What is Radiculopathy, or Pinched Nerve? Manifestations and Treatment

Radiculopathy, radicular syndrome - root stimulus syndrome indicate problems associated with the compression of the root of the nerve, and thus the nerve that emanates from the spinal cord. The most commonly affected areas are the lumbar and the cervical spine.

Damage and displacement, i.e. disc herniations, are a major problem in radiculopathy.

In addition to neck and back pain, there are a number of other problems associated with the syndrome.

It is reported that 60-90% of the population will have experienced back pain and difficulties associated with it at least once in their lifetime.

In most cases, these are less severe difficulties indicating spinal blockage. The most common difficulties occur in the lumbar and cervical spine.

The problem associated with spinal cord compression is referred to as nerve root syndrome, radicular syndrome, or radiculopathy. It is a state in which the nerve is compressed, or more precisely, the nerve root exiting the spinal cord.

This problem is associated with pain, radiating pain, but also various other neurological problems. They reduce the quality of life and restrict the affected person intensely and acutely, but also in the long term.

According to reports, up to 90% of cases with the first case of radiculopathy are cured by conservative treatment. In other words, there is no need for a surgery.

About the Spinal Cord and Spinal Nerves - A Brief Overview

The spinal cord, also called the medulla spinalis, is located in the spinal canal (canalis vertebralis). It is formed by the vertebrae with their openings. The connected vertebrae form the spine.

The spine is...

The spine - columna vertebralis, is the axis of the human body, which has a supporting, locomotor but also protective function, ie it protects the spinal cord.

The inward curvature of the lumbar (lower back) and cervical (the neck) spine is called lordosis. The curvature in the lumbar region is called kyphosis, i.e. curvature towards the back. It is found in the thoracic and sacral areas.

This curvature is physiological, i.e. natural.

Conversely, scoliosis is unnatural as it is a pathological sideways curve of the spine. There is a slight physiological sideways curve in every person.

A temporary sideways curve of the spine can be seen when standing on one leg, transferring the weight to one limb, or when carrying a heavier load in one hand.

The spine consists of 33 or 34 vertebrae.

Table: The Spine is Divided into Vertebral Segments by Their Location

The spinal cord is...

The spinal cord is located inside the spine and is enclosed by it.

The spinal cord passes through the spinal canal from the first cervical vertebra - C1. As it grows more slowly, it reaches about the level of the second lumbar vertebra, L2. The rest of the spine contains bundles and tangles of nerve fibres.

Cauda equina

The role of the spinal cord is to carry reflexes and transmit signals, ie it mediates nerve impulses to the brain. Spinal nerves go towards the periphery, to the body and its end parts, such as the limbs.

A fuller description of the pinal cord
It is approximately 40-50 centimetres in length.
It weighs between 30 and 50 grams.

The spinal cord, like the brain, is enclosed and protected by membranes called meninges. The contain white and gray matter. White matter is found on the surface. Gray matter is found on the inside and has the shape of the letter H.

Gray matter neurons form the anterior, posterior spinous processes and transverse processes.

In the area of the dorsal root, there is a nerve nodule, which is called the spinal ganglion.

It is divided into individual segments.

The spinal cord is made of 31 segments from which branch one pair of sensory nerve roots and one pair of motor nerve roots

• 8 cervical segments
• 12 thoracic segments
• 5 lumbar segments
• 5 sacral segments
• 1 coccygeal segments

The spinal nerve roots are formed by the connection of individual spinal nerves.

Spinal nerves...

...connect the spinal cord and the brain with other parts of the human body. The Latin name is nervi spinales.

The spinal nerves exit the spinal cord. Their initial part is called fila radicularia. These join into the anterior and posterior spinal nerve roots.

Anterior spinal nerve roots - radices anteriores. These exit the anterior processes of the spinal cord.

Lateral to the spinal cord, the entry and exit points of the spinal nerve roots are located, i.e. the posterior spinal nerve roots - radices anteriores.

Anterior efferent roots - leading stimuli from the centre, brain and spinal cord to the periphery. 
Posterior afferent roots - leading stimuli from the periphery, body, spinal cord or brain.

Depending on their function, they are also referred to as motor or sensory fibres.
Anterior (front) - motor.
Posterior (back) - sensory.

In addition, the anterior roots have sympathetic fibres in a certain section, i.e. C8 to L2 and in the part S2-S4 parasympathetic fibres.

