What Is Cervical Radiculopathy?

Jul 27

Cervical radiculopathy is the active compression or irritation of a spinal nerve root as it exits the spinal canal. Cervical nerve roots exit through foramen, which are potential spaces formed between cervical vertebrae. Compression or irritation of nerve roots as they exit foramen causes cervical radiculopathy. This can be an extremely uncomfortable and painful condition to deal with. There are multiple causes of this compression, and in many cases, symptoms can be reduced without surgical correction.

What Are the Symptoms of Cervical Radiculopathy?

Cervical radiculopathy generally presents with pain and altered sensory perception following a specific path along the arm. Patients experience numbness or tingling in parts of the arm supplied by the irritated nerve. Abnormal sensations can be felt anywhere along the course of the nerve and are often felt all down to the wrist and hand. Motion of the cervical spine can elicit pain in the cervical region, with radiating pain into the shoulder, arm, and hand. There is usually a spot of tenderness that can be felt around the neck and this palpation may lead to an increase in symptoms in the arm and hand. Local loss of blood flow can also result from the compression within the spinal column.

What Causes Cervical Radiculopathy?

Cervical radiculopathy results from the active compression of spinal nerve roots close to their exit of the spinal column. The most common cause of this is a vertebral disc herniation.[1] The herniation of the disc causes pressure changes within the spinal foramen. These foramina contain nerves and blood vessels that can be compressed by the bulging disc, resulting in pain, sensory loss, and motor changes.

Other causes of radiculopathy are osteophytes or abnormal bone formation, spondylotic or fracture of the spinal bones, and aneurysms within the blood vessels. The intervertebral disc compression is found to be causative in only 22% of cases, while 68% of cases appear to arise from a combination of discogenic and spondylotic causes.[3]

There are a number of typical presentations of cervical radiculopathy. One study found that pain patterns experienced in the arm originate from the C4 vertebrae in 60% of the cases. Other vertebral levels that contribute to arm pain were found to be at C6 (35%) and C7 (34%). Over 50% of cases also have a complaint of scapular or shoulder pain [3].

Is Cervical Radiculopathy Common?

The reported annual incidence of cervical radiculopathy is 83.2 cases per 100,000 persons. Individuals are most commonly affected in the 5th and 6th decades of life. Physical exertion or trauma is rare in causing cervical radiculopathy, as it only happens in less than 15% of cases. Automobile accidents cause this condition in 3–23% of cases [1,2,3]. Males and females appear to be affected equally.

How is Cervical Radiculopathy Usually Treated?

The pain and symptoms of cervical radiculopathy can be reduced without the use of surgery in 90% of cases. Such management includes manipulation of the spinal joints, traction of the spine, physical and occupation therapy, immobilization techniques, steroid injections, and medications. In cases of severe degeneration of bones and extremely painful symptoms, surgical repair of the facets and foramen of the spine may be warranted. While more evidence is needed, the results of manipulation and traction therapies on cervical radiculopathy are very promising.

How is the NeuroRescue Program Different?

Cervical radiculopathy generally develops over time, and results from imbalances in neck muscle tone that leads to inappropriate loading and early degeneration of spinal structures. The function of these systems can generally be improved with targeted manual therapies (4).

It is important to understand that cervical radiculopathy is a symptom of degenerative joint disease, which itself is a result of a lack of spinal stability (5). Joint complexes are stabilized by ligaments and connective tissue, and these structures require proper tone in deep spinal stabilizing muscles. In cervical radiculopathy, the tone of these muscles has been shown to be inappropriate (6).

Restoring spinal stability is not as simple as exercising the stabilizing muscles. The deep stabilizing muscles of the neck are not under conscious control, but rather are driven reflexively by the vestibulospinal pathway in the spinal cord. This pathway exists to provide the rapid ability to stabilize the spine against gravity and during movement. It is the fastest conducting pathway in the nervous system, and is driven by inputs from the inner ear and vestibular system. It fires down to stabilize the spine and control balance, and fires up to control eye movement.

