Radiculopathy — pressure on a spinal nerve root from a disc or bone spur — causes pain shooting down the arm or leg in a specific pattern. Dr. Anand Karnam explains cervical and lumbar radiculopathy and their treatment.
Key Points
- Radiculopathy is compression or irritation of a nerve root — most commonly from disc herniation or bone spurs.
- Cervical radiculopathy causes arm pain and tingling; lumbar radiculopathy causes leg pain (sciatica).
- Positive straight leg raise (SLR) test on examination strongly predicts L4-L5-S1 radiculopathy.
- MRI spine is the best investigation — shows the disc herniation and root compression clearly.
- 85% of lumbar disc herniations with radiculopathy recover with conservative management within 12 weeks.
85%
of lumbar radiculopathy cases recover without surgery within 12 weeks
Source: Cochrane
5%
of radiculopathy cases progress to require surgical intervention
Source: NHS
50%
of the working population will have radiculopathy at some point in their career
Source: WHO
"Sciatica — sharp, shooting pain from the back down the leg below the knee — is radiculopathy until proven otherwise. Most patients recover without surgery. But bladder or bowel involvement, or progressive leg weakness, changes that equation entirely."
Radiculopathy occurs when a spinal nerve root — emerging from the spinal cord between vertebrae — is compressed or irritated, usually by a herniated disc or osteophyte (bone spur from cervical or lumbar spondylosis). The result is a distinctive pattern of symptoms: pain, numbness, tingling, and weakness that follow the specific dermatomal and myotomal distribution of the compressed root — radiating down the arm (cervical radiculopathy) or leg (lumbar radiculopathy) in a predictable pattern that a trained clinician can map to the affected level.
Cervical Radiculopathy (Neck Disc)
C6 radiculopathy (C5-6 disc — the most common cervical level): Pain and tingling radiating from the neck into the shoulder, outer forearm, thumb, and index finger; weakness of biceps and wrist extension; diminished brachioradialis reflex. C7 radiculopathy (C6-7 disc — second most common): Pain into the posterior arm, middle finger; weakness of triceps; diminished triceps reflex. Typically worsened by extending and rotating the neck toward the affected side (Spurling's manoeuvre) — which narrows the neural foramen.
Lumbar Radiculopathy (Back Disc)
L4 radiculopathy: Pain down the front of the thigh and medial leg; weakness of knee extension (quadriceps); diminished knee jerk. L5 radiculopathy (L4-5 disc — the most common lumbar level): Pain down the lateral leg to the big toe and dorsum of foot; foot drop; no reflex change. S1 radiculopathy (L5-S1 disc — second most common): Pain down the back of the thigh and leg to the small toe; weakness of plantar flexion (calf); diminished ankle jerk.
Treatment
Most radiculopathies (80–85%) resolve with conservative management within 6–12 weeks: rest modification (not complete bed rest); NSAIDs; physiotherapy including nerve mobilisation and traction; short course of oral steroids for severe acute pain. Red flags requiring urgent imaging and possible surgery: progressive weakness, bladder/bowel dysfunction, bilateral symptoms. MRI spine is the investigation of choice. Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.
Dr. Anand Karnam
DrNB Neurology · Sri Anand CNC, Chanda Nagar Hyderabad · Sri Anand Child and Neuro Center
DrNB-qualified Neurologist, Fellow of the World Headache Society (FWHS), and Headache Specialist with 12+ years of experience treating epilepsy, stroke, migraine, and movement disorders. Practices at Sri Anand Child and Neuro Center, Chanda Nagar, Hyderabad.
References & Sources
- 1.Radiculopathy — NCBI StatPearls — NCBI StatPearls
- 2.Sciatica — NHS — NHS UK
- 3.Back Pain — NIH MedlinePlus — NIH MedlinePlus
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