Cervical Radiculopathy - Why do you hurt and what is the plan to get you better?

0:04 hey everyone dr armagani here again today to talk to you about common conditions of the spine that can cause pain and discomfort are you experiencing or have experienced pain that starts in your neck and goes into your shoulder blade have you had numbness and tingling that goes into your arm or into your forearm and hand have you experienced these symptoms doing certain activities or being in certain positions if so you may be experiencing symptoms of a pinched nerve in your neck which we in the spine community like to call cervical radiculopathy which is the topic of our video today in this video we will go over normal mri anatomy so that you have an understanding of what your surgeon is looking for as well as the symptoms causes and reasons why you hurt at the end of this video we'll go over the usual plan of care including treatments

0:49 so you know what to expect if you're unfortunately having these kinds of symptoms and that's the overview for the video today let's go ahead and get started okay so let's get right into it we're going to be talking about cervical radiculopathy today before we get into the symptoms and causes of cervical radiculopathy we should have a little bit of an understanding of what normal mri anatomy is this is going to be what we're going to be looking at together when you come in for a consultation this is going to be a view from the side as if we cut you right down the middle of your body so there is no left and right if you're looking at the mri image here the front of your body is going to be here on the left side of the screen this is going to be where your mouth and

1:35 throat are over on the left side of the screen this is going to be the skin of your back just for your orientation in blue are going to be your muscles and your spinous processes of the back of your neck so when you're touching the back of your neck that bone that you feel that's going to be your spinous processes the vertebral bodies are the building blocks that make up your spinal column these are highlighted here in red you have seven vertebrae in your cervical spine numbered one through seven in between the vertebrae are going to be the discs the discs are a rubbery type substance which gives cushion between the vertebrae now if you're looking closely though here this is going to be

2:21 the base of your brain stem and coming down from your brain stem in gray is going to be the spinal cord this is going to be highlighted in green for us right now and if you notice on either side of the spinal cord you have white that white is spinal fluid spinal fluid gives nutrients to the spinal cord to make sure that it stays healthy now let's move on to the top view what this is is it's a cross section through your neck so instead of the previous view where we cut you right down the middle this view we're cutting you in half so if you pay close attention the top part of the picture here is going to be where the front of your body is and the bottom part of the picture here is going to be where the back of your neck is let's talk about the different anatomic

3:06 landmarks that we have in this view in blue is going to be your muscles as well as your spinous process remember again that when you touch the back of your neck that hard bone that you feel that's going to be the tip of that spinous process so this is all going to be in the back of your neck the disc is here outlined in orange if you remember the disc is going to be the rubbery cushion between the vertebrae this next landmark is one of the most important landmarks that we have when we're looking at mris and that's called the foramen what the foramen is it's the hole in the vertebrae whereby your nerve exits your spinal canal and then goes down to specific areas of your arm and what you're able to see is that there is a space between

3:52 the edge of the spinous process and lamina versus where the disc is and it's in this red area where the nerve exits the spinal canal which is here and then goes down your arm if you have a smaller foramen on one side or the other it can cause nerve pinching which can cause cervical radiculopathy and pain for people lastly the spinal cord is here in green if you look closely it has a kidney bean type shape and outside of it is spinal fluid which we see surrounding it on all sides if we're able to see spinal fluid surrounding the spinal cord at all sides and the foramen are widely open it is very unlikely that a patient could be having symptoms from that particular area well what are some of the common

4:38 complaints that i hear from patients who have some issues in their neck they could be describing just arm pain just neck pain usually though a patient has a combination of both arm pain and neck pain but let's talk about some of the diagnoses that can cause either or or both of these complaints degenerative disc disease is something that can cause purely neck pain because of the normal age appropriate degeneration of the discs which can then cause bone spurs and arthritis in the back of the neck scoliosis is a curvature of the spine which can cause muscular imbalances that can also cause exclusively neck pain kyphosis is a specific type of scoliosis where you have your chin falling down

