What is Radiculopathy?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

Radiculopathy is a common condition that refers to any kind of pinched nerve root within the spine, which can then lead to a variety of painful symptoms. 

Nerve roots split off from the spinal cord as it travels through your vertebrae. Roots, in turn, anchor nerves, which can travel anywhere from a couple millimeters to all the way down your arm or leg. For this reason, radiculopathy pain can–but does not have to–travel.

You might be familiar with sciatica, the famous disorder that causes shooting pain down the legs. What is the difference between sciatica and radiculopathy?

That’s a trick question: there is no difference. Sciatica is another and more common name for lumbar radiculopathy, which is a pinched nerve root in your lower back.

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More About Radiculopathy

lumbar foraminotomy

The spine itself has an S-curve to it that allows for better balance and shock absorption throughout the body. There are five different regions of the spine, which you should be aware of when attempting to learn more about radiculopathy. These five regions include the: 

  • Tail bone
  • Sacrum, which is around the hips 
  • lower back or lumbar area
  • mid back or thoracic area
  • neck or cervical spine

 

Radiculopathy can occur in any of the five regions of the spine. Each of the 33 bones within your spine receives cushion from an intervertebral disc, which keeps the vertebrae from hitting one another. When you suffer from some form of injury, the intervertebral discs can suffer from damage that causes a pinching of any nerve roots in the immediate vicinity. When these nerve roots become pinched, you will officially be suffering from radiculopathy. While injuries are the main reason that a person can suffer from radiculopathy, it’s important to understand that the nerve can become pinched for a wide range of reasons. You’re more likely to experience radiculopathy between the ages of 30-50. If you ever feel like you may be suffering from radiculopathy, you’ll want to contact a doctor as soon as possible. If left untreated, the symptoms of this condition can worsen over time. 

What are the symptoms?

The symptoms that you experience when suffering from radiculopathy largely depend on which area of the spine that the pinched nerve has occurred in. Even though the symptoms are similar in every area of the spine, there are some key differences that you should be aware of. Since the nerves within your spinal cord travel over to different areas of your body, the location of the pinched nerve along your spine plays a big role in what types of symptoms you experience as well as which areas of the body these symptoms affect. Cervical radiculopathy refers to any pinched nerve that’s located within the cervical spine, which is the upper neck. The symptoms associated with this form of radiculopathy include pain within your shoulder, neck, arms, and upper back. It’s also possible for you to experience weakness and numbness in these areas, which is commonly felt on just one side of the body. 

When it comes to radiculopathy in the mid-back or thoracic region of the spine, it’s possible for you to experience a substantial amount of pain within the torso or chest. This is a very uncommon form of radiculopathy that can also include such symptoms as tingling, numbness, and a burning pain, the latter of which can be felt in your abdomen, ribs, or sides. As for radiculopathy in the lower back, the symptoms of this condition include numbness and pain within your lower back, legs, hips, buttocks, and feet. Some of the additional types of symptoms that can occur with all forms of radiculopathy include: 

  • Sharp pains when you sit
  • Numbness in your back, legs, or feet
  • Reflex changes
  • Pain that worsens when you move your neck or head
  • Pain that worsen when you walk or sit for lengthy periods of time

How is Radiculopathy Diagnosed?

When you schedule an appointment with your doctor because you’re experiencing symptoms of radiculopathy, it’s likely that they will perform a variety of tests in order to make sure that the pain and other symptoms are being caused by this condition as opposed to some other type of disease. In some cases, the testing may be extensive. However, other situations may only require a quick test or two before the doctor is able to identify that you are indeed suffering from radiculopathy. The most common types of tests are physical examinations that will check your reflexes and muscle strength. If particular movements bring about pain or a reduction in movement, it may be possible for your doctor to link this pain to an affected nerve. 

Once the doctor believes that you may be experiencing a case of radiculopathy, they will provide you with various imaging tests in order to take a closer and more detailed look at the area. These tests can include MRI scans, CT scans, and X-rays, each of which uses a different types of imaging. While the problems brought about by radiculopathy are typically muscle issues, it’s possible for them to be neurological ones, which is something that can be determined through the administration of nerve conduction exams. Once all of the proper testing has been administered, the doctor will be ready to diagnose whether or not you’re suffering from a pinched nerve. 

What are the Causes of a Radiculopathy?

low back pain

Since radiculopathy can be brought about by common injuries or mere strenuous movements, it’s not always possible to pinpoint a cause of the pinched nerve. However, there are a range of known injuries and conditions that can cause radiculopathy in the spine, which include: 

  • Degenerative disc disease
  • Herniated discs
  • Spinal stenosis
  • Bone spurs
  • Tumors within the spine
  • Compression fractures in the spine
  • Osteoarthritis
  • Diabetes

There are also a variety of additional risk factors that may heighten your chances of developing a pinched nerve. These risk factors include a poor posture, aging, being obese or overweight, repetitive motions, and lifting weights improperly during your workout routine. While these factors will increase the odds that you suffer from radiculopathy at one time or another, it’s certainly possible that you will never have a pinched nerve. 

How is Radiculopathy Treated?

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used in Diagnosis and Treatment of Radiculopathy

The main types of equipment that are used in the diagnosis of radiculopathy include the MRI scan, CT scan, and x-ray machines. Each of these machines use a different form of imagery in order to provide doctors with an image of the inner portion of your body. X-ray machines use a small beam of radiation, while MRI scans use radio waves and magnets to provide a closer look at the structures in your body. CT scans use computer processing in order to combine a large number of x-ray images for a more accurate look at your body. 

Since the main cause of radiculopathy is a herniated disc, the pieces of equipment that are used to treat this condition are largely centered around the types of tools used during a herniated disc surgery. While the exact steps of the surgery depend on where the herniated disc occurs along your spine, you’ll most likely be provided with anesthesia before incisions are made with a very sharp knife. A high-tech microscope will likely be used throughout this surgery to make sure that the right portion of the disc is removed. Either a part of the disc or all of the disc will be removed. The incisions will then be closed with sutures. 

 

How Does Radiculopathy Compare to Other Spine Conditions?

While there are a large number of conditions that can cause pain in the back, the most similar condition to radiculopathy is myelopathy, which refers to severe compression of the spinal cord. Radiculopathy often occurs at the same time as myelopathy, as whatever is doing the compressing–a bulging or herniated disc, degenerative disc disease, etc.–can affect the spinal column as well as a nerve root. Myelopathy is most common in the cervical–or neck–region, so the main symptoms of this condition are pain and potentially loss of movement in the arms and hands.

Another condition associated with radiculopathy is sciatica. As mentioned above, sciatica actually is radiculopathy in the lumbar area of the spine.

Analogy: Tree Roots

Radiculopathy affects the roots of one or more nerves in the spine. As with a tree, problems at the root can spread until the entire body is affected.

Good Roots

Bad Roots

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