Both of these roots join together to form a spinal nerve. It passes through an opening in the vertebra - foramen intervertebrale.

And here we encounter the issue of compression of the nerve or its root in the vertebrae.

Radicular Syndrome

This syndrome is a set of symptoms that stems from compression, i.e. pressing on the nerve root. Compression can occur on one side, i.e. unilaterally, or on both sides, i.e. bilaterally.

Radicular syndrome = pain, which radiates into the relevant innervation area of the damaged segment.

Besides pain, there are other neurological problems radiating towards the limb or other areas of the body.

The most frequently affected areas in radiculopathy are in the cervical and lumbar segments of the spine. According to rough estimates:

• cervical segment - cervical C
  • C7 - 60 %
  • C6 - 20 %
  • C5 a C8 10 %
• lumbar segment - lumbar L
  • L5 and S1 up to 90 %
  • L4 - 10 %
  • other segments rarely affected
• thoracic segment - thoracic Th
  • less frequently affected 

Radiculopathy is one of the most common causes of chronic back pain.

There are several concepts in use when it comes to spinal problems. They are not always about radiculopathy.

Back pain is usually local, i.e. with no serious radiating pain, for example in low back pain.

Radical syndrome, as we describe it, manifests itself in radiating pain and other neurological pain.

Yet another type is pseudoradicular pain. It is similar to radiculopathy. However, there is pain that spreads but in an open-ended space and does not have the accompanying neurological difficulties of nerve oppression. In most cases, they don't reach below the knee.

Learn more: 
Lower back pain - a less serious problem with the spine
Sciatic nerve, it is not always about inflammation as such
Spondylosis - degenerative disease
Spondylarthrosis - degenerative disease of the articular surfaces of the vertebrae

Radiculopathy can be caused by a variety of conditions. It is often a case of the disc compressing the nerve root. This happens in intervertebral disc herniation. However, there are other situations.

Radiculopathies can be more generally divided into compressive and non-compressive. That is, forms that cause compression, i.e. pressure, and those without compression of the nerve root.

Table: Various Causes of Radiculopathies

Several factors are involved in the compression form, i.e. spinal disc herniation with disc degeneration and reduction of its overall height.

However, a problem with congestion is associated, ischemia - non-congestion and ischemic changes occur. It is an inflammatory process with swelling - edema.

Dislocations of the intervertebral disc is the most common reason, i.e. a section of the lumbar spine called L5 and S1.

Apart from platelet herniation, these may be degenerative changes in terms of osteophyte formation. Osteophytes are bony spurs, projections or appositions. These reduce the space in an already tight arrangement of the spine and cause compression.

Compression may also occur due to the displacement of a vertebra. It is called spondylolisthesis. It often occurs at a young age.

Learn more:
The displacement of a spinal vertebra - spondylolisthesis
Spinal disc herniation
Vertebrogenic algic syndrome
Facet syndrome
Sacroiliac joint blockage

Some risk factors that contribute to problems are also mentioned in connection with the radicular syndrome.

Risk factors:

• work-related factors
  • vibrations
  • long-term sitting
  • inappropriate workplace ergonomics
  • lifting heavy loads
• hereditary
• frequent colds, hypothermia
• bad biomechanics affecting the spine
  • flat feet
  • lower limbs of various lengths
  • spinal deformities, scoliosis, pelvic problems
• being overweight and obese
• unsuitable footwear
• vitamin deficiency and malnutrition

Cervical radiculopathy

This is about pain radiating from the spinal segments of the neck. In most cases, the cause is intervertebral disc degeneration.

Let us illustrate:

Cervical disc height reduction - one or more - reduced space = nerve compression.

The highest frequency of pain is reported in the cervical vertebrae sections C6 and C7.

Another problem is the degenerative process on the articular surfaces and bones of the vertebra. Osteoarthritis affecting the intervertebral joints and the development of osteophytes, i.e. bone spurs.

Cervical disc herniation. The cause is direct damage to the disc. Nerve compression is caised by the curved part.

Lumbar radiculopathy

The pain occurs in the lower back area - the lumbar region.

It is very common, with 60-90% of the population facing this problem at least once in their lives. The vast majority of cases is radiculopathy caused by disc herniation.

More precisely: 
It is mainly due to herniation between vertebrae L5-S1, L4-L5, and less often L3-L4.

