Radiculitis - Pathophysiology, Symptoms, Diagnosis, and Treatment

Introduction

Radiculitis is a term that is used to describe the symptoms that are caused by nerve problems in the spine. Radiculitis refers to radicular pain caused by inflammation of the nerve at the root connected to the spinal cord. Radicular pain is severe back pain. It has a common prevalence. Individuals with mild symptoms usually take around one or two weeks to recover. Severe cases take time and resolve within six to twelve weeks.

Radiculitis can affect any part of the spine but is commonly seen in the lower back and neck regions. The symptoms depend on which part of the nerve is affected. If the nerve is affected at the neck, symptoms can be seen in the arms, and if the nerve is affected in the lower back region, the legs may get affected. The pain caused by radiculitis is termed radicular pain.

What Is the Pathophysiology of Radicular Pain?

Inflammation of the spinal nerve at the nerve root is the main cause of this condition. The inflammation of the nerve root is caused by its pinching in the spinal column. Radiculopathy is the term used to describe the symptoms caused by pinching the nerve root in the spinal column.

Pinching of the nerve roots occurs at the foramen. The foramen is a space where the nerve roots exit the spine. This condition is termed foramen stenosis. Foramen stenosis occurs due to degenerative changes in the bony structures of the spine. The narrow foramen puts excessive pressure on the nerves, thereby damaging them. The irritated nerves then cause alterations in the sensations and muscle power, resulting in pain, numbness, muscle weakness, and tingling sensations in the limbs.

What Are the Different Types of Radiculitis?

Based on the area that is involved where the nerve is getting impinged, radiculitis can be of two types -

1. Cervical radiculitis or radiculopathy.

2. Lumbar radiculitis or radiculopathy.

Cervical Radiculitis or Radiculopathy -

The spine consists of seven cervical vertebrae, bony structures forming the entire spinal column. The human body has eight cervical nerve roots. When the spinal nerve root emerges from the spinal cord, it passes from a bony structure called the intervertebral disc. This intervertebral disc is a funnel-shaped disc where the portion from which the nerve passes (intervertebral foramen) is quite constricted, which leads to the compression of the nerve roots in the intervertebral foramen.

This type of radiculopathy is seen in individuals above the age of 40. The possible causes may include the following -

1. Disc Herniation - The vertebrae of the spine have cushion-like discs situated between each one of them. These discs undergo degradation over time as an individual ages. A herniated disc may result in pain, numbness, and limb weakness.

2. Spondylosis - It is the disc herniation of the spinal discs present in the neck region. It is termed cervical spondylosis.

3. Osteophytosis - They are bony lumps that are formed on the bones of the spine or around any joints. They are most often found in the neck region.

The symptoms of cervical radiculopathy are commonly seen in the hands and neck because the nerves that supply these parts are associated with this spine region.

Lumbar Radiculitis or Radiculopathy -

Radicular pain due to compression, inflammation, or an injury of a spinal nerve root in the lower back region is called lumbar radiculopathy. This type of radiculopathy mainly involves the sciatic nerve. Therefore this condition is often termed sciatica.

What Are the Symptoms of Radiculitis?

Symptoms depend upon where the nerve impinges along the spinal column. The intensity of the symptoms may vary. Sometimes there might be flare-ups and other symptom-free periods. The following are the symptoms of radiculopathy -

• Sharp, severe pain in the back, arms, legs, and shoulders that may worsen with physical activity. Actions as simple as sneezing or coughing may also increase the pain.

• Weakness of the muscles of the arms and legs.

• Paresthesia (abnormal sensations such as prickling pins and needles felt in the hands and feet is also common).

How Is Radiculitis Diagnosed?

The physician carries out a detailed physical examination. Certain physical tests are also done to evaluate the status of the patient.

1. The Spurling Sign - This is a medical maneuver performed to assess the nerve root pain (radicular pain). The physician turns the head of the patient towards the affected side and applies pressure from the top of the head in a downward force. The Spurling sign is said to be positive when the neck pain radiates downwards to the spine. It is also known as the cervical compression test.

2. Lasguez Sign or Lazarevic’s Sign - This test is performed to confirm whether a patient with lower back pain has an underlying herniated disc. This test is also known as the straight leg raise.

The patient suspected of radiculopathy has to undergo the following investigative tests -

• The physician advises an X-ray of the affected regions.

• MRI (magnetic resonance imaging) and CT scan (computed tomography) may also be advised for better visualization of the bony structures

• Hematological tests are also performed to confirm the presence of any infection.

• Nerve conduction studies such as electromyography are advised to assess the nerve function in the muscles. This is done to rule out any other disease.

What Is the Treatment for Radicular Pain?

The physician will prescribe a comprehensive treatment plan for managing radiculopathy -

• Patients are advised to maintain mobility by doing mild to moderate physical activity, as this will retain the mobility of the joints.

• A high-protein vegetarian diet is recommended to patients to avoid elevated cholesterol levels. Losing weight is also recommended to decrease the unnecessary load on the joints and bones.

• Calcium, Vitamin D3, and Vitamin B supplementation are advised, along with multivitamin supplements rich in minerals and antioxidants, to improve the overall well-being of the patient and improve nerve health.

• Medication to manage pain is also advised. Pregabalin is recommended first-line treatment for neuropathic pains, and in some cases Duloxetine can also be prescribed for radicular pain.

• In addition, Non-steroidal anti-inflammatory drugs, muscle relaxants, and opioid medications are given for pain relief.

• Physical therapy is advised to retain the mobility of the joints and improve muscle strength and tone.

• In severe cases, steroid injections are given to control the pain and inflammation in the affected regions. Patients may also require surgery to widen the foramen space if no other treatment is beneficial.

Conclusion

Radiculopathy is an extremely painful condition and is highly debilitating. It is seen commonly nowadays due to an unhealthy sedentary lifestyle combined with a non-nutritional diet. These factors make a person more vulnerable to developing such disorders. Multivitamins, a good diet, and exercise can be extremely beneficial for patients with radicular pain. In cases where supportive therapy is not beneficial, the physician will resort to surgery for a more permanent solution.