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Radiculopathy is a disease that usually affects middle-aged and elderly people. It is often the cause of severe disability. What is a disease with a mysterious sounding name?
What is radiculopathy and what are its causes
The term radiculopathy is understood to mean diseases of the nerve roots which are caused by chronic pressure on the nerve root in or around the spine. The most common cause is the protrusion of the intervertebral disc. Bone changes in the course of rheumatoid arthritis or osteoarthritis, especially in the cervical and lumbar sections, may also compress individual nerve roots. People with diabetes may experience excruciating pain in the thoracic spine, which will also be a radiculopathy. Nerve root involvement may also occur in the course of mycosis, borreliosis, and syphilis. Infection with the herpes zoster virus usually causes painful radiculopathy with loss of sensation.
Radiculopathy – symptoms
Nerve root diseases cause characteristic radicular syndromes consisting of pain and segmental neurological defect symptoms that occur in different places – depending on the level of the spine involved. Muscles innervated by the occupied motor nerve root, affected by paresis and atrophy, tend to be flaccid and may experience fasciculations, i.e. small contractions of muscle fibers. The involvement of the sensory root causes a loss of sensation with a dermatomal distribution.
Pain may worsen with movement that transfers pressure to the spinal root through the subarachnoid space. Such movements may include repositioning the spine, coughing or sneezing. Damage to the cauda equina (the last nerves extending from the spinal cord), which occupy the multiple lumbar and sacral roots, causes symptoms in both legs and can even interfere with sphincter function and negatively affect sexual performance.
Symptoms indicative of compression of the spinal cord include levels of hypoaesthesia (sudden change in sensation below a horizontal line across the spine), flaccid paraparesis (paresis) or tetraparesis (paresis of the four limbs), abnormal reflexes below the pressure site, initial lack of reflexes followed by excessive reflexes, and dysfunction of the sphincters.
Depending on which part (level) of the spinal cord has been affected, symptoms and complaints may vary.
When the C6 and C7 (cervical spine) are affected, pain occurs on the back of the trapezius and at the top of the shoulder. Often it radiates to the thumb. Parasthesia and hypoaesthesia appear in the same area. In the course of radiculopathy there is also paresis of the biceps muscle, weakened reflexes of the biceps and radial pain in the area of the scapula and armpit, often radiating to the middle finger of the hand.
At each level of the thoracic spine, dysestasia (abnormal sensitivity) occurs that encompasses the entire chest.
When the lumbar fragment is occupied at the L5 level, the following appears:
- buttock pain
- posterior-lateral surfaces of the thigh, calf and foot.
In radiculopathy, there is sometimes a drop of the foot with paresis of the anterior and posterior tibia and peroneal muscles. Loss of sensation in the shin and back of the foot is possible.
With S1 involvement, the pain runs along the posterior surface of the limb and buttock. There is paresis of the medial head of the gastrocnemius muscle with impaired bending of the sole of the foot. There is also a lack of ankle reflex and a loss of sensation in the lateral surfaces of the calf and foot.
Diagnosis of radiculopathy
Correct diagnosis of radiculopathy requires magnetic resonance imaging or computed tomography. If radiculopathy occurs in multiple areas, it may be performed myelography, that is, a radiological examination consisting in the introduction of a contrast medium absorbing X-rays through a lumbar puncture. The aim of the examination is to visualize the spinal cord along with the spinal roots and the meningeal sac.
If imaging tests do not give a definite answer to whether we are dealing with radiculopathy, then the presence of infectious agents that may cause the disease is examined. Fasting blood glucose is also measured to rule out or confirm the presence of diabetes.
Radiculopathy – treatment
Treatment of radiculopathy depends on the underlying cause of the disease. Acute pain is treated with individually selected painkillers. Sometimes these are non-steroidal anti-inflammatory drugs and sometimes opioids. Low doses of tricyclic anti-inflammatory drugs are recommended for the night. Medicines that reduce muscle tension and act locally are sometimes needed, but they rarely bring the expected benefit to the patient. Physiotherapy and psychotherapy are also recommended for the treatment of radiculopathy. In some patients, transcutaneous electrical nerve stimulation, massage or acupuncture work well.