Cervical radiculopathy is caused by compression of a nerve root by a laterally bulging or herniated intervertebral disk, osteoarthritis, or degenerative spondylosis. Pain results from injury to the nerve roots and nerves innervating the dura, ligaments, facet joints, and bone. Common clinical features include pain, paresthesia, and root signs (sensory loss, lower motor neuron muscle weakness, impaired reflexes, and trophic changes). Frequently, there is numbness and tingling following a dermatomal distribution. Magnetic resonance imaging (MRI) is the test of choice to distinguish cervical radiculopathy from disk and bone disease. Electromyelography studies may also be helpful in ruling out other disease processes. Trauma, myelopathy, plexopathy, neurofibromatosis, metastatic tumor infiltration of nerve roots, neoplasm, shingles, and central cord syndrome should be considered in the differential.
Management and Disposition
Emergency treatment includes pain control and referral to an orthopedic surgeon or neurosurgeon. Although management may require opioid analgesics, appropriate doses of NSAIDs should also be initiated in patients without contraindications. Oral steroids and gabapentin can also be considered. Since prolonged nerve root compression can lead to permanent deficits, immediate referral is necessary for progressive neurologic signs. Patients with intractable pain, progressive weakness, and myelopathy should be admitted.
Cervical Radiculopathy. This is the classic position of relief for cervical radicular pain. This patient presented with severe neck pain with radiation to the extremity. The only way the patient was able to get relief was by holding his arm over his head in the position shown. This patient has a C5-C6 herniated nucleus pulposus. (Photo contributor: Kevin J. Knoop, MD, MS.)
Most radiculopathies resulting from cervical disk disease are seen in the 30- to 60-year age group and in the C5 to C7 region.
Patients with acute cervical radiculopathy may present with their upper extremity supported by their head to counteract the cervical root distraction caused by the weight of their dependent extremity.
CT myelography may be the next most appropriate study in patients with a contraindication to MRI.