Cervical Radiculopathy

General Information


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Description:

  • Impingement of cervical spinal nerve and/or nerve root, usually characterized by
    • Unilateral shooting or electric pain in upper limb
    • Neck pain
    • Sensory or motor deficits


Also called:

  • Pinched nerve
  • Cervical radiculitis


Definitions:

  • Cervical radicular pain – irritation and/or injury of a cervical spinal nerve characterized by shooting or electric pain in upper limb, not associated with sensory or motor symptoms(4)
  • There are multiple types of cervical radiculopathy
  • Myelopathy – progressive spinal cord dysfunction characterized by difficulty with manual dexterity, gait disturbance, upper motor neuron signs such as Hoffman sign, Babinski sign, hyperreflexia, and clonus


Incidence/Prevalence:

  • Limited data is available on the incidence and prevalence of cervical radicular pain or radiculopathy
  • Reported annual incidence of cervical radiculopathy is 83 per 100,000 persons
    • Based on observational study in Minnesota
    • 561 patients were diagnosed with cervical radiculopathy between 1976 and 1990
    • Annual incidence per 100,000 persons
      • 83.2 overall
      • 107.3 for men
      • 63.5 for women
      • 202.9 for patients aged 50-54 years
    • Reference – Brain 1994 Apr;117 (Pt 2):325
  • Reported prevalence 3.5 per 1,000 persons in cross-sectional study of 7,653 people in Sicily, Italy (Acta Neurol Scand 1996 Feb-Mar;93(2-3):184)


Causes and Risk Factors

Causes:

  • Irritation and compression of cervical spinal nerve and/or nerve root most likely due to
    • Narrowing of intervertebral foramen (decreased disk height or degenerative joint changes)
    • Intervertebral disk herniation
    • Infection
    • Inflammatory exudates
    • Physical injury or trauma
    • Spinal tumors


Pathogenesis:

  • Mechanism underlying radicular pain poorly understood(12)
    • Compression of exiting nerve root by herniated disk material or bony elements may lead to pain, especially if dorsal root ganglion also compressed
    • Hypoxia of nerve root and dorsal ganglion can aggravate the effect of the compression
  • Inflammatory mediators, changes in vascular response, and intraneural edema may contribute to radicular pain(12)


Complications and Associated Conditions

Associated conditions:

  • Spinal cord impingement
  • cord compression