Radicular pain is pain related to an irritated spinal nerve. “Radiculopathy” refers to damage or disturbance of nerves into the arms or legs from irritation and/or compression of nerve roots in the spine. This is most commonly due to a herniated disc. The disc itself does not often cause pain; rather, an irritated or pinched nerve is the source of pain.
Other common causes of pinched nerves include spinal stenosis and bone spurs from spinal arthritis.
Nerve roots in the low back (lumbar) area can cause pain, loss of sensation and weakness in the lower extremities, including the buttock, hip, thigh, calf and foot.
Nerve roots in the neck (cervical) area can cause pain, loss of sensation and weakness in the upper extremities, including the shoulders, arms, and hand.
The causes of radicular pain are quite varied. Some cases occur suddenly due to a specific incident while others have no exact inciting event and the symptoms start more gradually.
The type and degree of pain can be quite varied. For example, some people may feel just a slight ache in the shoulder blade and forearm with tingling in the fingers, while others will have intense burning all the way down the arm that keeps them from sleeping.
Radicular pain and radiculopathy are typically diagnosed by careful history and physical examination.
X-ray may be helpful but is not always necessary.
MRI is generally not necessary unless the symptoms are not responding to usual treatments. MRI is considered the gold standard to evaluate for compressed nerves, and to determine if injections or surgery are indicated.
Occasionally, a CT scan or other imaging modalities may be helpful.
Nonsurgical (physical therapy, medication mgmt.) – nonsurgical treatment is the first step for radicular pain unless there are significant neurologic symptoms. Initial treatment is aimed at decreasing pain and neurologic symptoms.
As long as there is no evidence of severe or worsening nerve damage, most patients with radiculopathy do not require surgery.
Treatment typically involves physical therapy, activity modifications and tailored medication management.
If these usual measures are not adequate, epidural steroid injections may be a good treatment option to treat the radicular pain.
Surgery is an option for those who continue to have painful nerve symptoms or have persistent or progressing weakness or numbness.
Surgical (injection/minimally invasive/surgical) – spine surgery for radiculopathy is indicated if one has not responded to other treatments or if there is progression of neurologic symptoms such as weakness or numbness.
The exact type of surgery will depend on multiple factors, though most are done with minimally invasive techniques to provide patients with the quickest recovery and minimize post-surgical pain.