Cervical radiculitis is a symptom complex that occurs when spinal roots are affected in the cervical spine. It is characterized by pain, paresthesia, hypesthesia, muscle weakness and atrophy in the neck, arms, upper shoulder girdle. Disease is established according to the symptoms and examination data. Additional examinations are aimed at finding causal pathology and include radiography, MRI, CT, EMG. Conservative treatment is carried out in a complex with the use of anti-inflammatory, neuroprotective, vascular drugs, physiotherapy, manual therapy, physical therapy, reflexology and massage.
ICD 10
M54.1 Radiculopathy
General information
Cervical radiculitis is the second most common form of sciatica. The first place belongs to lumbosacral sciatica. Statistics indicate that about 95% of cases of cervical radiculitis are caused by osteochondrosis of the spine. The highest incidence occurs in the age period from 50 to 55 years. 10-12% of people of this age go to the doctor with complaints of neck pain. On average, cervical radiculitis in the population leads to disability of 5% of people.
In clinical neurology, cervical radiculitis is also called cervical radiculopathy. Modern clinicians note a tendency to decrease the age peak of morbidity. The relevance of cervical radiculitis for neurology, orthopedics and vertebrology is due to its prevalence, the defeat of people of working age, the probable secondary nature of the lesion of the roots (for example, in the oncological process in the spine.
Causes
In the cervical region there are 7 vertebrae, on both sides of which the spinal roots, or spinal nerves, originate in the spinal cord. There are 8 pairs of cervical roots in total, because the first pair comes out above the 1st cervical vertebra, between it and the base of the skull. It is the defeat of one or more cervical spinal roots that causes cervical radiculitis.
The most frequent etiofactor provoking cervical radiculitis is osteochondrosis of the cervical spine. The formation of osteophytes, or, as they say, “salt deposition”, has an irritating effect on the spinal root at the point of contact with it. Chronic irritating effects lead to inflammation of the root — sciatica. Osteophytes that increase in size can eventually squeeze the root, causing its compression, which is aggravated by inflammatory edema. In addition, osteochondrosis is accompanied by a decrease in the height of the intervertebral discs and can be complicated by a hernia of the cervical spine, which, in turn, squeezes the root.
Other causes of cervical radiculitis are:
- spinal injuries in the cervical region;
- subluxations of the cervical vertebrae;
- circulatory disorders (for example, diabetes mellitus, vasculitis);
- extramedullary spinal cord tumors, craniospinal tumors;
- anomalies and curvature of the spine in this department: some vertebrobasilar anomalies, cervical scoliosis or lordosis;
- in old age, cervical radiculitis can occur against the background of cervical spondylosis;
- some cases of the disease are associated with the defeat of the roots with herpes zoster, although usually a herpetic infection provokes thoracic radiculitis.
Symptoms
In the initial stage of sciatica, clinical manifestations associated with root irritation prevail. Acute pain paroxysms are characteristic, which are provoked by turning or tilting the head. The localization of pain depends on which root is affected. The lower cervical roots are most often affected: In 5% of cases — C5, in 20% – C6, in 60% – C7, in 10% – C8. In pathology C2-C3 there is pain in the occipital region, radiating into the ear, mastoid process. Cervical radiculitis C4-C5 manifests pain in the neck, upper arm and upper arm, C6-C7 — pain on the outer surface of the shoulder and the back surface of the forearm, C8 — on the inside of the arm.
Pain syndrome provokes tension of the neck muscles, forces the patient to restrict head movements. It can be combined with paresthesias that capture the same areas as pain. Patients with cervical radiculitis have trouble falling asleep because they cannot find a comfortable position for the head. They often wake up because of pain in the neck and arms. Against this background, insomnia may develop. Over time, the pain becomes subacute and chronic, becomes almost constant with periods of exacerbation that occur with sudden movements in the cervical spine, sneezing, coughing.
Compression of the spine is clinically manifested by symptoms of loss of its function: numbness of the area of the neck, shoulder or arm corresponding to the spine, weakness of the muscles of the shoulder and arm, muscular atrophy. If cervical radiculitis has a secondary character, then its clinic is combined with signs of the underlying pathology (tumors, injuries, vascular disease). With an intervertebral hernia of the cervical spine against the background of sciatica, vertebral artery syndrome may occur — a violation of blood circulation in the basal parts of the brain with dizziness and vestibular ataxia.
