Cervical Radiculopathy or Cervical Radiculitis
Cervical Radiculopathy
What Is It?
Cervical radiculopathy is a condition that occurs when one or more cervical roots are compressed. This damage to the neck usually also causes symptoms in the areas innervated by the specific root, namely the shoulder and upper limbs. Cervical compression radiculopathy is due to a multitude of problems involving the bone structures and soft tissues.
Causes of the condition
1.
Herniated intervertebral disc: When a herniated disc occurs, the herniation presses on the nerve root and pain occurs.
2.
Degenerative disc disease: It occurs when the disc weakens and the vertebrae do not move normally, resulting in compression of the roots.
3.
Spinal stenosis: When the vertebrae degenerate, osteophytes can form, causing myelopathy and radiculopathy.
Cervical Radiculopathy
Symptoms
- Neck pain that extends to the shoulder and arm
- Hypoesthesia-paresthesia (numbness-“tingling”)
- Muscle Weakness
Cervical Radiculopathy
Treatment
If symptoms do not subside within 2-3 months with conservative treatment (physiotherapy/collar/medication), then surgical treatment is recommended.
1.
Anterior Cervical Discectomy and Fusion (ACDF)
If a patient with cervical spinal stenosis continues to experience symptoms such as radiating arm pain despite conservative treatment, then surgery is the recommended solution. Anterior cervical discectomy and fusion (ACDF) is a common procedure used to address symptoms caused by cervical disc degeneration and disc herniation.
The entire disc is removed and is usually replaced with an artificial implant (cage). The vertebrae are stabilized either with a metal plate or with screws placed through the cage. The ultimate goal is to remove the osteophytes and herniated disc material compressing the nerves and to immobilize the intervertebral segment in order to reduce pain.
2.
Cervical Disc Arthroplasty
Disc arthroplasty follows the same surgical approach; however, instead of eliminating motion at the removed disc level, an artificial disc is implanted to restore the disc’s function after decompression of the nerves and spinal cord. Like a natural disc, the artificial disc is capable of all necessary movements to preserve cervical spine kinematics and biomechanics.
Disc arthroplasty is performed via an anterior approach to the cervical spine, using a small incision in the neck and accessing the spine between the muscles and the delicate structures of the trachea and esophagus. It is worth noting that no muscle is cut or damaged, resulting in minimal postoperative pain. The disc is removed, osteophytes are cleared, and the site is prepared for implantation. The patient is typically discharged the next day, just as in the case of fusion.
3.
Posterior Decompression – Foraminotomy
In cases of extensive degenerative changes, posterior decompression via a posterior approach is selected, often combined with foraminotomy.
A single incision is made on the back of the neck, and under radiological guidance, the approach is directed to the level of foraminal stenosis. There, the foramen is enlarged, and the compressed nerve root is released. This effectively eliminates the pain. The patient is mobilized on the same day.
4.
Epidural Perineural Injections
This technique involves the administration of medication via injection, selectively into the spine, with the purpose of identifying the pain source. These injections serve both diagnostic and therapeutic purposes. They are performed in an operating room setting, without general anesthesia, under radiological guidance, and typically take no more than 20 minutes.