Another common cause is degenerative changes across the entire vertebral segment. This pathological process is then referred to as spondylosis. Another cause, even in adolescence and adolescence, is spondylolisthesis, i.e. displacement of a spinal vertebra.

The disease presents with a awide range of symptoms. They are characterized by the site of compression and damage.

Typically, radiculopathy symptoms can be classified into three groups:

1. back pain
2. pain and other problems radiating into the innervation area - towards the upper or lower limbs
3. muscle weakness + hypotension, hypotrophy and reduction of associated reflexes

Radiculopathy is manifested by neurological issues. The first group presentws with irritative symptoms and the second one with paretic symptoms.

What does this mean?

Irritative issues are those manifested by pain, paresthesias (e.g., tingling). So it's an irritation.

On the other hand...

Paretic symptoms and these indicate disorders of sensitivity or reflexes. Less muscle strength and lower muscle tone are also associated - hypotension and hypotrophy.

Table: Several Irritative and Paretic Symptoms

The pain is localized in the spine and thus at the site of injury. Impaired mobility may occur along with pain.

However, pain radiating to another part of the body is also a symptom of nerve root irritation.

So:

Sensitive dermatoma symptoms that are localized at the site of nerve innervation. Sensitive sensation means pain and, for example, tingling, numbness or other abnormal sensation.

Unlike in pseudoradiculopathy, the issues are well demarcated.

The second group is segmental motor symptoms. Examples include muscle weakness, reduction of muscle tension or changes in reflexes.

Table: Some Radiculapthies Based on the Most Common Area of Damage

Diagnosis is based on a medical history and clinical signs. She is followed by a physical examination. Postural stability, posture and gait are evaluated as well.

This is done by an expert, i.e. a neurologist. The GP, neurologist, orthopedist, neurosurgeon, physiotherapist all cooperate in case issues arise.

Imaging methods are used for detection:

• X-ray
• CT
• MRI
• EMG - electromyography

Differential diagnosis is important, as problems in the back can indicate another problem.

For example:

• lumbago - general term for lower back pain, without sciatica
• coxarthrosis - arthrosis of the hip
• abdominal diseases - ulcer disease, gallbladder colic, diverticulitis, tumour
• retroperitoneal kidney disease, abdominal aortic aneurysm
• gynecological diseases - in women, ectopic pregnancy, inflammation, tumour
• shingles - neuralgia after herpetic inflammation
• vascular diseases
• tumourous diseases
• spinal inflammation
• injury
• psychological causes

The presence of three symptoms can help with the differentiation, as described in the section on symptoms. Issues with mobility that worsens the other issues are also indicative.

Symptoms vary according to the site of the dysfunction. Usually, there is local pain in the spine. However, the pain radiates to the relevant area of innervation = the spread is within the associated dermatoma.

When the cervical spine is affected, it can be located in the head, shoulders or in different areas of the upper limb. Of course, other neurological difficulties may be associated. An example is a disorder of sensitivity, but also momentum or muscle weakness.

If the problem occurs in the lumbar region, it radiates to the pelvis, sciatic muscle and lower limb, up to the fingers.

Both local spinal pain and radiating pain to lower levels are present. It is associated with aforementioned neurological symptoms.

The pain is usually intense, sharp, burning, jerky or even convulsive. It is worsened by certain movements, but also by the constricting the abdominal muscles, such as during bowel movement, coughing and sneezing. The mobility of the spine is limited.

Pain may occur unilaterally (on one side) or bilaterally (on both sides). It depends on the extent of the damage.

Caudy Equina Syndrome is a Serious Medical Condition

It is a serious condition that arises as a result of nerve entanglement - that nerve bundle is cauda equina. The spinal cord runs through the spinal canal to approximately the level of the lumbar vertebrae L1 to L2. Subsequently, this entanglement of nerves recedes from it.

Learn more about cauda equina.

The syndrome is characterized by significant impairment of both motor and sensory functions. There is a disorder at the level of the organs of the pelvis and pelvic floor, as well as the lower limbs.

The reason is the disc herniation in the area of the lumbar spine lower than vertebra L2.

The symptoms are variable and depend on the site and extent of the compression. There is sensitivity disorder in the genital and rectal areas. Lower back pain radiating to both or one side of the body after dermatoma.

An example of motor dysfunction is the weakening of the muscles in the lower limbs, but also a dysfunction of sphincter muscles (opening/closing) and associated incontinence, i.e. involuntary excretion of bodily fluids.

There is a risk of sexual dysfunction.