What Is It, Causes, Diagnosis, Treatment, and More
Author: Corinne Tarantino, MPH
Editors: Ahaana Singh, Ian Mannarino, MD, MBA
Illustrator: Abbey Richard
Copyeditor: Joy Mapes
What is radiculopathy?
Radiculopathy encompasses several symptoms, such as pain, numbness, tingling, or weakness in the arms or legs, caused by compression of a nerve root in the spinal column. Radiculopathy can occur in different regions of the spinal column, usually indicated by different symptoms.The spinal column consists of small pieces of bone called vertebrae that are separated by vertebral discs, which are pads of strong tissue, or fibrocartilage. There are five classifications of vertebrae, organized by location and structure. From top to bottom (cranial to caudal) of the spinal column, they are the cervical, thoracic, lumbar, sacral, and coccygeal vertebrae. The spinal cord extends through the open space of the vertebrae, ending in the lumbar vertebrae, and it serves as the main pathway for information between the brain and the rest of the body (i.e., peripheral nervous system). The vertebral discs absorb shock and allow the spine to move flexibly. In general, radiculopathy occurs when there are problems with vertebrae or their discs, most frequently in the cervical or lumbar regions.
What is cervical radiculopathy?
Cervical radiculopathy results from a pinched or damaged nerve in the cervical region of the spinal column, located in the upper back and neck. This can lead to pain in the neck, shoulders, upper back, or arms. Most cervical radiculopathies occur in people between the ages of 30 and 60 and generally affect the lowest cervical vertebrae, which are labeled C5 to C7.
What causes cervical radiculopathy?
The most common causes of cervical radiculopathy are compression of the vertebrae when a vertebral disc weakens (i.e., disc degeneration) or age-related arthritis of the vertebra (i.e., spondylosis), which can form small outgrowths of bone called bone spurs. Both conditions can cause the vertebrae to shift positions, resulting in foraminal stenosis, or the narrowing of the space where the nerve roots exit the spinal cord. Such narrowing can put pressure on the nerve and consequently lead to nerve compression and, at times, damage. Other causes of cervical radiculopathy include bone disease, cancer, and a ruptured, or herniated, disc.
What is lumbar radiculopathy?
Lumbar radiculopathy, also known as sciatica, is the most common type of radiculopathy and refers to a pinched nerve in the lower back, or lumbar region of the spinal column. Symptoms of lumbar radiculopathy frequently include pain and numbness extending from the spinal nerve root location on the lower back, down to the legs or feet. The pain and numbness usually worsens after sitting or walking for a long period of time. If radiculopathy affects the spinal nerves that control the bladder and bowel, this can result in incontinence, or loss of bladder or bowel control. A co-occurrence of lower back pain, incontinence, leg weakness, and loss of sensation around the buttocks may be indicative of cauda equina syndrome, which is rare but can result in permanent disability if not promptly treated.
What causes lumbar radiculopathy?
Lumbar radiculopathy is most commonly caused by disc herniation. When the outer wall of a vertebral disc tears, the soft interior of the disc bulges out, or herniates. The herniated disc causes radiculopathy when it presses against a nerve root. A disc may herniate due to trauma or straining of the back, and disc degeneration often increases the risk for herniation. Similar to cervical radiculopathy, lumbar radiculopathy may also result from bone spurs, bone disease, or cancer.
What does radicular pain feel like?
Radicular pain is often sharp and spreads from the specific location of radiculopathy to other parts of the body. The pain has also been described as a burning or electric sensation that shoots down the leg or arm. Commonly, the pain is accompanied by feelings of numbness and tingling along the area of skin associated with the pinched nerve. Some people may also experience root signs, which include loss of sensation, muscle weakness, impaired reflexes, and chronic changes to soft tissue (i.e., trophic changes). Pain may increase when the affected individual is in certain positions or moves in a particular way.
Is radiculopathy a disability?
Radiculopathy can sometimes be considered a disability depending on the cause and severity of the pain. In some cases, individuals with radiculopathy may have difficulty completing their typical everyday activities.
