Radiculopathy

Original Editor - Daan Vandebriel

Top Contributors - Muhammad Osama, Kim Jackson, Wendy Walker, Khloud Shreif, Daan Vandebriel, Ellen Hopmans, Joao Costa and Amrita Patro  

Description Definition

Radiculopathy refers to a set of conditions in which one or more nerves are affected and do not work properly (a neuropathy). The location of the injury is at the level of the nerve root (radix = "root"). This can result in pain (radicular pain), weakness, numbness, or difficulty controlling specific muscles.

In a radiculopathy, the problem occurs at or near the root of the nerve, shortly after its exit from the spinal cord. However, the pain or other symptoms often radiate to the part of the body served by that nerve. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the foot.

The radicular pain that results from a radiculopathy should not be confused with referred pain, which is different both in mechanism and clinical features. Polyradiculopathy refers to the condition where more than one spinal nerve root is affected

Clinically Relevant Anatomy

Radiculopathy is a mechanical compression of a nerve root usually at the exit foramen or lateral recess. It may be secondary to degenerative disc disease, osteoarthritis, facet joint degeneration/hypertrophy, ligamentous hypertrophy, spondylolisthesis, or a combination of these factors. Rarer causes of radiculopathy may include radiation, diabetes mellitus, neoplastic disease, or any meningeal-based disease process.

The most common site of radiculopathy is the cervical and the lumbar spine.

Cervical Radiculopathy

Lumbar Radiculopathy

Cervical radiculopathy is defined as a disorder affecting a spinal nerve root in the Cervical Spine, therefore a knowledge of the brachial plexus is crucial to understanding the impact of nerve root impingement or damage has on the body. We have 8 cervical nerve roots, for 7 cervical vertebrae and this may seem confusing at first. However a nerve root comes out of the spinal column between C7 and T1, hence C8 as T1 already exists [2].

Nerve roots and the local vessels lack a perineurium and have a poorly developed epineurium, making them vulnerable to mechanical injury when compared to the periphery. The blood supply is also less secured and vulnerable to ischemic damage[5]. These anatomical difference to peripheral nerves may explain why low pressures on the nerve root elicit large changes and signs and symptoms. The nerve roots are vulnerable to pressure damage which is why small impingements can cause signs and symptoms. At 5-10mmHg (0.1psi) capilliary stasis and ischemia has been observed with partial blockage of axonal transport. At 50mmhg tissue permeability increases with an influx of oedema, higher to 75mmhg, there is nerve conduction failure if sustained for 2 hours. At 70+mmhg neural ischemia is complete and conduction is not possible [5]. It is rare to get pressures that high but 5-10mmhg is a large small amount of pressure and signs and symptoms occur [5]. These pressures can occur with a less severe clinical picture in unique circumstances, if the pressure is acute then symptoms are severe however if chronic the nervous tissue is given time to adapt and evolve to the surrounding structure and symptoms are less severe.

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