Cervical Radiculopathy

Question 1

When were ruptured cervical discs first recognized as a cause of radicular symptoms in the arm in the absence of myelopathy?

Answer 1

in the 1940’s

Question 2

What is the most common cause of cervical radiculopathy?

Answer 2

compression

Question 3

What 2 derangements can cause compression on nerve roots?

Answer 3

• cervical spondylosis

- disc herniation

Question 4

Define spondylosis

Answer 4

general term for nonspecific, degenerative changes of spine

Question 5

Bony growths at which joints typically result in the neural foramina narrowing, causing compression of the nerve roots and radicular symptoms?

Answer 5

Zygapophyseal and uncovertebral joints

Question 6

Radicular symptoms tend to arise following a ____ disc herniation

Answer 6

lateral

Question 7

What are some examples of diseases/disorders that can cause noncompressive radiculopathy?

Answer 7

• diabetes
• vasculitis with nerve root infarction
• infections (herpes, Lyme disease, TB, syphilis, etc.)
• infiltration
• acute demyelination (GB)

Question 8

Noncompressive causes of radiculopathy affect the ventral and dorsal roots more _____.

Answer 8

diffusely, meaning they may span multiple myotomes and dermatomes

Question 9

What is the mean age at diagnosis of cervical radiculopathy?

Answer 9

47.9

Question 10

What is the incidence ratio of men to women?

Answer 10

1:1.7

Question 11

Incidence rates are highest for which age group?

Answer 11

50-54 years age group

Question 12

What is the most frequently affected nerve root? It accounts for what percentage of patients?

Answer 12

C7

70%

Question 13

C6 root involvement was found in approximately __%

Answer 13

20%

Question 14

Involvement of which nerve roots accounted for the remaining 10%?

Answer 14

C5, C8, and T1

Question 15

Typically if symptom onset is acute what is the cause? If onset is indolent?

Answer 15

herniated disc

spondylosis

Question 16

Where is pain experienced?

Answer 16

In the neck, arm, shoulder, interscapular region, chest, breast, and face

Question 17

What is a danger sign associated with cervical radiculopathy?

Answer 17

Lhermitte’s phenomenon

Question 18

If there is associated fever, chills, and/or unexplained weight loss what might the cause be?

Answer 18

tumor or infection

Question 19

What type of events may trigger cervical radiculopathy?

Answer 19

• Physical exertion in the form of golf, shoveling snow, diving from a board, etc.
• Trauma
• Motor vehicle accident

Question 20

Is sensory loss common or not? Explain…

Answer 20

It is frequently mild or absent due to an extensive overlap of dermatomes

Question 21

What special test screens for cervical radiculopathy?

Answer 21

the Spurling maneuver

Question 22

When are neuroimaging and electrodiagnostic testing indicated for diagnosis?

Answer 22

When…

• localizing signs and symptoms suggest a nerve root injury
• there are there are persistent symptoms that do not resolve with conservative therapy

Question 23

If a noncompressive radiculopathy is suspected, what type of imaging should be performed?

Answer 23

imaging with contrast

Question 24

What is the imaging study of choice for diagnosing cervical radiculopathy?

Answer 24

MRI

Question 25

What are 4 other possible diagnoses that must be ruled out first?

Answer 25

- Pain arising from the zygapophyseal or uncovertebral joints - Orthopedic problems of the neck or shoulder - Entrapment neuropathy - Brachial plexopathy

Question 26

What does prognosis depend upon?

Answer 26

Whether the cause is compressive or noncompressive

Question 27

What type of therapy is preferred when compressive radiculopathy is suspected?

Answer 27

conservative

Question 28

What are some examples on conservative therapy?

Answer 28

- Oral analgesics - A short course of oral corticosteroids - Avoidance of provocative activities - Cervical traction - Short-term neck immobilization with the use of a hard or soft cervical collar - Use of a cervical pillow - Physical therapy with exercise and gradual mobilization

Question 29

What may patients with persistent cervical radicular pain, with or without radiculopathy (inspite of conservative therapy) benefit from?

Answer 29

Epidural glucocorticoid injections

Question 30

What are the criteria for surgery?

Answer 30

- Symptoms and signs of cervical radiculopathy - Evidence of cervical nerve root compression by MRI or CT myelography - persistence of radicular pain despite nonsurgical therapy for at least six to 12 weeks or progressive motor weakness that impairs function

Question 31

What are 3 types of surgeries that cervical radiculopathy patients may benefit from?

Answer 31

- Anterior cervical discectomy and fusion - Posterior laminoforaminotomy - Artificial disc replacement