Sorry to hear of your pain and troubles.
Cervical radiculopathy is a dysfunction of a nerve root of the cervical spine. The seventh
-C7; 60%- and sixth -C6; 25%- cervical nerve roots are the most commonly affected.
In the younger population, cervical radiculopathy is a result of a disk herniation or an acute injury causing foraminal impingement of an exiting nerve. In the older patient, cervical radiculopathy often is a result of foraminal narrowing from osteophyte formation. Factors associated with increased risk include heavy manual labor requiring lifting of more than 25 pounds, smoking, and driving or operating vibrating equipment. The purpose of this article is to provide information on the presentation, evaluation, differential diagnosis, and treatment of cervical radiculopathy.
Cervical radiculopathy occurs at an annual incidence rate of 85 per 100,000, with much less frequency than radiculopathy of the lumbar spine.
Seven cervical vertebra and eight cervical nerve roots exist. C1-2, or the atlantoaxial joint, forms the upper cervical segment. This joint allows for 50% of all cervical rotation motion. The occipital atlantal joint is responsible for 50% of flexion and extension. Below the C2-C3 level, lateral bending of the cervical spine is coupled with rotation in the same direction. This is due to the 45° inclination of the cervical facet joints.
The vertebral bodies of C3-C7 are similar in appearance and function. They articulate via zygapophyseal or facet joints posteriorly. On the lateral aspect of the vertebral bodies are sharply defined margins, which articulate with the facet above. These articulations are called uncovertebral joints, or joints of Luschka. These joints can develop osteophytic spurs, which can narrow the intervertebral foramina.
Intervertebral disks are located between the vertebral bodies of C2-C7. The disks are composed of an outer annular fibrosis and an inner nucleus pulposus and serve as force dissipators, transmitting compressive loads throughout a range of motion. The intervertebral disks are thicker anteriorly and therefore contribute to normal cervical lordosis. The foramina are largest at C2-3 and progressively decrease in size to the C6-7 level.
The nerve root occupies 25-33% of the foraminal space. The neuroforamen is bordered anteromedially by the uncovertebral joints, posterolaterally by facet joints, superiorly by the pedicle of the vertebra above, and inferiorly by the pedicle of the lower vertebra. Medially, the foramina are formed by the edge of the end plates and the intervertebral disks. The nerve roots exit above their correspondingly numbered vertebral body from C2-C7. C1 exits between the occiput and atlas and C8 exits below the C7 vertebral body. Degenerative changes of the structures that form the foramina can cause nerve root compression. This compression can occur from osteophyte formation, disk herniation, or a combination of the two.
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