What is Cervical Radiculopathy?
Cervical radiculopathy is a condition that results from the compression or inflammation of the nerve roots in the cervical spine, which is the neck area. This condition is often caused by herniated disc material or arthritic bone spurs, leading to nerve impingement [1]. The compression and inflammation of the spinal nerves or nerve roots in the cervical spine lead to neurological dysfunction [2].
The symptoms of cervical radiculopathy typically include neck and radiating arm pain or numbness, sensory deficits, or motor dysfunction in the neck and upper extremities [1]. The pain usually affects one side of the neck more than the other and can spread down into the shoulder and arm [3]. Other symptoms can include weakness and reflex changes according to the dermatomal distribution [2].
Cervical radiculopathy is a common condition, with a reported prevalence of 3.3 cases per 1000 people, and its peak annual incidence is 2.1 cases per 1000, occurring in the fourth and fifth decades of life [4].
Causes of Cervical Radiculopathy
In younger adults, cervical radiculopathy is often caused by an injury to one of the cushiony discs between the vertebrae. However, in older adults, around 50 years old and older, the most common cause is disc degeneration, a type of age-related wear and tear that affects the size and shape of the vertebral discs [5].
Other common causes include bulging discs, herniated or slipped discs, spinal injuries, bone spurs, and certain spinal conditions such as scoliosis. A bulging disc occurs when wear and tear causes one of the discs between the vertebrae to flatten and bulge, potentially putting pressure on a nearby nerve root. A herniated disc happens when the outer surface of the disc is damaged, causing the soft, jelly-like material inside the disc to leak out and potentially push against a nerve [5].
Certain factors can predispose or precipitate the occurrence of cervical radiculopathy. These include male sex, uncontrolled diabetes mellitus, and manual labour-related occupations or activities [6].
In rare cases, spinal column or brain tumours can also push on nerves and cause pain. These tumours are usually benign (noncancerous), but in rare cases, they can be cancerous [5].
How to sleep with Cervical Radiculopathy
Cervical radiculopathy can cause sleep disturbances in over half of patients, making it crucial to find ways to improve sleep quality. Here are some strategies that may help.
Firstly, consider your sleeping position. Your spine naturally arches in three places, and maintaining these natural curves can help minimize neck or back pain. If you sleep on your back, use a thin or cervical pillow to support your neck and head in a neutral position. Avoid overly high pillows, and keep your chin neutral if you're a side sleeper. Putting a pillow between your knees can help keep your lower spine in alignment.
Try a self-traction procedure. This involves lying prone with the anterior chest and abdomen flat on a bed, shoulders off the mattress edge, and arms to the side. The weight of the head provides traction, which can provide relief from chronic cervical neuropathic pain [7].
Maintain good sleep hygiene. Try to get at least 7–8 hours of sleep every night, establish a regular sleep schedule, and avoid alcohol, large meals, and excess fluids right before bedtime. Also, consider relaxing activities before bedtime, such as gentle stretching, meditation, or a warm bath [8].
Treatments for Cervical Radiculopathy
Cervical radiculopathy can cause significant discomfort, but several treatment options can help manage the symptoms and improve quality of life.
Conservative treatment: One of the primary treatments for cervical radiculopathy is conservative management, which includes medication and physical therapy. This approach is often successful, with 75%-90% of patients achieving symptomatic improvement without surgery [1].
Physical therapy is a critical component of conservative management. It can include a multimodal approach, incorporating McKenzie exercises, thoracic manipulation, rib mobilizations, manual cervical traction, peripheral nerve mobilization, and scapular retraction with postural exercises [9]. Conventional physiotherapy, including transcutaneous electrical nerve stimulation, hot pack application, and therapeutic ultrasound, has also been shown to reduce pain and improve motor function [10].
Medication is another crucial aspect of conservative treatment. Oral corticosteroids can reduce inflammation and swelling around the affected nerve, which can help alleviate pain [11]. Topical treatments, such as a 5% lidocaine medicated plaster, can also be beneficial in managing pain and reducing the time necessary to start physiotherapy [12].
CESI: In some cases, cervical epidural steroid injections (CESI) can be used. This treatment effectively reduces pain and the need for surgery, with success rates of 93% in the 1st month, 86% in the 3rd month, and 72% in the 6th month [13].
Surgical methods: If conservative treatments are ineffective, surgical options may be considered. These include posterior cervical foraminotomy, anterior cervical foraminotomy, anterior cervical diskectomy and fusion, and cervical disk arthroplasty [14].
In conclusion, there are a variety of treatments available for cervical radiculopathy, ranging from conservative management to surgical interventions. The choice of treatment will depend on the individual patient's symptoms, the severity of their condition, and their response to conservative treatments.