Radiculopathy

Referred pain into the upper or lower extremities often accompanies back or neck pain. Referred pain can be the initial symptom of a compressed nerve root by a ruptured disc or neural foraminal stenosis from osteophytes. Radicular pain is usually described as sharp or even shock-like, and may be associated with certain activities or positions. The distribution of the pain may not always be classic, and often doesn’t respect dermatomal distributions.

Cervical

Cervical radiculopathy can present acutely, as with a traumatic ruptured disc, or can be of a more chronic and intermittent nature, as is seen in foraminal narrowing from osteophytes. Typically, the inferior nerve root is affected (e.g. C5-6 disc abnormalities affect the C6 nerve root). C5-6 and C6-7 are the most commonly affected segments.

Lumbar

Sciatica is a classic syndrome of lower lumbar nerve root compression. Low back pain, that may or may not have been associated with some sort of trauma, is commonly antecedent to the onset of leg pain by days to a few weeks. Pain tends to be more proximal, and in a slightly different distribution than sensory changes. Motor weakness is also seen, but can be missed if dynamic testing is not done. All patients should be asked to stand on their toes and heels, as confrontational testing will miss subtle motor deficits in the lower extremities. As in the cervical spine, the pathologic level usually affects the caudal nerve root (e.g. L5-Sl disc produces an S1 radiculopathy). L5-S1 and L4-5 are overwhelmingly the most common levels affected. The upper lumbar spine is affected less frequently.