Radiculopathy refers to damage or irritation of the nerve roots. This results in pain, sensory disturbances or paralysis.
What is radiculopathy?
Radiculopathy is also known as radiculitis, root syndrome or root neuritis. It refers to damage to the nerve root, which can take either an acute or chronic course. It is accompanied by pain, sensory disturbances and paralysis. If the impairment affects several nerve roots, it is a polyradiculopathy. Nerve roots are defined as nerve fibers that radiate into or emerge from the spinal cord. They then unite to form a spiral nerve. There are two nerve roots on the right and left side of each root segment. Sensitive data is transmitted from the posterior nerve roots to the spinal cord. In contrast, the anterior nerve roots have the function of sending motor impulses originating from the spinal cord toward peripheral muscles. If these nerve roots are affected, physicians speak of a radiculopathy. People in middle and older age are particularly affected by a root syndrome.
Causes
Numerous causes can be considered as triggers for radiculopathy. In most cases, pathological changes in the spine are responsible for the condition. Thus, most radiculopathies occur in the lumbar or sacral region. The most common causes are a protrusion of the intervertebral discs or a herniated disc, which in turn cause irritation or damage to the adjacent nerve roots. In the case of a herniated disc, there is a protrusion of the entire disc towards the nerve roots. Sometimes even a contusion may occur. Another cause of radiculopathy are osteopathies, which are inflammatory changes of the bones. In rare cases, damage to the nerve roots is caused by a bone tumor. However, the musculoskeletal system is not always involved in the development of radiculopathy. Thus, nerve root dysfunction can also be caused by impairments of the nervous system. Another conceivable trigger of a root syndrome is herpes zoster, a disease caused by viruses. The virus responsible initially manifests itself in the form of chickenpox. After the infection has been overcome, it remains within the glial cells in the body. From there, it can cause disease for the rest of a person’s life. Another infectious disease responsible for radiculopathy is Lyme disease. The disease is triggered by the tick-borne bacterium Borrelia burgdorferi.
Symptoms, complaints, and signs
A characteristic leading symptom of radiculopathy is formed by radicular pain. This means that the discomfort originates from the nerve roots on the spine. Depending on the course of the damaged nerve, the pain radiates into the segment. In the outer segment area, the pain is often felt more intensely than at its origin. Sometimes the radicular pain reaches such an intensity that the patient’s quality of life suffers considerably. In some people, this circumstance even triggers depression. Other symptoms include sensory disturbances in the affected nerve root region. Sensory disturbances or motor impairments are also possible. Occasionally, certain reflexes may also fail. If radiculopathy affects multiple nerve roots that supply the respiratory support muscles or diaphragm, there is a risk of life-threatening respiratory failure.
Diagnosis and course of the disease
Diagnosing radiculopathy is not always easy because the symptoms are nonspecific and may indicate other diseases. The attending physician therefore first looks at his patient’s medical history and asks him about possible previous illnesses and other complaints. As a rule, information can be obtained by means of imaging procedures. These include X-ray examinations to detect bone changes, myelography, in which a contrast medium is injected, and computer tomography (CT) or magnetic resonance imaging (MRI), in which images of the spinal cord region are taken. In most cases, radiculopathy takes a positive course.However, if medical treatment begins too late, there is often a risk of complications. The same applies to chronic pre-existing conditions that take a degenerative course. Possible consequences can include damage to the spine, the nervous system or the spinal cord. Sometimes there is even an inability to work.
Complications
The pain typical of radiculopathy can develop into a chronic condition as the disease progresses. As a result, the quality of life of the affected person suffers considerably and depression occasionally occurs. Furthermore, there are insensations in the affected nerve roots, which, if not treated or treated too late, can turn into complete paralysis of the affected area. Occasionally, certain reflexes may fail – accidents or falls are a possible consequence. If nerve roots of the respiratory support muscles or the diaphragm are affected, a life-threatening respiratory failure may occur. If treatment is started too late, the radiculopathy may have already caused severe damage to the nerve roots. Long-standing pre-existing conditions also cause complications. Then, among other things, there is permanent damage to the nervous system, the spine and the spinal cord. Chronic pain can also develop with corresponding pre-existing conditions. In treatment, complications depend on the chosen therapy method. Both drug therapy and radiation and chemotherapy can cause serious discomfort and cause long-term damage to the body. As a result of surgery, bleeding, wound healing problems, infections and other typical complications are possible.