When the vestibular system is activated, it has a powerful influence on activity of deep and superficial cervical stabilizing muscles (7). The vestibular system contains receptors called otoliths, which among other things sense the head’s position in relation to gravity. The otolithic inputs contribute to the vestibulospinal pathway firing of spinal stabilizing muscles that resist the demands of gravity. When these inputs are impaired, the ability to maintain spinal stability is decreased (8). Proper rehabilitation of the cervical spine thus demands a thorough evaluation of the vestibular system and its contribution to spinal stability.

There are other neurological mechanisms that contribute to the tone of cervical musculature. It is well understood that the auditory system can influence spinal muscle tone (9), and that imbalances in hearing can thus contribute to spinal instability. The visual system also contributes to spinal stability by firing neck muscles in response to eye movements (10). These mechanisms allow the eyes to coordinate with head movements by integrating with the vestibular system. These mechanisms are commonly impaired in cervical whiplash injuries (11), which is one of the most common causes of cervical radiculopathy.

Proper evaluation and treatment of cervical radiculopathy requires not only addressing the spine and nerve roots, but also evaluating and treating any dysfunction in the vestibular system, in eye movements, and in balance.

Proper rehabilitation of the muscles and joints involved begins with a thorough analysis of all of these neurological systems. We evaluate every neurological system involved in your cervical radiculopathy using cutting edge diagnostic technologies. We use this information to create specific therapy protocols that work to restore and reintegrate the function of all the systems contributing to your dysfunction. This allows us to not only help get you out of pain, but generate lasting results that help you get back to living the life you deserve.

How Does the NeuroRescue Program Work?

We design your unique NeuroRescue Program to be among the most comprehensive diagnostic and therapeutic protocols available today. We create individual NeuroRescue Programs based on a comprehensive analysis of every relevant neurological system and pathway, using gold-standard, cutting edge neurodiagnostic technologies and examination procedures and state-of-the-art therapies.

We begin with your Discovery Day, wherein we perform a comprehensive history of not only your condition, but your life on a timeline. This allows us to dive deeply into your case and see all of the factors that led to where you are now. It helps us uncover hidden problems and associated conditions that may be making it difficult for you to move your recovery forward.

Our examination allows us to identify the areas and pathways of your brain that are involved in your allodynia. In all of our cases of chronic pain, we begin by making certain that there are no central nervous system factors contributing to your symptoms. We do this by precisely quantifying the function of your visual, vestibular, and proprioceptive systems through computerized analysis of your eye movements, your inner ear reflexes, and your balance in a host of different sensory conditions.

We employ technologies including Videooculography and Saccadometry to measure several classes of eye movements. We use Video Head Impulse Testing to measure the function of your inner ear, and Computerized Dynamic Posturography to assess your balance in different sensory conditions.

We use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and perception of vertical in a virtual reality environment.

We combine all of this with a comprehensive physical and neurological examination of your sensory, motor, autonomic, and cognitive systems. We review any relevant laboratory testing, radiological imaging, and prior neurodiagnostic testing, and integrate that information with our findings.

We use this information to identify which parts of your nervous system are working properly, which systems are struggling, and the precise point at which your systems fatigue.

We can then design a NeuroRescue Program that is unique and specific to your brain, and yours alone. Your NeuroRescue Program works to rejuvenate and reintegrate the damaged neurons and pathways in your central and peripheral nervous systems. It works to improve energy, endurance, and functional capacity within your involved fragile systems.

We use our technologies and procedures to not only see what we need to address, but also when it is time to stop and let you rest. We address your impaired neurological function from multiple angles of therapy, and provide metabolic support to improve neurological recovery. We employ a vast array of therapies and technologies that have been shown in research to help with central sensitization pain, ranging from electrical stimulation (12), to low level laser (13), to transcranial magnetic stimulation (14), eye-head motor control retraining therapy (15), to specific manual therapies (16). We tailor all of these along with neurological rehabilitation exercises to the specifics of your case, in order to create your unique protocol to resolve your allodynia.

While we cannot bring back neurons that have been lost, your NeuroRescue Program allows us to take the pathways that remain and maximize their efficiency and endurance. And by focusing on the integration of systems, we can do more than just get pathways working better, we can get them working together again. This gives us our best opportunity to return you to living a healthy, vibrant, and fulfilling life.