Makindo Medical Notes

Radicular Syndromes (Radiculopathy)

Radicular syndromes, also known as radiculopathies, are conditions caused by the compression, irritation, or inflammation of a nerve root in the spinal column. This leads to pain, numbness, weakness, or motor dysfunction along the distribution of the affected nerve. The symptoms usually follow the path of specific nerve roots and dermatomes.

Definition

Radicular syndrome refers to a collection of symptoms that arise from the compression or irritation of a spinal nerve root, leading to radiating pain, weakness, or sensory changes along the course of the affected nerve. It typically manifests in the upper or lower limbs, depending on the level of the spine affected.

Common Causes

• Disc Herniation: Compression of a nerve root by a herniated disc in the cervical, thoracic, or lumbar spine is a frequent cause of radicular pain.
• Degenerative Disc Disease: Age-related degeneration can cause narrowing of the intervertebral foramen, resulting in nerve root compression.
• Spinal Stenosis: Narrowing of the spinal canal or foramen can compress nerve roots.
• Osteophytes (Bone Spurs): Bony overgrowths due to osteoarthritis can impinge on nerve roots.
• Trauma: Injury to the spine can lead to nerve root compression or damage.
• Infections and Tumors: Rarely, infections (e.g., spinal abscess) or tumours (e.g., metastatic cancer) may compress nerve roots.

Types of Radiculopathy

The type of radicular syndrome depends on which part of the spine is affected:

• Cervical Radiculopathy:
  • Involves the cervical (neck) spine and commonly causes radiating pain, numbness, or weakness in the shoulders, arms, and hands.
  • Commonly affected nerve roots: C5, C6, C7, and C8.
• Thoracic Radiculopathy:
  • Less common, but involves compression in the mid-back (thoracic spine).
  • Pain may radiate around the chest or abdomen, often mimicking heart or abdominal conditions.
• Lumbar Radiculopathy (Sciatica):
  • Involves the lumbar (lower back) spine and causes radiating pain, numbness, or weakness in the lower back, buttocks, legs, and feet.
  • The most common form of radiculopathy, often affecting the L4, L5, and S1 nerve roots.

Symptoms of Radicular Syndrome

• Pain: The hallmark symptom is radiating pain that follows the distribution of the affected nerve root. It can be sharp, burning, or shooting in nature.
• Numbness and Tingling: Patients may report numbness, tingling, or a "pins and needles" sensation in the affected area.
• Weakness: Muscle weakness in the area controlled by the compressed nerve root. This may affect grip strength (in cervical radiculopathy) or leg strength (in lumbar radiculopathy).
• Loss of Reflexes: Reflexes corresponding to the affected nerve root may be diminished or absent. For example, in lumbar radiculopathy, the knee or Achilles reflex may be reduced.
• Changes in Gait or Balance: Patients with lumbar radiculopathy may have difficulty walking or maintaining balance due to leg weakness.

Diagnosis of Radicular Syndromes

Diagnosis is based on a combination of clinical history, physical examination, and imaging studies.

• Clinical History: A thorough history is crucial, including the nature of the pain, distribution, and any factors that worsen or relieve symptoms.
• Physical Examination: Neurological examination, including assessment of muscle strength, reflexes, and sensation, can help localize the affected nerve root.
• Imaging Studies:
  • MRI: The gold standard for detecting nerve root compression, particularly due to disc herniation or spinal stenosis.
  • CT Scan: Useful for identifying bony abnormalities, such as osteophytes.
  • X-rays: Can detect spinal alignment issues or bone spurs but are less sensitive for soft tissue pathology.
• Nerve Conduction Studies/EMG: These tests assess the electrical activity of muscles and nerves to confirm the location and severity of the nerve involvement.

Treatment of Radicular Syndromes

• Conservative Treatment:
  • Physical Therapy: Exercises to strengthen the muscles around the spine and improve posture can help alleviate symptoms.
  • Medications:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain.
    • Muscle relaxants or corticosteroids for severe inflammation.
    • Neuropathic pain medications like gabapentin or pregabalin.
  • Epidural Steroid Injections: Steroids injected into the epidural space can reduce inflammation and pain in the affected nerve root.
• Surgical Treatment: Surgery may be necessary for severe cases where conservative treatment has failed or when there is significant neurological impairment.
  • Discectomy: Removal of part or all of the herniated disc compressing the nerve root.
  • Laminectomy: Removal of part of the vertebra (lamina) to relieve pressure on the spinal cord or nerves.
  • Foraminotomy: Widening of the intervertebral foramen to reduce nerve compression.

Prognosis

The prognosis for radicular syndrome varies depending on the underlying cause and the severity of nerve root compression. Many patients respond well to conservative treatment, and symptoms may resolve over time. However, in more severe cases involving significant nerve damage, long-term pain or weakness may persist, even with surgical intervention.

Prevention

• Posture Correction: Maintaining good posture can reduce the risk of nerve root compression, particularly in the cervical and lumbar spine.
• Regular Exercise: Strengthening core and back muscles helps support the spine and prevent injury.
• Avoiding Heavy Lifting: Proper lifting techniques and avoiding excessive strain on the back can prevent disc herniation.

Each Root

Nerve Root	Pain	Sensory Loss	Motor Weakness	Reflex Changes
C5	Neck to shoulder, lateral upper arm	Shoulder and lateral upper arm	Shoulder muscles (deltoid, supraspinatus)	Reduced biceps reflex
C6	Neck, lateral arm, forearm, and thumb	Lateral forearm, thumb, and index finger	Biceps and wrist extensors	Reduced biceps and brachioradialis reflex
C7	Neck, posterior arm, forearm, and middle finger	Middle finger and back of the hand	Triceps, wrist flexors, and finger extensors	Reduced triceps reflex
C8	Neck, medial arm and forearm, ring and little fingers	Ring and little fingers, medial forearm	Finger flexors, intrinsic hand muscles	No significant reflex changes

Lumbar Radiculopathy (Sciatica): Signs and Symptoms by Nerve Root

Nerve Root	Pain	Sensory Loss	Motor Weakness	Reflex Changes
L3	Lower back to anterior thigh	Anterior thigh	Hip flexion and knee extension (quadriceps)	Reduced patellar reflex
L4	Lower back to anterior thigh, medial shin	Medial thigh, knee, and shin	Knee extension (quadriceps), foot dorsiflexion	Reduced patellar reflex
L5	Lower back, lateral thigh, top of foot	Lateral calf, top of foot, and toes	Foot dorsiflexion, big toe extension (extensor hallucis longus)	No significant reflex changes
S1	Lower back, buttock, posterior thigh, calf, sole of foot	Lateral foot and sole	Foot plantarflexion (gastrocnemius, soleus)	Reduced Achilles reflex