How are cervical and lumbar radiculopathies diagnosed?
Diagnosis begins with a review of medical history and symptoms. If radiculopathy is indicated, additional tests and imaging may be conducted. A physical exam may involve the individual moving their legs or arms to determine when the pain occurs and if there are any limitations in motion. A common test for cervical radiculopathy is the Spurling’s maneuver, during which the individual tilts their head to the side, backwards, and tries to pull their head back upright while a clinician pushes it down. With lumbar radiculopathy, a straight-leg-raise test is commonly performed, where the individual lays flat on their back as a clinician lifts the individual’s legs into the air one at a time. If an individual experiences pain during a maneuver test, radiculopathy may be the culprit.In order to determine the cause and location of the radiculopathy, imaging studies, such as magnetic resonance imaging (MRI), may be performed. An MRI can be particularly useful for ruling out cauda equina syndrome. An X-ray or computerized tomography (CT) scan may also be used to visualize bone abnormalities. Sometimes, an electromyography, which tests the function of certain nerves, is conducted to rule out other diseases that cause nerve damage.
How are cervical and lumbar radiculopathies treated?
Treatment of cervical and lumbar radiculopathies vary depending on the cause and severity of the radiculopathy. To reduce pain, individuals may be instructed to take over-the-counter pain medications called non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs include aspirin, ibuprofen, and naproxen. Physical therapy may also be suggested to reduce pain, improve posture, and strengthen muscles. If pain persists, steroid injections, which can reduce inflammation specifically in the affected area, may be considered. Other medications -- such as oral steroids, stronger pain medications (e.g., tramadol), or the anti-seizure medication gabapentin -- may also be prescribed. If symptoms continue to intensify, surgical procedures to alleviate the spinal nerve compression may be necessary.
What are the most important facts to know about radiculopathy?
Radiculopathy refers to a set of symptoms that occur from spinal nerve root compression. Pain, muscle weakness, and numbness are symptoms, presenting either individually or in some combination. Radiculopathy most commonly occurs from compression in the neck (cervical) or lower back (lumbar) regions. Causes of radiculopathy include problems with the vertebrae or vertebral discs, such as disc degeneration, disc herniation, or age-related spondylosis. Diagnosis often requires a physical exam and imaging tests. Depending on the cause and severity of the radiculopathy, a clinician’s medical advice may include nonsurgical treatment options, like NSAIDs and physical therapy, or when necessary, surgical procedures to relieve the nerve compression.
Quiz yourself on Radiculopathy
7 Questions availableQuiz now!
Watch related videos:
Related linksBack pain
Bones of the vertebral column
Cauda equina syndrome
Lower back pain
Resources for research and reference
Berkowitz, A. (2016). Clinical neurology and neuroanatomy: A localization-based approach. McGraw-Hill Education.
Engstrom, J. (2018). Back and neck pain. In J. Jameson, A. Fauci, D. Kasper, S. Hauser, D. Longo, & J. Loscalzo (Eds.), Harrison's principles of internal medicine (20th ed.). McGraw-Hill Education.
Powers, A., Stafford, J., & Rickels, M. (2018). Diabetes mellitus: Complications. In J. Jameson, A. Fauci, D. Kasper, S. Hauser, D. Longo, & J. Loscalzo (Eds.), Harrison's principles of internal medicine (20th ed.). McGraw-Hill Education.
Ramayya, A., Sinha, S., & Grady, M. (2019). Neurosurgery. In F. Brunicardi, D. Andersen, T. Billiar, D. Dunn, L. Kao, J. Hunter, J. Matthews, & R. Pollock (Eds.), Schwartz's principles of surgery (11th ed.). McGraw-Hill.Ritter, K., & Fitch, R. (2021). Cervical radiculopathy. In K. Knoop, L. Stack, A. Storrow, & R. Thurman (Eds.), The atlas of emergency medicine (5th ed.). McGraw-Hill.