The cervical spine refers to that portion of the spinal column that is within our neck. This section of the spine has two essential roles: providing flexibility so that we can move our head up and down and side to side, and protecting the spinal cord nerves that pass through it. Cervical radiculopathy, or pinched nerve, tends to occur when the nerve roots are irritated or compressed by one of many conditions.
Cervical radiculopathy can occur in a wide variety of patients, with those younger than 50 tending to suffer as a result of disc herniations. Other than trauma or injury, degenerative conditions as a result of aging are the main cause of neck pain. As disks age, they lose height and the vertebrae move closer together, causing the body to respond by forming more bone—called spurs—around the disk to strengthen it. However, the spurs can also contribute to stiffening of the spine. Bone spurs may also narrow the area of the foramen and pinch the nerve root.
The primary symptoms of cervical radiculopathy include pain radiating from the neck into the shoulder, upper arm, forearm, or hand. Sometimes the symptoms radiate into all of these areas, whereas in other cases, the symptoms may radiate to only some of these areas. Other associated symptoms can include tingling and numbness. In some cases, weakness of various muscle groups in the shoulder, arm, and hand may occur.
Interventional treatments for cervical radiculopathy are generally attempted first and may include:
- Physical therapy and/or exercise to help relieve the pressure on the nerve root. Stretching as many dimensions of the neck as possible is essential to maintain flexibility and relieve chronic stiffness.
- Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain and analgesics to relieve pain.
- Use of a cervical collar, cervical pillows, or neck traction may also be recommended to stabilize the neck and improve alignment.
- Injections of steroid medications around the affected nerve root, commonly known as nerve root or epidural injections, can be considered for pain relief as well.
If symptoms persist despite nonoperative care, or if there is substantial motor weakness, surgical treatment is recommended and generally has excellent outcomes. In fact, cervical spine surgery generally has the best outcomes of any spinal operation. Surgical treatment generally involves relieving the pressure off of the affected nerve root. Depending on the circumstances, it may be performed either from the front (anterior) or back (posterior) of the neck, although the anterior approach is more common.
Some of the surgical spine procedures used to treat cervical radiculopathy at the Emory Orthopaedics and Spine Center are:
- Anterior Cervical Discectomy and Fusion (ACDF)
- Cervical Laminectomy and Fusion
- Cervical Laminoplasty
- Cervical Disc Replacement
- Cervical Posterior Foraminotomy
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About Dr. Rhee
John M. Rhee, MD, is a Spinal Surgeon and Associate Professor of Orthopaedic Surgery specializing in cervical spine surgery, lumbar spine surgery, complex spinal deformity surgery (scoliosis and kyphosis) and surgery for spinal tumors. Dr. Rhee is an active researcher and sought-after teacher/lecturer at the national and international level in multiple medical societies. He has served as faculty and been an invited lecturer at numerous meetings and courses on spine surgery. In addition, he has served as Program Chairman at numerous national and international spine surgery meetings. Dr. Rhee has also published extensively in a number of peer reviewed journals and books, and he has received numerous awards and honors. He is actively involved the training of international research scholars and other spinal surgeons and has been the author and editor of major textbooks on spine surgery techniques.