Cervical and Lumbar Radiculopathies
Radiculopathies: A lesion involving the dorsal and ventral nerve roots and/or the spinal nerve. The common syndromes associated with pathology of the nerve roots and spinal nerves are:
- Prolapsed intervertebral disc
- Herpes zoster
- Metastatic disease in the spine
Cervical radiculopathies
- The stability of the spine results from the integrity of four structures: vertebral bodies, intervertebral disks, ligaments between the vertebral bodies and paraspinous and other muscles.
- Center of healthy disc contains gelatinous, spongy nucleus pulposus, which is surrounded by fibrous tissue called the annulus fibrosus. This allows the disc to act as a shock absorber. Repetitive excessive stresses do exacerbate the normal ageing process and cause disc degeneration.
- After the second decade, deposition of collagen, elastin, and altered glycosaminoglycans in the nucleus pulposus causes it to lose water progressively Æ disc becomes thinner and more fragile
- The extrusion of the nucleus pulposus may produce local back pain from an inflammatory response and the extrusion fragment may compress or stretch nerve roots before they exit the neural foramina.
Cervical disc prolapse and cervical spondylosis are the two common cervical spine disorders.
Cervical spondylosis
Bony changes that may produce narrowing of spinal canal and intervertebral formina. The disc of the older patient is flattened, desiccated and degenerated. Additionally, the ligamentum flavum is thick and unelastic; with extension the neck buckles inward to compress the spinal cord from behind. Symptoms resemble acute herniation but are less intense. Head movement enhances pain.
Prolapsed intervertebral disc
- When the nucleus pulposus of an intervertebral disc protrudes through a tear in annulus fibrosus, the situation is known as a prolapsed intervertebral disc.
- The cervical disc prolapse is usually in the posterolateral direction, because the strong posterior longitudinal ligament prevents direct posterior herniation.
The typical clinical features of a prolapsed intervertebral disc, regardless of the level, are:
1. Skeletal
- Pain, tenderness and limitation in the range of movement in the affected area of the spine
- reduced straight leg raising on the side of the lesion, in the case of lumbar disc prolapses.
2. Neurological
- Pain, sensory symptoms and sensory loss in the dermatome of the affected nerve root
- Lower motor neuron signs (weakness and wasting)
- Loss of tendon reflexes of the appropriate segmental value
- Most disc prolapses are posterolateral, so neurological features are almost always unilateral.
Clinical symptoms
- Neck, shoulder, and arm pain, with or without distally radiating paresthesias