Cervical radiculopathy

Abstract

Cervical radiculopathy is a common clinical scenario. Patients with radiculopathy typically present with neck pain, arm pain, or both. We review the epidemiology of cervical radiculopathy and discuss the diagnosis of this condition. This includes an overview of the pertinent findings on the patient history and physical examination. We also discuss relevant clinical syndromes that must be considered in the differential diagnosis including peripheral nerve entrapment syndromes and shoulder pathology. The natural history of cervical radiculopathy is reviewed and options for management are discussed. These options include conservative management, non-operative modalities such as physical therapy, steroid injections, and operative intervention. While the exact indications for surgical intervention have not yet been elucidated, we provide an overview of the available literature regarding indications and discuss the timing of intervention. The surgical outcomes of anterior cervical decompression and fusion (ACDF), cervical disc arthroplasty (CDA), and posterior cervical foraminotomy (PCF) are discussed.

Cervical Radiculopathy: Focused on Primary Care

“…As the intervertebral disc ages, the nucleus pulposus loses hydrostatic pressure, and the annulus fibrosus loses cellularity, this causes its rupture and the herniation of the nucleus pulposus, which leads to the compression and localized ischemia, together this changes lead to the activation of a proinflammatory cascades mediated by the tumor necrosis factor alpha, interleukin 6 and matrix metalloproteinase [3,8]. There are also degenerative changes in the cervical spine that lead to a decrease of the disc height and therefore foraminal narrowing [9], this increases the load through the intervertebral joints that finally lead to the hypertrophy of the joint causing the narrowing and foraminal stenosis [10].…”

“…The shoulder abduction test checks for the relief of symptoms when shoulder is abducted as the nerve is taken off tension. Investigators have found the sensitivity of this test to range from 17-78% with a specificity ranging from 75-92% [3,11]. Some possible differential diagnosis is cardiac pain, herpes zoster, ParsonageTurner syndrome, intra and extraspinal tumors, and thoracic outlet syndrome which should be ruled out depending on the scenario in which the patient comes in [1].…”

“…It's also associated with diminish Musculoskeletal reflexes [3]. The most common cause of CR is the result of degenerative changes that affect the anatomy of the cervical spine including the vertebral bodies, the intervertebral discs, the facet joints and the ligament component of the cervical spine [4].…”

“…The most common cause of CR is the result of degenerative changes that affect the anatomy of the cervical spine including the vertebral bodies, the intervertebral discs, the facet joints and the ligament component of the cervical spine [4]. This causes compression of the nerve root that could be due to a herniation of the disc material or the creation on bony osteophytes [3]. The CR is a common cause of consultation to the general physician or the emergency room, it is estimated that in the United States exist an CR incidence of 83 cases per 100.000 people [2,5].…”

“…The CR is a common cause of consultation to the general physician or the emergency room, it is estimated that in the United States exist an CR incidence of 83 cases per 100.000 people [2,5]. The literature describes various risk factors associated with the presence of CR, which include: white race, smoking, prior lumbar radiculopathy, lifting heavy objects and playing golf, among others [3,[5][6][7].…”