Cervical Radiculopathy Focus on Characteristics and Differential Diagnosis

Abstract

Cervical radiculopathy is characterized by neurological dysfunction caused by compression and inflammation of the spinal nerves or nerve roots of the cervical spine. It mainly presents with neck and arm pain, sensory loss, motor dysfunction, and reflex changes according to the dermatomal distribution. The most common causes of cervical radiculopathy are cervical disc herniation and cervical spondylosis. It is important to find the exact symptomatic segment and distinguish between conditions that may mimic certain cervical radicular compression syndromes through meticulous physical examinations and precise reading of radiographs. Non-surgical treatments are recommended as an initial management. Surgery is applicable to patients with intractable or persistent pain despite sufficient conservative management or with severe or progressive neurological deficits. Cervical radiculopathy is treated surgically by anterior and/or posterior approaches. The appropriate choice of surgical treatment should be individualized, considering the patient's main pathophysiology, specific clinical symptoms and radiographic findings thoroughly.

Keywords: Cervical radiculopathy; Characteristics; Differential diagnosis.

Fig. 1.

A 53-year-old male patient’s radiographs of cervical spine. He complained severe left-side scapular medial border pain and weakness of left finger extension. Intervertebral disc space narrowing and posterior ostephytes were observed in multiple levels (A, yellow arrows) and large bony spur and foraminal stenosis were well presented at C6–7 segment of oblique X-ray (B, black arrow). The C6–7 and C7–T1 foraminal stenoses seems to be more clear in oblique coronal images of magnetic resonance imaging (C) than in axial computed tomography scans or magnetic resonance images (D).

Fig. 2.

Differential diagnosis of peri-scapular pain in according to the dermatomal distribution of lower cervical spinal nerves. Pain on supra-scapular areas are associated with C5 or C6 radiculopathies, interscapular and infra-scapular pains are considered to be mainly from C7 and C8 radiculpathy, respectively.

Fig. 3.

A 43-year-old right hand dominant female with a previous history of C7–T1 anterior cervical discectomy and fusion presented with significant pain on posterior neck, left side of supra-scapular area, radial side arm and 1st & 2nd fingers. (A) Plain radiograph of cervical spine showed the prior C7–T1 fusion. Magnetic resonance imaging (B) and CT revealed disc protrusion and foraminal stenosis at the left-side of C5–6 (C, E) and C6–7 (D, F) segments. The patient underwent left C5–6 and C6–7 PCF. The postoperative plain radiograph (G) and CT (H, I) showed the left-side PCF state on C5–6 (J) and C6–7 (K). After surgery, her radicular symptom was completely resolved. CT, computed tomography; PCF, posterior cervical foraminotomy.