5:26 onto your chest and you have difficulty lifting your head up that can commonly cause pain in the neck exclusively but then there's this black box frequently there are many patients who have neck pain and we don't have an anatomic reason why they hurt that does not mean that they don't have pain it just means that we're not able to see it on any advanced imaging like an mri and unfortunately there may not be any surgical treatment that can help them with their discomfort with regards to arm pain though shoulder issues can commonly cause patients who have pain that go into the arm that can frequently be confused with having a neck issue and lastly a peripheral neuropathy something like carpal tunnel syndrome can cause symptoms of numbness and

6:11 tingling into the hand that are commonly seen in patients who have neck issues as well but there are a couple diagnoses that can cause both neck and arm pain that we're going to be talking about cervical radiculopathy is one and cervical myelopathy is another today though we will be discussing cervical radiculopathy what are the common symptoms of cervical radiculopathy a lot of times patients can come in and they complain of what we call discomfort in specific areas of the neck shoulder blade shoulder or arm forearm or hand the reason why i say discomfort is patients can be feeling many different things with cervical radiculopathy sometimes patients can complain of a

6:57 terrible ice pick type sharp pain others complain of a burning electrical type pain others though also describe just numbness and tingling that occurs in certain positions that's why i like to describe this as discomfort as opposed to pain because frequently patients don't have pain they can also have sensation loss and weakness in more advanced cases infrequently about 10 to 15 percent of the time it can cause exclusively neck pain but typically that neck pain is off to one side or the other rarely is it ever going to be in the front of the neck though lastly it can also cause unusual type symptoms that we talk about sometimes patients come in to see me and they've been to the er multiple times because of chest pain and pain going down to the

7:44 arm to the point where they feel they're having a heart attack they've gone to the er they've gotten an ekg they've gotten blood work and they've shown everything is okay with their heart what we come to find out later is that they actually had a disc herniation causing severe nerve root compression and that nerve compression was causing symptoms which made them think like they were having a heart attack what is the cause of cervical radiculopathy though let's go back to our top view of our mri and again let's remember some of the aspects that we're going to be looking at here this is going to be the front of the neck this is going to be the back of the neck and this is the cross section as if we cut you in half spinal cord is in the middle here looking like a kidney bean and spinal fluid is surrounding it on all sides the space between this bone and this

8:31 disc in this clear area or gray area here is the foramen where the spinal cord is able to take a nerve and it exits the spinal canal going down your arms so a patient can have what's called a disc herniation and in red here is what a disc herniation would look like you can see this disc herniation has gone into the spinal cord here and has gotten rid of some of the spinal fluid that usually acts as a buffer between the disc and the spinal cord this compression can cause pain for patients in addition they can also have what we call bone spurs that form as a result of normal age appropriate degeneration but if these bone spurs go into the foramen which is again the hole by which a nerve exits the spinal canal and goes down your arm

9:17 that narrowing of that foramen can cause nerve pinching and problems as we're seeing here and over here now that we know causes of discomfort why are you hurting physiologically well in my mind there are two different reasons to make it simple why somebody can be having discomfort they can be having discomfort from physical compression of the nerve which is for example not a lot of space for the nerve inside of the foramen which can be more of a chronic type condition or the body's reaction to physical compression which is inflammation inflammation tends to happen quicker on onset so for example if you've had pain for only a few weeks it is much more likely

10:03 that you're going to be having pain related to inflammation as opposed to physical compression which has been there for maybe many many years but what i like to think about here is there's usually a lot of interplay between physical compression and inflammation and for each patient the distribution of that pain is different for example in some patients they may have much more inflammation than physical compression as a reason why they hurt in some other patients however it may be physical compression which is far outweighing the inflammation as the cause for their pain and that's really where the art of being a spine surgeon comes in is to help find out what is the distribution of their pain between physical compression and inflammation knowing the distribution of the pain

10:49 between physical compression and inflammation helps guide our treatment to get you better if we look back to the causes of why you hurt a disc herniation or bone spurs we find that a disc herniation is much more likely to be causing pain through inflammation as opposed to physical compression however bone spurs tend to be more of a physical compression type issue a long-term chronic issue as opposed to inflammation these are treated in different ways physical compression again is something that i've said has been there for a long time so one of the analogies i like to tell my patients all the time is the analogy of an ant mound imagine yourself at a park and you see an ant mound one or two ants may be coming out of the top it's not bothering anybody but let's say