When should you see a doctor?
Radiculopathy should always be treated by a physician. This disease cannot be treated by means of self-help, nor does self-healing occur. The sooner a doctor is consulted for radiculopathy, the higher the chances of a complete cure. As a rule, a doctor should be consulted when the affected person suffers from severe pain radiating from the damaged nerve. In this case, the pain can also take the form of pain at rest and have a negative effect on the patient’s sleep. Similarly, many patients suffer from severe limitations in movement and also disturbances in sensitivity, which have a negative impact on the quality of life. In some cases, radiculopathy can also lead to depression or other psychological upsets that should be treated by a psychologist. Radiculopathy itself is treated by a specialist. Whether a complete cure will occur cannot be universally predicted. However, the patient’s life expectancy remains unchanged.
Treatment and therapy
Treatment of radiculopathy depends on the responsible cause. If a herniated disc is present, conservative treatment is usually given in the form of pain therapy and physiotherapy exercises. In the acute phase of the disease, the pain is treated with non-steroidal anti-inflammatory drugs (NSAIDs). If the pain is intense, a combination of opioids and neuroleptics may also be used. If the patient suffers from osteoporosis (bone loss), infection, incontinence, or urinary retention, surgery is considered reasonable. Minimally invasive nucleoplasty is recommended as the first-line therapy. If a bone tumor is the originator of the radiculopathy, it may also be possible to remove it surgically. If the tumor is extensive, radiation therapy or chemotherapy must be given to shrink it prior to surgery. After surgery, treatment often continues with further radiation or administration of cytostatic drugs. If the radiculopathy originates from the herpes zoster virus, the patient receives antiviral agents such as valaciclovir, aciclovir or brivudine. In contrast, chronic Lyme borelliosis is considered difficult to treat. To prevent this from causing radiculopathy, early antibiotic therapy is recommended.
Prevention
In some cases, radiculopathy can be prevented. To counteract a herniated disc, care should be taken to maintain stable and strong back muscles. It is also important to get enough exercise and reduce excess weight.
Aftercare
Radiculopathy is a neurological disease in which certain nerve roots are injured or affected.The patient feels pain in the affected area, paralysis or numbness also occur. In some cases, the respective area can no longer be moved. In severe cases, the nerve damage spreads to the lung muscles, resulting in respiratory distress and danger to life. Follow-up care is necessary to avert such a progression. The aim is to avoid a life-threatening clinical picture. In addition, the pain should be relieved, motor function restored and the patient cured after therapy. Various underlying diseases are possible causes. The physician makes the diagnosis and initially treats the triggering disease. During follow-up care, he monitors the progress of healing, and the patient is given painkillers to counteract the symptoms. In the case of chronic radiculopathy, the follow-up is more long-term. During regular medical appointments, the condition of the patient is determined. If necessary, the specialist prescribes additional medication. In many patients, radiculopathy leads to inability to work. Concurrent psychotherapy is advisable if the affected person develops depression. Surgery may be required as a last treatment option. Follow-up care begins in the surgical ward after surgery and is continued by the primary care physician.
Here’s what you can do yourself
Radiculopathy is associated with pain and poor posture. To alleviate this discomfort, the back muscles should be consistently exercised. This can be accomplished under the guidance of a physical therapist or trained sports medicine professional. An independent workout is also possible and gives the back the necessary stability. Sufferers should be gentle on their backs in everyday life and not lift heavy loads. These measures prevent an intensification of the symptoms and thus also a recurrence of the radiculopathy. Natural painkillers can also be used symptomatically. Preparations with aloe vera or devil’s claw have proven to reduce pain and inhibit inflammatory processes in the body. In the case of severe radiculopathy, surgery must be performed, which can be supported by the patient through sparing and dietary measures. The doctor in charge will explain which steps are useful in detail. Finally, the trigger of the radiculopathy must be found and eliminated. After severe damage to the nerve roots, many sufferers change jobs or alter their hobbies in order to relieve the strain on their backs. Purchasing a back-friendly bed and/or office chair can support therapy.
