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What causes Cervical radiculopathy?
Question: Hi Doctor XXXXXXX My radicuopathy condition continues to improve. The pain in my neck and shoulder is greatly reduced from 5 weeks ago. It is a 0-1 in the neck and and a 0-3 in the shoulder depending on whether I am using good posture, maintaining good head position etc. I have long periods of no pain at all now. My questions relate to the "possible development of myelopathy"; which is a different issue and is overwhelmingly my primary concern. To review, I have compression of the cord at C-4-C-5 with an accompanying abnormal cord signal. Both of these findings were confirmed by an MRI on a 1.5 Tesla machine on 2/17/2014. The good news is that I have no current neurological symptoms of myelopathy. These are my questions: 1. My physical therapist says even though my radiculopathy is improving it does not mean that the pressure on my cord at C4-C-5 is improving. Do you agree with that? 2. What percentage of patients who have MRI's findings that indicate pressure on the cord with an abnormal cord signal NEVER develop myelopathy?
Brief Answer: Prognosis differs from indivially. Detailed Answer: Hi, Thanks for your query my friend. I want to explain you the whole scenario, so that you may know what is happening in your spine. First of I want to let you know the difference between cervical myelopathy and Cervical radiculopathy. Cervical myelopathy refers to a loss of function in the upper and lower extremities secondary to compression of the spinal cord within the neck. Cervical radiculopathy refers to a loss of function in a specific region within the upper extremity secondary to irritation and / or compression of a spinal nerve root in the neck. Initially the compression is intermittent and the cord continues to recover between cycles of compression. Later on, as the pressure becomes more intense and longer lasting, the insult caused by the repeated episodes of ischemia results in permanent tissue damage. This damage may not recover well or, at times, not at all, even after surgical relief of the compression. As we age, the spine may develop degenerative changes in the joints that can create tightening of the spinal canal. Over time this process may lead to pinching the spinal cord and compromise of coordination of the extremities. Cervical stenosis is a slowly progressive condition that pinches the spinal cord in the neck. Cervical myelopathy refers to this compression of the cervical spinal cord as a result of spinal stenosis. Cervical spinal stenosis with myelopathy is more common in elderly patients. So I want to say that for the proper diagnosis to be made you have to consult orthopedic surgeon who will ask you a series of questions and a physical examination that is directed primarily at your neck, and nerve function in your arms and legs. He will check your balance, test your gait. He may advise you Somatosensory Evoked Potentials (SSEP), an electrical study. In future you must be concerned about myelopathy only, if you have following complaints- -Heavy feeling in the legs - -Inability to walk at a brisk pace -Deterioration in fine motor skills (such as handwriting or buttoning a shirt) -Intermittent shooting pains into the arms and legs (like an electrical shock), especially when bending their head forward (known as Lermitte’s phenomenon) -Arm pain (cervical radiculopathy). You must know that often with cervical stenosis symptoms, it is the arm pain that prompts someone with this condition to seek medical treatment. At this point, the cervical stenosis with myelopathy is then discovered through medical history and physical exam. Research shows that, in patients who have had symptoms for a slightly longer period of time, the prognosis is less clear. Some patients will go onto complete resolution of pain with (and, in some cases, without) limited treatment such as modification of activities, heat, ice, physical therapy or over-the-counter medications. Approximately one third of these patients will have some lingering degree of symptoms that they may be able to cope with. A small percentage will have symptoms that are unbearable and may need further treatment. From my experience and clinical researches it has been proved that the “natural history” of clinically obvious cervical myelopathy is somewhat more guarded. The consensus is that patients with myelopathy will have progression of symptoms. What is not known is when the symptoms will progress, how much they will progress or how rapidly they will progress. Approximately 75% of patients will have stepwise deterioration in their function with stable periods in between the episodes of deterioration. Twenty percent will have slow steady deterioration and another 5% will have rapid deterioration. It is good that you have not symptoms develop till now, although you have compression of the cord at C-4-C-5 with an accompanying abnormal cord signal. Both of these findings were confirmed by an MRI on a 1.5 Tesla machine on 2/17/2014. Your physical therapist has rightly explains that even though your radiculopathy is improving it does not mean that the pressure on my cord at C4-C-5 is improving. So you must be careful in future ans must have regular follow up with your doctor and try to avoid activities which demand heavy work as explained previously. At-last I would like to say that every patient is individual patient i.e so it is not possible to say in advance what percentage of patients who have MRI's findings that indicate pressure on the cord with an abnormal cord signal NEVER develop myelopathy. I hope it helps. Thanks. Dr.Singh.