women in their 70s, affects patients’ ability to walk and puts them at a higher risk of falling.
Stenosis of the lumbar spine can cause bilateral radicular pain—in other words, pain on both sides of the body radiating from the lower back into the buttocks, leg, and foot. Stenosis of the cervical spine can limit range of motion and cause weakness, tingling, loss of sensation, and pain radiating to the shoulder arm, or hand.
The cause and origin of back pain are always hard to nail down, so your doctor will need to gather information from a number of different sources.
Your physician will ask when and how your pain began, whether it’s constant or intermittent, how intense it is, and whether there are positions (such as a stooped posture) or activities that either relieve or aggravate the pain.
Your physician or surgeon will also want to know about your general health
and current lifestyle habits, such as your exercise routine and any use
of tobacco products. Those who smoke are more likely to have back pain
and may not recover as well after surgery.
The doctor may also discuss your weight, as research has found that people
with a high body mass index (BMI) are at greater risk of having back pain.
It’s important to tell your doctor if you have diabetes, because
peripheral nerve pain can mimic the pain of radiculopathy.
The doctor may also want to perform imaging studies, such as a CT or MRI scan. Needle electromyography (EMG) is a noninvasive test in which a technician applies a mild electrical stimulus to small needles placed at strategic points near the presumed origin of your pain. The test is positive if the stimulus reproduces your pain. CT and MRI scans can reveal stenosis, nerve compression, disc degeneration, or disk herniation.
Treatment of radiculopathy is aimed at restoring lost functionality (grip strength, for example), reducing pain, and preventing progression of the disorder. Before deciding on a specific treatment, your doctor will explain your options and help you choose the interventions that fit your lifestyle and pain management goals.
Before determining whether surgery is needed to address radiculopathy, your doctor may suggest one or more of the following conservative treatments.
Placing the spine in traction by means of a system of weights and pulleys can relieve pressure and encourage blood flow to compromised areas.
Physical therapy for radiculopathy focuses on strengthening the muscles that support the back, stretching to promote flexibility and range of motion, and improving posture to distribute body weight more evenly. A physical therapist can also apply interventions such as hot or cold packs.
In some patients, range of motion in the neck is so limited that it’s disabling. Restoring range of motion can not only diminish pain, but also improve the patient’s ability to care for him- or herself, which in turn improves social interaction and boosts emotional health.
Over-the-counter or carefully prescribed narcotic pain medication might offer some relief as other therapies are initiated. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Aleve) and ibuprofen (Advil) can be extremely effective in reducing radicular pain. Muscle relaxants, opioid medications, and short-term oral corticosteroids can help as well.
Injections are both a treatment and a diagnostic tool. If injection of an anesthetic (or an anesthetic mixed with a corticosteroid) relieves your pain, it probably originates in the nerve that was blocked by the anesthetic.
If pain persists despite lifestyle changes, medications, and other interventions, you and your physician might decide to proceed with surgery. Younger, nonsmoking patients whose pain is relatively mild are the best candidates for surgery, but older patients and those with more severe pain can benefit as well.
The type of surgery the surgeon performs depends on the underlying cause of the radiculopathy. For example, in a patient with cervical disc herniation, the disc might be removed and replaced with a bone graft, followed by fusion of that segment of the spine. A patient with lumbar radiculopathy caused by a calcified ligament might have part of a vertebra removed to give the offending ligament a little elbow room, so to speak.
Inspired Spine is the national leader in minimally invasive spinal surgery. We offer a full range of treatments, beginning with more conservative measures and advancing to surgical options in patients with persistent pain.
Call Inspired Spine today at (952) 225-5266 or schedule a consultation to learn more about our conservative treatment path.
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