Diagnostics
Patient complaints do not always indicate a lesion of the cervical spine. With sciatica of the upper cervical roots, patients can contact a neurologist or therapist about headaches, with inflammation of the lower cervical roots — about pain in the shoulder or arm. Examination of the patient allows you to determine that the problem is actually in the spine. This is indicated by soreness during palpation of paravertebral (located on the side of the spine) points. The examination also reveals tonic tension of the neck muscles, more pronounced on the affected side.
Cervical radiculitis is diagnosed by a neurologist, therapist, vertebrologist or orthopedist according to clinical data. However, it is important to establish its cause. For this purpose, an instrumental examination is carried out:
- Cervical x-ray. It allows you to detect curvatures, subluxations, a decrease in the height of intervertebral discs, the presence of osteophytes, destruction of vertebral tissues (with a tumor).
- CT or MRI of the spine. CT scans visualize bone structures in more detail. However, to assess the condition of the roots and other soft-tissue components, it is possible to identify their tumor lesion only with the use of MRI.
- Blood test. A hemogram usually shows inflammatory changes.
- Electromyography. EMG allows you to exclude the muscular nature of the disease and determine which root is compressed.
Cervical radiculitis must be differentiated from cervical myositis. Hypesthesia (decreased sensitivity) and muscle weakness detected during the assessment of the neurological status indicate compression of the cervical spine.
Treatment
Conservative therapy
In the initial stage, cervical radiculitis, as a rule, lends itself well to conservative therapy. It is carried out comprehensively and includes the following aspects:
- Pharmacotherapy: anti-inflammatory drugs (ibuprofen, diclofenac, nimesulide, etc.), vascular and neuroprotective medications for internal administration, external agents (dimexide, anti-inflammatory ointments),
- Physiotherapy: UVI, hydrocartisone electrophoresis. Reflexotherapy can be used to relieve pain. If a tumor is suspected, physiotherapy and massage are contraindicated.
- Manual therapy. It is effective in eliminating subluxations and stretching the spine to reduce compression of the cervical spine. However, in the cervical department, it should be carried out with extreme caution and only by an experienced chiropractor.
In the acute period, patients with cervical radiculitis are shown rest. To limit the movements of the cervical spine, it may be recommended to wear a Trench collar. During the period of convalescence, massage and physical therapy are connected to treatment. In the future, patients are recommended to take regular exercise therapy and periodic massage courses to strengthen the muscles of the spine. It is especially important to strengthen the muscular corset of the necks after wearing the collar of the Trench, because during the period of wearing the muscles atrophy to a certain extent.
Surgical treatment
Cervical radiculitis is treated surgically with persistent compression of the roots with a lack of effectiveness of conservative therapy. In such cases, the cause of sciatica is usually an intervertebral hernia or tumor, the removal of which greatly facilitates the patient’s condition. But it should be remembered that surgical intervention on the cervical spine is always traumatic and may have complications. For hernias, depending on their size, an open or endoscopic microdiscectomy, discectomy is performed. The tactics of removing a spinal tumor depends on its nature and growth.
Forecast
As a rule, cervical radiculitis caused by osteochondrosis responds well to treatment. But, since osteochondrosis persists, relapses of sciatica are possible in the future. Moreover, along with the cervical form, lumbar and thoracic radiculitis can occur. The prognosis is most unfavorable if cervical radiculitis is a consequence of a malignant tumor, especially when it grows into the spinal canal and metastasizes.
Prevention
The best both primary and secondary prevention of cervical radiculitis is proper nutrition and maintaining your body in good physical shape. A decrease in the diet of salts and fats delays and slows down the development of osteochondrosis. A mobile lifestyle, swimming, moderate physical activity with exercises for the muscles of the back and neck allows you to strengthen the latter so much that they hold the vertebral column, not allowing the vertebrae to shift and sag.
Prevention of cervical radiculitis is especially relevant for people with sedentary work (accountants, programmers, copywriters, jewelers, cashiers, etc.). To prevent prolonged immobile and often forced position of the head and neck, they are recommended to take breaks with simple exercises to relieve the lower back, back and neck.