Describe the anatomy of common sites of nerve root compression (C6, C7, L5, S1)

Identify the common causes of radiculopathy

Describe the clinical features of common radiculopathies
Predict the outcome of common radiculopathies

Definition:
• radiculopathy is a pathologic process affecting the nerve root

Anatomy:
• The cervical spinal column is comprised of seven vertebral bodies.
• The vertebral bodies are separated by intervertebral discs, which provide support and
mobility.
• The dorsal and ventral spinal nerve roots emerge from the spinal cord and travel
through the intervertebral foramina.
• There are seven cervical vertebrae but eight cervical nerve roots. As there is no C8
vertebra, the C8 nerve root exits through the C7 to T1 intervertebral foramen

Dorsal Root Ganglia

 Pathogenesis

Compressive
• Spondylosis (degenerative change of spine)
- Osteoarthritis (uncovertebral join, facet joint)
- Disc space narrowing (degenerative changes)
- spondylolisthesis

• Disc prolapse/herniation

non-degenerative causes:
• Tumour infiltration
• nerve root infarction
• infection (herpes zoster)
• neurodegenerative causes

Cervical – nerve root comes out

above the vertebrae (C5 root
comes above C5 vetebrae)

Thoracic and lumbar – nerve root

comes out below the vertebrae
 Common radiculopathies:
Cervical Lumbar
C7>C6>C7 L5>S1

Cervical Radiculopathies

• Strongly associated with lumbar radiculopathies (40%)

• Often relapsing course
Pathogenesis • spondylosis (70%)>disc herniation (20%)
• rarely associated w trauma (~15%)
Clinical manifestations • see below
Diagnosis History + clinical findings

Imaging:
• Imaging diagnostic not required with little or no motor deficits
• Imaging done if:
 Progressive/severe motor deficits
 Suspected neoplasm, myelopathy, epidural abscess
 Bilateral signs and symptoms
• MRI imaging of choice
• CT myelography good for foraminal compression
Electromyography:
• may provide information regarding both ongoing axon loss and
compensatory reinnervation

Cervical radiculopathy symptoms:

• Neck pain, scapula pain
• upper arm pain
• difficulty with fine motor skills
• headache
• most common sign is depressed reflex
Root Pain Numbness Weakness Reflex affected
C5 Neck, scapula Lateral arm (axillary Shoulder abd. Biceps
(C4-5 shoulder nerve distribution) External rotation Brachioradialis
disc) Elbow flexion
Forearm sup.
C6 Neck, scapula, Lateral forearm Shoulder Abd. Biceps
(C5-6 shoulder Thumb External rotation brachioradialis
disc) lat. Arm Index finger Elbow flexion
lat. Forearm Forearm supination
lat. hand Forearm pronation
C7 Neck Index finger Elbow extension Triceps
(C6-7 Shoulder Middle finger Wrist extension
disc) Middle finger Palm (radial)
Hand Forearm pronation
Wrist flexion
C8 Neck Medial forearm Finger extension None
(C7- Shoulder Medial hand Wrist extension
T1 Medial forearm 4th/5th digit (ulnar)
disc) 4th/5th digit Distal finger
Medial hand flex./exten./abd./add.
Distal thumb flexion
T1 Neck Anterior arm Thumb abduction None
(T1-2 Medial Arm Medial forearm Distal thumb flexion
disc) Forearm Finger abd/add
 Lumbar radiculopathy
• Lower back pain
• Pain worsening on lumbar flexion (intervertebral foramen narrower)
• benign prognosis (90% better in 3 months)
• L5 most common lumbar radiculopathy
• Aetiology: commonly: disc herniation

Roo Pain Numbness Weakness Reflex affected

t
L5 Back Paraesthesia outer Dorsiflexion Semitendinosus/
aspect of leg + top of semimembranosus
Radiating to foot Hip abduction, knee (internal hamstrings)
buttock, lateral flexion, foot tendon
thigh, lateral calf, Lateral calf, dorsum dorsiflexion, toe
dorsum of foot, foot, web space extension and flexion,
great toe between first and foot inversion and
second toe eversion

S1 Back Paraesthesia back of Unable to stand on Achilles tendon

leg + along outside tip toes on affected
radiating into of foot foot
buttock, lateral or
posterior thigh, Posterior calf, lateral Hip extension, knee
posterior calf, or plantar aspect of flexion, plantar
lateral or plantar foot flexion of the foot
foot

For L5: