Abstract
Cervical radiculopathy is a constellation of symptoms consisting of neurogenic neck and upper extremity pain emanating from the cervical nerve roots. In addition to pain, the patient may experience numbness, weakness, and loss of reflexes. These symptoms are usually unilateral. The C6 and C7 nerve roots are most commonly affected. The causes of cervical radiculopathy include herniated disc, foraminal stenosis, tumor, osteophyte formation, and, rarely, infection.
Patients suffering from cervical radiculopathy complain of pain, numbness, tingling, and paresthesias in the distribution of the affected nerve root or roots. Patients may also note weakness and lack of coordination in the affected extremity. Muscle spasms and neck pain, as well as pain referred to the trapezius and interscapular region, are common. Decreased sensation, weakness, and reflex changes are demonstrated on physical examination. Spurling test will often exacerbate the pain of cervical radiculopathy. Cervical epidural blocks with local anesthetic and steroid are extremely effective in the treatment of cervical radiculopathy. Underlying sleep disturbance and depression are best treated with a tricyclic antidepressant.
Keywords
cervical radiculopathy, neck pain, upper extremity pain, cervical nerve roots, herniated discs, Spurling text, spinal abscess, epidural abscess
ICD-10 CODE M54.12
The Clinical Syndrome
Cervical radiculopathy is a constellation of symptoms consisting of neurogenic neck and upper extremity pain emanating from the cervical nerve roots. In addition to pain, the patient may experience numbness, weakness, and loss of reflexes. These symptoms are usually unilateral. The C6 and C7 nerve roots are most commonly affected. The causes of cervical radiculopathy include herniated disc, foraminal stenosis, tumor, osteophyte formation, and, rarely, infection. The age-adjusted incidence of cervical radiculopathy is 83 per 100,000 persons with smoking, axial load bearing, female gender, white race, and the arthritides being predisposing factors.
Signs and Symptoms
Patients suffering from cervical radiculopathy complain of pain, numbness, tingling, and paresthesias in the distribution of the affected nerve root or roots ( Table 16.1 ). Patients may also note weakness and lack of coordination in the affected extremity. Muscle spasms and neck pain, as well as pain referred to the trapezius and interscapular region, are common. Decreased sensation, weakness, and reflex changes are demonstrated on physical examination. Patients with C7 radiculopathy commonly place the hand of the affected extremity on top of the head to obtain relief ( Fig. 16.1 ). Spurling test will often exacerbate the pain of cervical radiculopathy. This test is performed by asking the patient to extend and laterally rotate the cervical spine while the physician applies an axial load.
| Cervical Root | Pain | Sensory Changes | Weakness | Reflex Changes |
|---|---|---|---|---|
| C5 | Neck, shoulder, anterolateral arm | Numbness in deltoid area | Deltoid and biceps | Biceps reflex |
| C6 | Neck, shoulder, lateral aspect of arm | Dorsolateral aspect of thumb and index finger | Biceps, wrist extensors, pollicis longus | Brachioradialis reflex |
| C7 | Neck, shoulder, lateral aspect of arm, dorsal forearm | Index and middle fingers and dorsum of hand | Triceps | Triceps reflex |
Occasionally, patients suffering from cervical radiculopathy experience compression of the cervical spinal cord, with resulting myelopathy. Cervical myelopathy is most commonly caused by a midline herniated cervical disc, spinal stenosis, tumor, or, rarely, infection. Patients suffering from cervical myelopathy may experience decreased manual dexterity of the upper extremities and, occasionally, lower extremity weakness and bowel and bladder symptoms. This condition represents a neurosurgical emergency and should be treated as such.
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