Cervical Radiculopathy

Background 

• Unilateral am pain in dermattomal, weakness in myottomes 
• Non works in 75-90% 
• Nerve root below 
  • C67 disc affects C7 (as that is the one that exits) 
    • Nerve root exits above that named vertebra 
• Lumbar roots are vertical  
  • Paracentral affects traversing, foraminal affects exiting root 
• Cervical roots are horizontal 
  • Paracentral and foraminal disc will affect same root 
  • Ventral course; ventral compression 

Etiology 

• Spondylosis  
  • Discosteophyte complex 
  • Disc height loss 
  • Facet and uncovertebral osteopjytes 
• Disc herniations 
  • Intraforaminal – radicular pain 
  • Posterolateral (most common) – posterior edge uncinate, lateral edge PLL 
  • Midline – myelopathic 
• Double crush 
  • Cervical root compression + distal nerve 
  • Decrease axoplasmic flow from root compression predisposes downstream nerves to peripheral entrapment syndromes 

Presentation 

• Occpital headache 
• Trap pain 
• Unilatearl pain and weakeness 
• Differentiatte with shoulder pathology 
  • Abduction RELIEVES symptoms (detension nerves) 
  • Spurling test 

EMG 

• Compression is distal to ventral horn (motor) 
  • Fibrillatitons and sharp waves in affected disstibution 
• Compression proximal to dorsal horn (sensory) 
  • Normal sensoryy 

Management 

• Non op 
  • Rest and rehab – improves in 75% 
  • Return to play with repeat MRI 
  • Selective Nerve Root Corticosteroids injections 
    • Long term 
• Operative 
  • Failed 3 months nonop 
  • ACDF gold standard