Do you have a pinched nerve?

Radiculopathy (often referred to as a “pinched nerve” in the neck or back) is usually caused by compression of a nerve root as it exits the spine either by a herniated disc or arthritic changes.

Disc herniation copy

Compression of the affected nerve root results in pain (radicular pain), weakness, numbness, and/or loss of deep tendon reflexes.

In cervical radiculopathy (“pinched nerve in the neck”), the radicular pain is referred from the the neck down the arm on the affected side:

cradic

The pain and numbness are usually felt most strongly in the area of the arm innervated by the affected nerve root (dermatome). For example, pain from a herniated C67 disc compressing the C7 nerve root will radiate down the arm into the back of the hand and middle finger:

UE derm

In lumbar radiculopathy (“pinched nerve in the back”), the radicular pain will usually radiate from the low back or buttock down the leg (“sciatica”):

lumbar-radiculopathy-visa\

A herniated L5S1 disc will usually compress the S1 nerve root, the sciatica will radiate down the back of the leg into the little toe, and the ankle jerk will be absent:

LE derm

In most cases, the diagnosis of radiculopathy, as well as the spinal level involved, can be deduced from a careful review the history and examination findings.

An electrodiagnostic study (electromyogram, or EMG) can be useful for confirming the diagnosis of radiculopathy and quantifying the degree of nerve damage in selected cases.

Spinal imaging studies, including plain X-rays, computed tomography (CT) or magnetic resonance (MR) imaging studies are usually needed to identify the cause of the radiculopathy, such as herniated disc, osteoarthritis, tumor or infection.

Disc herniationMRI copy

Most cases of radiculopathy are treated conservatively with pain medicines, activity modification and physical therapy, and ultimately recover spontaneously.

The SPORT study found that while lumbar radiculopathy patients treated surgically with discectomy improved more rapidly that those treated conservatively, both groups improved to about the same degree by 2 years.

Epidural steroid injections are frequently advocated as a treatment modality for recalcitrant cases, despite a paucity of well-designed trials of their efficacy. In fact a recent randomized controlled study published in Evidence Based Medicine showed no benefit of epidural steroids over saline or sham injections, click here for more details.

Surgery is usually reserved for patients with intractable pain despite an adequate trail of conservative measures, or those with severe and progressive motor deficits or cauda equina syndrome (with bowel and bladder dysfunction).

Surgical interventions can include a simple discectomy, discectomy with fusion, percutaneous discectomy, or microdiscectomy.

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