Radiculopathy is caused by a compression of a nerve in the spine that in turn causes pain, numbness, tingling, sciatica, or weakness along the course of the nerve. Radiculopathy can occur in any part of the spine, but is most common in the lower back (lumbar radiculopathy) and the neck (cervical radiculopathy). It is less commonly found in the middle, or thoracic, portion of the spine (thoracic radiculopathy).
Radiculopathy is caused by compression or irritation of nerves as they exit the spine. Compression can arise from a disc herniation, a bone spur (osteophytes) from osteoarthritis, or from thickening of surrounding ligaments.
Other less-common causes of mechanical compression of the nerves are a tumor or infection. Either can reduce the volume of space in the spinal canal and compress the exiting nerve.
Scoliosis can cause nerves on one side of the spine to become compressed by the spine's abnormal curvature.
Other causes of radiculopathy include diabetes, which can decrease normal blood flow to spinal nerves. Inflammation due to trauma or degeneration can lead to radiculopathy through direct irritation of the nerves.
Most common symptoms include numbness, pain, and tingling in arms or legs. Patients also frequently report localized neck or back pain. Sciatica, which is pain that radiates down to a lower extremity, may be a symptom of lumbar radiculopathy. Thoracic radiculopathy begins as pain in the middle back that travels around to the chest, and is often mistaken for shingles.
Patients may be asked to obtain imaging studies as a means for identifying the source of the radiculopathy, beginning with X-rays which can identify trauma or osteoarthritis, as well as early signs of tumor or infection. An MRI scan may then follow so that the physician may view the soft tissues around the spine including the nerves, the disc, and the ligaments. If an MRI can't be obtained, a CT scan may be used instead to explore possible compression of the nerves.
In some cases the doctor may order a nerve conduction study or electromyogram (EMG) to look at the electrical activity along the nerve and diagnose possible nerve damage.
This may include anti-inflammatory medications, physical therapy, or chiropractic treatment, and avoiding activity that strains the neck or back. If patients do not improve with the treatments listed above they may benefit from an epidural steroid injection. With the help of an X-ray machine, a physician injects steroid medication between the bones of the spine adjacent to the involved nerves. This can help to rapidly reduce the inflammation and irritation of the nerve and help reduce the symptoms of radiculopathy.
A laminectomy or a discectomy may be performed, depending on the cause of the radiculopathy. In a laminectomy the surgeon removes a small portion of the bone covering the nerve, giving it additional space. In a discectomy the surgeon removes the herniated portion of the disc that is causing nerve compression.
Most patients respond favorably to conservative treatment that may include medications, physical therapy, or chiropractic treatment. Those requiring surgery typically also obtain favorable results, with no long-term restrictions.
Radiculopathy often resolves between 6 weeks and 3 months.
Here's what you can expect at home after your laminectomy:
- Some significant pain is likely to occur, requiring strong medicine such as narcotics or opiates. Don't drive while taking opiate pain medicines. Most people are able to cease taking opiates or narcotics and return to driving in between one and two weeks. Your surgeon will tell you when it's safe to resume driving.
- Limitation of activities that include bending, stooping, or lifting, for a period of several weeks following laminectomy.
- Keep the incision site clean and dry. Your doctor can provide instructions for showering and bathing.
- After about two weeks your doctor will remove stitches or staples.
- Avoid prolonged sitting, as usually happens on long plane flights or car rides. This can lead to blood clots in the legs. If you must travel during this time, stand and walk at least once per hour.
Recovery time depends on the extent of your surgery and other personal factors. Here are some general time periods to keep in mind:
- Following minor (decompressive) laminectomy, light activity (desk work and light housekeeping) can usually resume within a few days to a few weeks.
- If laminectomy is accompanied by spinal fusion, the recovery time is longer. Resumption of light activity may not take place until between two and four months.
- A return to full activities involving lifting and bending may not be possible for between two and three months.
- Begin light walking for exercise and for physical therapy exercises as soon as your doctor says it's OK to do so, as this will speed your recovery.
Following discectomy, here's what to expect:
- Healing and recovery will not happen overnight.
- Soreness will continue for 2 to 3 days.
- Pain will gradually reduce over the following 1 to 2 weeks, as healing begins.
- Deep healing will require 4 to 6 weeks.
- If before surgery you experienced numbness and/or tingling in your legs and/or your feet, these symptoms may still be present following surgery. These symptoms are usually the last to improve.
How can I manage my pain?
Pain in your back after the surgery is normal, as is leg pain. Pain is caused by the incision and swelling around the nerve. It will decrease as your back heals. You may also experience muscle spasms across your back and down your legs. This does not mean that the surgery was unsuccessful or that your recovery will be slow.
Remember these points:
- Everyone experiences pain differently.
- Most pain or spasms can be controlled or reduced.
- In general, the more active you are, the less pain you will have. Muscles that are not used will become stiff and sore.
- You may be given a prescription for pain medications before you leave the hospital. Take your pain medication as directed. Do not allow your pain to become too severe.
- You may also use ice on your low back to relieve pain during the first week after surgery. Use crushed ice in a plastic bag, a bag of frozen peas, or a frozen gel pack for 15 to 20 minutes at a time. From the second week on, you may use heat to relieve pain as the swelling in your back goes down. Moist heat such as a warm shower or gel pack is best. Leave heat on for 30 minutes at a time.