11:35 you have kids or you see kids at the park and if they're anything like me when i was a kid what do the kids do when they see the ant mound well they stomp it and if they stomp it what happens to that quiet ant-man that was there not bothering everybody well the ants go ballistic the ants go crazy they go everywhere think of the ants as inflammation after something has stirred up your physical compression which has been long standing this is why people can have arthritis or bone spurs for a very long time and then quickly develop pain in a very short period of time but if you go back to that park after about a week or two and you see that ant mound again what happens

12:21 the ants are gone the ants rebuilt that mound and it's no longer bothering anybody anymore this is what i like to call as the analogy for your physical compression the ant mound has been there for a long long time something stirred it up and it's up to us to try to get those ants back in the mounds so you're not hurting anymore many patients ask me will i get better from this well the overwhelming opinion on this is absolutely yes the vast majority of patients with cervical radiculopathy do get better with non-operative care so what is that non-operative care that can get you better about 75 to 90 percent of patients will get symptomatic improvement in their cervical radiculopathy with conservative care what are some of the ways though that we

13:07 can get you better conservatively medication is one with these medications specifically anti-inflammatories and steroids can help decrease the inflammation in your body which can help with the inflammation type part of your pain picture as opposed to physical compression so if you have a high inflammatory component to your pain medications like anti-inflammatories and steroids can help a lot physical therapy and chiropractic care is another way that we can get you better what physical therapy and chiropractic care are able to do is they're able to stretch you and put you in different positions such that your nerve may not be getting as compressed and it also helps keep some of your muscle tone if you are developing weakness sometimes if physical therapy and medication don't work we try what are

13:54 called epidural steroid injections these are procedures where we have an injection specialist put numbing medication as well as steroid right next to your nerve where you're getting compression or inflammation and that can significantly help with pain sometimes patients get up to three of these in a given time period so most importantly patients will ask me how will i get better well let's take you through a general course of treatment for someone who may have a week or two of cervical radiculopathy type symptoms well what happens first is they come in and they see me with their symptoms and we generally try to start very conservative with them unless there are red flag signs because i'm a conservative surgeon we will start off with the medication as

14:39 well as physical therapy and steroids i'll bring them back in about four to six weeks now of these patients who undergo treatment with medication as well as physical therapy some improve which is perfect again 75 to 90 of these patients will get better with conservative care unfortunately a portion of these patients after four to six weeks will not get better with just the anti-inflammatory steroid and physical therapy if this is the case we then talk about getting an mri of the neck the reason why we want an mri at the neck is to try to know exactly where your physical compression could be coming from this helps dictate our treatment later on i generally have patients come back in one to two weeks following their mri

15:25 and some patients are miraculously better again so another portion of patients can just get better as time goes on unfortunately though there are going to be that subset of patients who are not going to be better even after six to eight weeks of treatment as well as an mri but the good thing about having the mri at that point is we know exactly where your physical compression is and then we can order an epidural steroid injection which is again a procedure where we pinpoint place medication to decrease inflammation in your body generally i ask patients to get one to three of these injections if they're having severe pain or discomfort because again many of these patients are going to improve based on our studies we know that 75 to 90 percent of patients are going to get

16:11 improvement during this time period but unfortunately there may be that subset of patients who do not get long lasting relief or no relief at all with these conservative measures and if that happens we then talk about surgery now what's what is surgery going to involve here surgery for this type of condition generally is two different procedures those procedures involve an anterior cervical discectomy infusion where we physically remove the disc out put a spacer in its place and fuse the bones together or in some patients with favorable anatomy we can perform what's called a cervical disc arthroplasty or a disc replacement procedure where we're able to maintain your range of motion if you would like to know about details about these two procedures

16:58 see the description below for those educational videos thank you okay so there you have it you've learned today about the anatomy symptoms causes and treatment plan for cervical radiculopathy remember the majority of patients with cervical radiculopathy do get better with non-operative care surgery is really only reserved for those who fail conservative care if you or someone you love may be experiencing symptoms of what you think is cervical radiculopathy and you would like to have a consultation with me you can find our office phone number below or you can click book an appointment above if you're on our website i can also be found on these various platforms here or on my website armaganispine.com

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