Related articles: Radiculopathy
Definition
Radiculopathy is a pathological condition that affects the spinal nerve roots and their extensions.
Most radicular diseases are attributable to a compression of the nerve roots inside the spine or in the adjacent area; this compression is caused more frequently by a hernia of an intervertebral disk.
Radiculopathy can also derive from bone alterations secondary to osteoporotic or arthrosic degeneration of the spine, or to rheumatoid arthritis, especially if located in the cervical or lumbar region.
Less frequently, multiple radicular dysfunctions are found in meningeal carcinomatosis (a serious complication that occurs in cancer patients, determined by the spread of cancer cells from the original tumor to the meninges).
Spinal masses (eg, epidural abscesses and tumors, spinal meningiomas and neurofibromas) can rarely occur with radicular symptoms, rather than with the usual bone marrow dysfunction.
Other causes include acute trauma (eg fractures of the vertebrae), diabetes (which among the various complications also causes painful radiculopathy in the thorax or extremities, resulting from nerve root ischemia) and some infectious diseases (histoplasmosis, Lyme disease and syphilis).
Herpes zoster infection usually causes painful radiculopathy with reduced sensitivity to dermatomical distribution (ie in the area innervated by the affected spinal root), associated with the characteristic rash; furthermore, it can cause a radicular motor disease with muscle weakness and loss of reflexes.
Most common symptoms and signs *
- Asthenia
- Muscular atrophy and paralysis
- Muscular atrophy
- Erectile dysfunction
- Bladder dysfunction
- Neck pain
- Foot pain
- Hand and wrist pain
- Shoulder pain
- Arm pain
- Back pain
- Articolar pains
- Muscular collation
- Tingling in the legs
- Sore legs
- Fecal incontinence
- Hyperalgesia
- hyperreflexia
- Hypoaesthesia
- weakness
- Backache
- Headache
- Paraplegia
- Paresthesia
- Stiffness in the muscles of the back and neck
- Spastic tetraparesis
Further indications
The clinical presentation of radiculopathy depends on the damage of sensory and / or motor fibers, which results in a characteristic painful syndrome.
Depending on the medullary level corresponding to the affected root, segmental neurological deficits may also appear, such as pain or paresthesia with dermatomal distribution, loss of sensitivity and weakness of the muscles (hyposthenia) and reduction of osteotendinous reflexes in the same areas.
Pain can be exacerbated by movements that transmit pressure to the nerve root through the subarachnoid space (eg sudden head flexions, coughing or sneezing). Lesions that affect multiple sacral and lumbar roots produce radicular symptoms in both legs and can induce sphincter alterations and sexual dysfunction.
The diagnosis can make use of neuroimaging studies (MRI or CT of the affected area), electrophysiological tests and general examinations to detect any underlying diseases. The findings indicating a spinal cord compression include: abrupt changes in sensitivity below the affected region, reflex changes, flaccid paraparesis or tetraparesis and sphincter dysfunction.
If the neuroimaging does not detect the presence of an anatomical anomaly, the rachicentesi is performed in search of an infectious or inflammatory cause and the fasting blood glucose is measured to ascertain the possible presence of diabetes.
The therapy depends on the specific cause, but may include the use of symptomatic drugs, such as acetaminophen (paracetamol), NSAIDs and other analgesics. Tricyclic antidepressants and antiepileptics can be effective, as can physical therapy.
If all other approaches are ineffective, alternative medical treatments can be tried (eg transdermal nerve stimulation, vertebral manipulation and acupuncture).