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
You have done an excellent job explaining these issues, my questions are these: a. if the arm/neck pain of a radiculopathy is, in fact, "a symptom of myelopathy" and if that arm/neck pain is improving greatly compared to five weeks ago, could this mean there is less pressure on the spinal cord now than there was previously. Another way of saying it is this: If my Radiculpathy pain is improving, does this indicate that I may have less risk of developing myelopathy than we might have feared? b. What conclusions can you draw from the fact that I have spinal cord compression and an abnormal signal; yet no neurological symptoms, what are all the possibilities? I have had intermittent pain in my neck for 25 years whenever I turned my head too far to the right and I believe the pain in my detoid has been there intermittently; yet not as noticeable for the same period of time . I always thought it was a sore muscle. You are helping me, I apologize for all the questions. One bit of additional information: I had a very hard collision playing basketball 25 years ago and I could hardly raise my right arm for a week, or so. It was hard to shake hands as well. For the next 5, or 10 years when ever I tried to sleep on my right should I had the same kind of ache I feel in the deltoid at times now. I believe the neck pain when I turned too far to the right began intermittently then too. just so you have more perspective, the collision playing basketball was 25 years ago and when I asked both of the surgeons I saw here in Indianapolis, if that collision could have caused the spinal cord compression that long ago; they both said possibly. I thought they would rule that possibility out as a silly theory and to my surprise they both said it may be the case that I have had pressure on the cord that has been stable for a while and possibly a long while. Do you agree that this is possible? Is it possible to have pressure on the cord and a abnormal cord signal and to "not" develop neurological symptoms; which would indicate relative stability for 25 years?
Brief Answer: Every patient is individual patient. Detailed Answer: Hi, Thanks for the query again my friend. If the your arm/neck pain is improving greatly compared to five weeks ago, this mean there is less pressure on the spinal cord now than there was previously. Another way of saying it is this: If your radiculpathy pain is improving, does this indicate that you may have less risk of developing myelopathy than we might have feared. But you have to be careful for whole of your life and must have regular follow up with your doctor every 6 months. Yes, it possible to have pressure on the cord and a abnormal cord signal and to "not" develop neurological symptoms; which would indicate relative stability for 25 years. My friend, we always tally reports of MRI scan and other investigations and physical findings to make proper diagnosis and it is a fact that every patient is individual patient, some patients have less compression on MRI scan but they have more problem and vice verse. To explain this there are many theories which are beyond the scope of our discussion. I want to explain you that Dynamic mechanical factors relate to the fact that the normal motion of the cervical spine may aggravate spinal cord damage precipitated by direct mechanical static compression. During flexion, the spinal cord lengthens, thus stretching over ventral osteophytic ridges. During extension, the ligamentum flavum may buckle into the spinal cord causing a reduction of available space for the spinal cord. So you should avoid movements which include excessive and repetitive flexion and extension of spine for prolong time,but you can do daily routine work. But one thing I want to clarify is that if you follow doctors advise your spine cord will have less edema and what ever the available space is there in your spine cord, is sufficient for your cord and it will not cause further symptoms. I hope you have got your answer. Thanks. Dr.Singh.
Above answer was peer-reviewed by : Dr. Prasad
The User accepted the expert's answer
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