Cervical Radiculopathy – Cervical Nerve Compression

The cervical spine, located in the neck, plays a crucial role in supporting the head and linking it to the trunk. This region bears less weight compared to other parts of the spine, yet it offers the highest degree of mobility and flexibility, allowing the neck to bend, tilt, and rotate in various directions.

The cervical spine consists of seven vertebrae. Each vertebra has a back portion that arches to form the lamina, creating a protective roof over the spinal canal, which houses the spinal cord. Between these vertebrae are intervertebral discs, made of strong connective tissue, with a tough outer layer known as the annulus fibrosus and a gel-like center called the nucleus pulposus. These discs, along with small spinal facet joints, provide movement, stability, and act as shock absorbers for the cervical vertebrae.

The upper part of the cervical spinal canal is particularly spacious, offering ample room for the spinal cord, which helps prevent pressure during neck movements. The spinal cord segments in the neck are labeled C1 to C8, and these nerves supply function to the shoulders, arms, and hands.

Cervical radiculopathy arises when nerves exiting the spinal cord in the neck are pinched or compressed. Common causes include herniated discs, degenerative disc disease, bone spurs, and spinal stenosis. A herniated disc occurs when the outer layer of the disc ruptures, allowing its contents to protrude into the spinal canal, potentially pressing on spinal nerves. Degenerative disc disease leads to the deterioration of intervertebral discs, causing thickening of the vertebrae that can encroach upon the spinal canal. Bone spurs, resulting from osteoarthritis, can also grow into the spinal canal or nerve openings, contributing to spinal stenosis, which narrows the canal and exerts pressure on the spinal cord and nerves, causing pain and dysfunction.

Although the underlying issue is in the spine, symptoms of cervical radiculopathy may be felt in areas along the nerve pathways, such as the shoulders, arms, and hands. Individuals may experience pain, numbness, or weakness in these regions, along with neck pain and potential headaches at the back of the head. In severe cases, muscle atrophy and symptoms in the legs may also develop.

A doctor can diagnose cervical radiculopathy by reviewing the patient's medical history, conducting a physical examination, and analyzing results from imaging tests. It is essential for patients to communicate their symptoms, risk factors, and any functional challenges, such as difficulties with daily activities. The examination may include tests for muscle reflexes, tone, strength, coordination, and range of motion, as well as sensory evaluations.

Diagnostic imaging may involve X-rays to assess vertebral condition, and in some cases, a myelogram—where dye is injected into the spinal column to enhance X-ray images—may be performed to identify pressure on the spinal cord from herniated discs, bone spurs, or tumors. Advanced imaging techniques like CT scans and MRIs provide detailed views of spinal structures. While X-rays and myelograms visualize the cervical spine, CT scans slice through images for a comprehensive view, and MRIs offer the most sensitive detection of issues related to discs, ligaments, and nerve roots.

Cervical radiculopathy can often be managed with conservative treatments such as rest, anti-inflammatory medications, and physical therapy. A cervical collar may provide additional support. If symptoms persist after 6 to 12 weeks, surgical intervention may be necessary to relieve nerve pressure, stabilize the spine, alleviate symptoms, and restore function. Anterior cervical decompression and spine fusion (ACDF) is a common surgical option.

During ACDF surgery, the patient is sedated, and an incision is made at the front of the neck, carefully avoiding nearby structures. The surgeon removes the problematic disc and any bone abnormalities before placing a bone graft or interbody fusion cage to support healing and stabilize the spine. Surgical hardware like plates and screws may also be used to secure the vertebrae together.

Post-surgery, patients can expect to stay overnight in the hospital and may require assistance during the initial recovery period. Activity restrictions will be advised, and physical therapy will help with rehabilitation. While arm pain often resolves quickly, weakness and numbness in the arms may take longer to improve, typically requiring several weeks to months for full recovery.

Adhering to activity restrictions and engaging in a prescribed exercise program post-surgery is vital. Proper body mechanics during all activities are crucial. Additionally, avoiding smoking is important, as it can complicate surgical recovery and hinder bone fusion. Those struggling to quit smoking should discuss available resources and medications with their doctor.

Am I at Risk?

Several factors can increase the risk of developing cervical radiculopathy, including:

- Age: Individuals who are middle-aged or older may experience age-related spinal changes that elevate the risk.

- Osteophytes: Bone spurs can heighten the likelihood of cervical radiculopathy.

- Wear and Tear: Previous spinal trauma or degeneration can contribute to increased risk.

- Pre-existing Conditions: Individuals with herniated cervical discs, spinal stenosis, or degenerative disc disease are more prone to this condition.