Sciatic/ Radicular Pain
WHAT IS IT?
This condition is when a nerve root in the cervical spine becomes inflamed or damaged. Our spine is made up of many bones called vertebrae which form together building a canal for the spinal cord to run through. From this cord, nerve roots split and travel between the spinal bones and various parts of the body including our shoulders, arms, and hands while also carrying sensory fibers to the skin providing sensation. An injury to the cervical spine can manipulate the nerves resulting in them to become pinched which ultimately leads to the pain felt in our shoulders, arms and hands.
Nerve root injury in the cervical spine most commonly involves one of the three lowest levels of cervical vertebrae which are called C5, C6 and C7.
There are various causes that can lead to Cervical Radiculopathy such as a herniated disc, degenerative disc disease and/or spinal stenosis.
A herniated disc is a rupture in the fibrous outer wall of a vertebral disc, which allows the soft nucleus of the disc to bulge outward. This bulge can press harmfully against a nerve root.
Degenerative Disc Disease
It occurs when a spinal disc weakens, allowing vertebral bones above and below the disc to shift out of position. The bones can touch, pinching nearby nerve roots.
When bones, discs or joints of the spine degenerate, boney spurs may form and push into the spinal canal or foramen space. This is called spinal stenosis, and it can also create harmful pressure against the spinal cord or nerve roots.
This condition may have different names depending on the location of injury:
- Lumbar: The most common case. Occurs in your lower back and often involves the sciatic nerve
- Cervical: Occurs when a nerve root in the neck becomes compressed causing you to feel pain and discomfort that radiates through your arms and hands
- Thoracic: Occurs when a nerve root in the upper back becomes compressed causing you to feel numbness and pain that wraps around to the front of your body.
Most individuals experience pain, pins and needles tingling, numbness, and/or weakness in the areas in which the nerve radiates to (ex. Shoulders, arms, hands). You may only feel these signs and symptoms in one area, such as the shoulder, while in some cases you may feel it progress throughout your entire arm and into your hands and fingers.
In most cases, signs and symptoms are primarily located on one side of the body (ex. Left shoulder) but can affect both sides.
If Cervical Radiculopathy is left untreated, it may lead to neurological defects that may be experienced in the neck, shoulder, arm, hand and/or fingers. Your ability to perform many routine tasks, such as gripping or lifting objects, writing, typing or getting dressed can be directly affected.
Most common signs of this progression include:
- Sensory – feelings of numbness or reduced sensation in the skin. You may also feel tingling or electrical sensations
- Motor – weakness or reduced coordination in one or more muscles.
- Reflex – changes in your body’s involuntary reflect responses. Some individuals may experience diminished ability to respond when the skin touches hot or cold surfaces or in some cases reduced tricep and bicep reflex.
DIAGNOSIS AND TREATMENT
Regardless of the severity of your symptoms, it is imperative to seek medical attention to prevent further damage. Your treatment will depend mainly on the underlying cause and severity of your symptoms. Once our physicians evaluate the state of your condition, possible treatments may be physical therapy, ice and/or heat therapy to alleviate inflammation , cervical epidural steroid injection or manual manipulation.
Cervical epidural steroid injection: when imaging confirms which cervical nerve root is inflamed or compressed, our physicians will perform the epidural. This is done by using contrast dye and fluoroscopy (x-ray) as guidance to carefully inject the cervical spine’s epidural space with steroid medication.
If these listed treatments show no sign of positive progress, your physician may recommend surgery. We are determined in finding you optimal relief and in some cases that may include performing multiple treatments.
Possible surgical treatments may include an anterior cervical discectomy and fusion to remove the disc. Fusion of that level of the cervical spine will restore normal height providing space for the cervical nerves. Another surgical technique would be artificial disc replacement. This surgery replaces the damaged disc with an artificial disc in order for the spine to maintain mobility instead of fusing vertebrae together.