Radiculopathy is the term for any mechanical problem or disease that affects the spinal nerve roots. These spinal nerves connect the spinal cord with the rest of the body. Often called a "pinched nerve," radiculopathy can be caused by a herniated disk, bone spur, an injury to the spine or osteoarthritis. It may involve any part of the spine, but it is most frequently found in the neck (cervical region) or lower back (lumbar region). Those considered at the highest risk are older individuals and younger people who play contact sports or perform manual labor.
Radiculopathy can result in pain near where the injured nerve is located. In addition, some sufferers feel a tingling, numbness and weakness in the area or a nearby extremity. So if the radiculopathy occurs in the neck, pain and discomfort may radiate down one or both arms and if it occurs in the lower back, it may radiate down one or both legs. When it affects the legs, it is also known as sciatica. Movements that pull on the affected part of the body, such as a quick reach, may sharpen the pain.
Your physician will take a complete medical history, which includes asking numerous questions about your symptoms. He or she will examine the affected area and check on your strength, reflexes and sensation of feeling. Additional tests may be required as well. These can include X-rays to view spinal alignment and disks and an MRI to more clearly visualize the spinal cord and nerve roots. CT scans may also be used to obtain detailed views of the spinal bones and electromyelography, which helps the physician to study the electrical activity along the nerve.
Conservative treatments are always the first options considered for radiculopathy. If the problem lies in the neck region, your physician may begin with a soft collar. This will limit the range of motion in your neck and rest the muscles. Physical therapy may be able to strengthen the muscles in the problem area, maximize flexibility with stretching exercises and take some pressure off of the injured nerve roots.
There are medications that can help as well. Anti-inflammatories and oral corticosteroids can reduce pain and swelling. Steroid injections in the spine are sometimes used to decrease swelling too, allowing for healing to take place. In severe cases when pain does not respond, stronger prescription pain medications may be incorporated into the care plan.
If these treatments cannot provide the patient with relief or symptoms are worsening, surgery will often be required. There are several types of procedures that can be used to correct radiculopathy, depending on the reason for your nerve problem and its location. Diskectomy with fusion is the most common and it can restore the alignment of the spine, reduce the compression on the nerves and support the affected area of spine. A laminoforaminotomy may be used to remove the segments of bone that are compressing the nerves. If the radiculopathy is caused by a degenerated disk, artificial disk replacement may be the best surgical option to remove the worn disk, relieve pressure on the nerves and restore height between the vertebrae.
Occipital neuralgia is a neurological disorder characterized by inflammation or injury to the occipital nerves. These nerves, one on either side of the head, span from the base of the neck to the scalp. This condition produces terrible headaches that are usually located on one side of the head. At times, the symptoms of these headaches may be similar to those caused by a migraine, so it is essential to undergo an examination that will determine their source.
Patients suffering from occipital neuralgia may experience:
- Tenderness in the scalp
- Pain when moving the neck
- Pain radiating from the base of the head to the scalp
- Sensitivity to light
For some patients, the pain may spread across the scalp and extend as far as reaching the forehead and eyes. This chronic condition often produces pain that has a severe shooting or throbbing quality. The scalp may become so uncomfortable and the symptoms so easily triggered, that even such simple activities as leaning against a headrest or brushing hair, cause extreme pain.
Occipital neuralgia may be caused by injury to or irritation of the occipital nerves. It may be the result of underlying trauma, such as a head injury or nerve inflammation or compression. Nerve compression can be caused by prolonged tightness of the neck muscles, osteoarthritis in the neck or a tumor growing near the nerve. In addition, conditions that may cause occipital neuralgia may include:
Posture issues may also cause occipital neuralgia if the patient's head is often held forward and down, as this position can place excessive pressure on the nerve over time. In some cases, however, the exact cause of cause is never determined.
Occipital neuralgia is diagnosed after a medical history is taken and a physical examination is conducted. Additional tests, including an MRI scan or a blood test may be performed. In addition, a nerve block, in which an anesthetic is injected into the occipital nerve, is often performed for diagnostic reasons. If this procedure provides the patient with significant symptom relief, it is considered a confirmation of the occipital neuralgia diagnosis, because it definitively indicates that the nerve is the source of the pain.
Treatment for occipital neuralgia may include may include conservative measures to relieve discomfort which may include:
- Over-the-counter pain medication
- Anti-inflammatory medications
In some cases, prescription medicines such as antidepressants or muscle relaxants can also be effective. If the pain does not respond to these treatments, occipital nerve blocks may be used to reduce inflammation and provide pain relief in the area. This minimally invasive treatment option uses corticosteroids that are injected directly into the affected nerve. The effectiveness of occipital nerve blocks varies from patient to patient, and pain relief may last anywhere from a few days to a few months.
In the most severe cases, surgery may be necessary to remove tissue or trim away parts of the bone or muscles that are compressing the nerve. Occipital nerve stimulation may also be an option for some patients. In this procedure, a neurostimulator is used to deliver electrical impulses to the occipital nerves, which help to stop the nerve from sending signals of pain to the brain.