What Is Cervical Radicular Pain?
The cervical spine is made up of seven vertebral bodies separated by compressible shock-absorbing discs. A central canal protects the spinal cord and nerve structures.
Degeneration in the cervical spine can lead to several different symptoms and conditions.
In general, pain coming from the neck is divided into the pain originator, that is ligaments or muscles, cervical disc or nerves, or from the bone or facet joints.
Cervical Radiculitis (inflammation of the large nerves in the neck), or cervical radiculopathy (severe compression of the large nerves in the neck leading to functional changes), can originate commonly from a herniated cervical disc or spinal stenosis.
(Pinched nerves due to spinal stenosis as discussed elsewhere)
Our usual range of motion of flexion and extension and lateral rotation as well as side to side bends all-cause gradual degeneration and take its toll on the disc. Just as car tires will gradually lose their tread and show signs of wear, cervical discs are no exception.
When the center of the disc, the nucleus proposes, pushes outwards on the outer ring of the disc, called the annulus, it can cause inflammation and irritation of the adjacent nerve root.
The annular fibers may remain intact or can degenerate and even rupture allowing the internal pulposis to push outwards in the middle or on the side. Because the back of the disc is the thinnest, the nucleus pulposis, center of the disc, often herniated are backward. This is called a central disc herniation.
In the cervical region pressure backward on the spinal cord can result in very severe symptoms and in some cases require immediate surgery.
More often however the herniation is to either the left or the right side towards the foramen, the opening where the nerve passes through, causing a chemical irritation and pressure on the nerve.
The symptoms the patient exhibits are often directly related to which nerve is pinched.
For example, a herniation at the C4/C5 level can cause pain referred to the shoulder to the top of the upper arm and the front of the arm up to the elbow. Cervical herniated discs occur more commonly in the fourth and fifth decades of life.
Trauma from car accidents, head strike against the dashboard or windshield, or conditions, habits such as chronic smoking, chronic obesity, and genetic factors may also cause weakening of the disc leading to herniation.
Cervical spinal stenosis can also cause cervical radiculitis.
Diagnoses involve a thorough history and physical as well as proper imaging including CAT scans, x-rays, MRI, electrodiagnostic studies, and
bloodwork in certain cases. Treatment options include analgesics for temporary pain relief, antiepileptic medications to help deaden sensitive nerves, low-dose antidepressants which are helpful in both sleep and chronic pain, as well as opioid use for worsening chronic pain.
Physical therapy including home exercises to help strengthen and improve the flexibility of the spine is important.
Epidural steroid injections, and trigger points injections into local muscles, may also be effective and augment the effects of oral medication and physical therapy.
If these fail one can be evaluated for their candidacy for surgery.
