Radiculopathy

Question 1

What is radiculopathy?

Answer 1

Conduction block in axons of a spinal nerve or its roots.
This leads to weakness and paraesthesia and numbness depending on which axons are involved

Question 2

Radiculopathy vs radicular pain

Answer 2

Radiculopathy = State of neurological loss +/- radicular pain

Radicular pain = Pain from damage or irritation of spinal nerve tissue, particularly the dorsal root ganglion.

Question 3

Explain the route of the roots.

Answer 3

Roots originate from the cord.

Anterior and posterior roots of spinal nerves unite within intervertebral foramina.

Evaginates the dura mater seperately before uniting to form the mixed spinal nerve.

Question 4

Causes of radiculopathy.

Answer 4

Intervertebral disc prolapse (lumbar spine)

Degenerative disease of the spine -> Neuroforaminal or spinal canal stenosis (cervical spine due to its mobility)

Fracture

Malignancy (metastatic most commonly)

Infection (extradural abscess, osteomyelitis like TB (Pott’s disease) or HZV)

Question 5

Clinical features

Answer 5

Paraesthesia and numbness

Weakness

Radicular pain (burning, deep, strap-like or narrow pain) This pain can be intermittent

Question 6

Examination findings

Answer 6

Dermatomal and myotomal involvement

Evaluate for cauda euqine by pinprick sensation in perianal dermatomes, anocutaneous reflex, anal tone, rectal pressure sensation which may all be reduced.

Question 7

Faecal incontinence, urinary retention and saddle anaesthesia are red flags of what?

Answer 7

Cauda equina syndrome along with ED and bilateral sciatica

Question 8

Immunosuppression, IV drug abuse and unexplain fever (along with radiculopathy) are red flags of what?

Answer 8

Infection like osteomyelitis or abscess

Question 9

Chronic steroid use + radiculopathy are red flags of what?

Answer 9

Fracture or infection

Question 10

Significant trauma + osteoporosis or metabolic bone disease + radiculopathy are red flags of what?

Answer 10

Fracture

Question 11

New onset of radiculopathy after 50 year olds are is a red flag of?

Answer 11

Malignancy

Question 12

History of malignancy is a red flag of?

Answer 12

Metastatic disease

Question 13

Dx

Answer 13

Referred pain (MI (arm), hepatobiliary disease (right shoulder), urinary tract disease (flank, groinm thigh)

Myofascial pain

Thoracic outlet syndrome

Greater trochanteric bursitis

Iliotibial band syndrome

Meralgia paraesthetica

Piriformis syndrome

Question 14

Only condition requiring emergency surgical treatment

Answer 14

Cauda equina syndrome

Question 15

How are most IV disc prolapses managed?

Answer 15

Non-operatively

Question 16

Indications for surgical intervention of IV disc prolapses

Answer 16

Unremitting pain despite comprehensive non-surgical management

Progressive weakness

New or progressive myelopathy.

Question 17

Types of symptomatic management

Answer 17

Analgesia by WHO analgesic ladder.
Neuropathic pain medications are frequently utilised.

Physiotherapy is very important

Question 18

Neuropathic pain medications

Answer 18

Amitryptiline 1st line

Pregabalin and gabapentin as alternatives

If there are muscle spasms diazepam can be used or baclofen.