Definition

Radicular syndrome is a collection of symptoms arising from disorders of the nerve roots in the spinal vertebrae area. Also known as radiculopathy, this condition commonly occurs when nerve roots are pinched due to changes in the surrounding bones and cartilage, often due to aging or injury. These changes lead to pressure on the nerve roots.

Nerve roots are parts of the nerves that exit the spinal cord and pass through openings in the vertebrae. When these roots are compressed, they can become inflamed, causing pain, numbness, or weakness. Prompt and appropriate treatment can relieve these symptoms.

Causes

Radicular syndrome occurs when nerves are compressed by surrounding tissue. This can sometimes be caused by spinal disc herniation, where a spinal disc shifts out of place. Herniation begins with weakening or tearing of the disc's outer edge, allowing the nucleus, or inner part of the disc, to protrude and press on nearby spinal nerves.

Bone spurs or sharp bone protrusions can also cause radicular syndrome. These spurs may develop due to injury or osteoarthritis (joint inflammation). They stiffen the spine and narrow the space for the nerves, causing compression.

Risk Factor

Many spinal changes occur with aging. Radiculopathy is typically experienced by individuals aged 30-50 years. Conditions such as osteoarthritis, rheumatoid arthritis (joint inflammation), and obesity can increase the risk of radiculopathy.

Other risk factors include poor posture, spinal abnormalities such as scoliosis (excessive curvature of the spine), and repetitive movements. Pregnant women are at higher risk for radiculopathy. This condition can also be hereditary, increasing your risk if your family has a history of radiculopathy.

Symptoms

Symptoms of radiculopathy can range from mild to severe. The location of symptoms depends on the affected nerve root. There are three types of radiculopathy:

1. Cervical radiculopathy involves compression of one of the nerve roots in the neck. This can cause weakness, burning sensations, tingling, and loss of feeling in the shoulders, arms, hands, or fingers.
2. Thoracic radiculopathy occurs when a nerve is pinched in the upper back region of the spine. This can cause pain around the chest area. It is rare and can be mistaken for shingles (herpes zoster).
3. Lumbar radiculopathy involves pressure on one of the nerve roots in the lower back. This can cause hip pain and sciatica, or stabbing pain around the legs. In severe cases, it can lead to incontinence (loss of bladder control), sexual dysfunction, or paralysis.

Symptoms vary depending on the type of radiculopathy that occurs. Other possible symptoms include:

• Sharp pain that worsens with certain movements
• Numbness
• Weakness
• Tingling
• Changes or loss of sensation
• Loss of reflexes

Diagnosis

To diagnose radicular syndrome, a doctor will conduct an interview about complaints and medical history and perform a physical examination. Further tests may include:

• X-ray imaging to check for bone alignment or spinal disc narrowing
• MRI scans to get images of soft tissues, the spinal cord, and nerve roots
• CT scans for a detailed view of bones, including bone spurs
• Electromyography to measure muscle electrical activity at rest and during contraction
• Nerve conduction studies to measure the ability of nerves to send electrical signals

Management

Doctors may recommend home care, medications, surgery, or a combination of treatments.

Home Care

You should limit activities that exacerbate your pain. Your doctor may recommend a soft splint, back brace, or neck brace to limit movement in the affected area. This makes it easier to rest your injured area.

Your doctor may recommend bed rest or mechanical traction treatment. Traction uses weights or special devices to create space between the vertebrae, relieving pressure on the spinal nerves.

Your doctor may also recommend physical therapy, such as cold therapy or other treatments. Your therapist will teach you how to strengthen, stretch, and protect the affected area. For some people, losing weight can help reduce pressure on the nerve.

Medications

Several medications can effectively treat radiculopathy, including:

• Pain relievers, some available over-the-counter and others by prescription
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, available over-the-counter
• Muscle relaxants, as recommended by a doctor
• Oral corticosteroids, requiring a prescription
• Opioids for severe pain also requiring a prescription
• Corticosteroid injections in the affected area, requiring a prescription

Surgery

Surgery can help relieve nerve pressure. One procedure is known as a discectomy. This surgery removes bone spurs or repairs a shifted disc in the spine.

As with any surgery, risks include infection, bleeding, and complications from anesthesia. Post-surgery, some may continue to experience pain or other symptoms, but most recover and return to normal activities.

Complications

Radiculopathy is not life-threatening but can lower quality of life by disrupting daily activities. Complications can include muscle weakness or loss of sensation, making walking difficult and causing imbalance with lumbar radiculopathy. Cervical radiculopathy can lead to issues with hand and finger movement and sensation.

Patients who do not improve within 6-12 weeks may experience chronic pain. Gradual radicular symptoms can lead to muscle nerve impairment, causing muscle atrophy (muscle wasting due to disuse).

Cervical radiculopathy complications include incomplete nerve function recovery, reduced neck range of motion, disc space narrowing, loss of normal cervical curvature, and bone spur formation.

Consulting a doctor for appropriate management can help address these complications.

Prevention

Prevent the risk of experiencing radiculopathy by:

• Maintaining good posture
• Avoiding slouching and keeping both feet on the floor when sitting
• Maintaining a healthy weight
• Using safe lifting techniques to prevent back injuries. Bend your knees to reach an object rather than bending to pick it up.
• Seeking help when moving heavy or large objects
• Taking frequent breaks during repetitive activities
• Wearing comfortable shoes. Look for shoes with good arch support and avoid wearing high heels for extended periods
• Regular exercise, particularly strength and flexibility training. Fitness can help protect your spine. Consult a doctor for appropriate exercises

When to See a Doctor?

Seek medical attention if you:

• Experience severe pain that doesn't improve with over-the-counter pain relievers
• Experience sudden weakness in your arms or legs
• Have difficulty controlling bladder or bowel functions

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