Q: Dear Doctor, I am reaching out to ask for your guidance and expertise concerning my mother, who is 46 years old. She has been experiencing symptoms that seem to suggest cervical radiculopathy, and it has been causing her a lot of discomfort and distress. I would be incredibly grateful for any advice or recommendations you might have on how to best manage her condition. This includes potential treatment options, lifestyle changes, or any further diagnostic steps we should take to make sure she gets the most effective care.
A: Cervical radiculopathy is a complex and often debilitating condition that occurs when the nerve roots in the cervical spine (the neck region) become compressed or irritated. This condition can lead to significant discomfort, pain, and functional impairments that can impact daily life. Cervical radiculopathy often arises due to structural abnormalities such as herniated discs or arthritic bone spurs that encroach upon the nerve space within the cervical spine. These abnormalities exert pressure on the nerve roots, leading to a range of symptoms that can affect not only the neck but also the upper extremities.

Herniated discs, one of the common causes of cervical radiculopathy, occur when the inner gel-like core of an intervertebral disc protrudes through its outer layer. This bulging disc material can press against the nerve roots, causing pain and other neurological symptoms. Similarly, arthritic bone spurs, which are bony projections that develop along the edges of bones, can grow into the nerve space and compress the nerve roots. These structural changes can result from degenerative processes like osteoarthritis, where the cartilage that cushions the joints breaks down over time, leading to increased friction and bone growth.

The pressure exerted on the nerve roots by herniated discs or bone spurs can lead to a variety of symptoms. One of the most common symptoms is neck pain, which can range from a dull ache to severe discomfort. Additionally, patients may experience radiating pain that extends from the neck into the shoulders, arms, and even the hands. This radiating pain is often described as a sharp or burning sensation. Numbness and tingling in the affected areas are also common, as the compressed nerve roots struggle to transmit signals effectively. In more severe cases, cervical radiculopathy can cause muscle weakness, leading to difficulties with motor functions in the neck and upper extremities.

The etiology of cervical radiculopathy involves multiple pathologies that impact the nerve roots. Among the most common causes are herniated discs, which can bulge out and press against the nerves. Another significant cause is foraminal narrowing, where the foramina – the spaces through which nerves exit the spinal column – become constricted. This narrowing can result from degenerative changes such as osteoarthritis. As the condition progresses, it can lead to stenosis, or the narrowing of the intervertebral foramen. These small openings are crucial as they allow nerve roots to pass from the spinal column to the rest of the body. When these foramina narrow, the nerve roots can become compressed, leading to the aforementioned symptoms.

Typically, cervical radiculopathy manifests unilaterally, affecting one side of the body. However, in instances where severe bone spurs are present at a single spinal level, bilateral symptoms can occur. This means that both sides of the body can be impacted due to nerve root compression on either side of the spine. When patients experience peripheral radiation of pain, muscle weakness, or a sensation akin to pins and needles, these symptoms can often be traced back to the specific nerve root that is affected.

Cervical radiculopathy is a broad disorder with several underlying mechanisms and can affect individuals across a wide age range. However, it is most commonly diagnosed in individuals between the ages of 40 and 50. The range of symptoms is diverse and can include arm pain that follows a dermatomal pattern – specific areas of the skin supplied by particular nerve roots – along with neck pain, paresthesia (abnormal sensations like tingling or prickling), muscle weakness in a myotomal pattern (specific muscles controlled by certain nerve roots), impaired reflexes, headaches, scapular pain, and both sensory and motor dysfunction in the upper extremities and neck. It is crucial to note that the absence of radiating pain does not rule out nerve root compression, as significant sensory and motor dysfunction can occur without major pain symptoms.
to be continued...