Ortho Dx: Which nerve root is being compressed in this patient? - Clinical Advisor

Ortho Dx: Which nerve root is being compressed in this patient?

Slideshow

  • Lateral radiograph of the cervical spine of a 66-year-old woman with neck pain and radiating right arm pain show severe degenerative changes including loss of cervical lordosis, disk narrowing, degenerative facet joints, and endplate sclerosis.

    OrthoDx_Image_1_Lateral_Cervical_Radiculopathy_CA0

    Lateral radiograph of the cervical spine of a 66-year-old woman with neck pain and radiating right arm pain show severe degenerative changes including loss of cervical lordosis, disk narrowing, degenerative facet joints, and endplate sclerosis.

  • Anteroposterior radiograph of the patient.

    OrthoDx_Image_2_AP_Cervical_Radiculopathy_CA081601

    Anteroposterior radiograph of the patient.

A 66-year-old woman presents with a 4-week history of neck pain and radiating right arm pain. Her right small finger seems to feel numb at times as well. Her pain has not improved despite oral nonsteroidal anti-inflammatory drugs and rest. On examination, positive Spurling test is found, with radiation of pain down the arm and paresthesia to the small finger on the right side. Intrinsic muscle weakness of the right hand is also noted. Anteroposterior and lateral radiographs of the cervical spine show severe degenerative changes including loss of cervical lordosis, disk narrowing, degenerative facet joints, and endplate sclerosis. Magnetic resonance imaging is ordered to determine which nerve root is being compressed.

This case has been brought to you in partnership with the Journal of Orthopedics for Physician Assistants.

This patient has multilevel cervical spondylosis and cervical radiculopathy. Cervical spondylosis is a chronic degenerative process of the intervertebral disks and facet joints. Degeneration of the cervical spine can lead to syndromes of axial neck pain, radiculopathy from nerve root...

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This patient has multilevel cervical spondylosis and cervical radiculopathy. Cervical spondylosis is a chronic degenerative process of the intervertebral disks and facet joints. Degeneration of the cervical spine can lead to syndromes of axial neck pain, radiculopathy from nerve root compression, and myelopathy from cord compression. Spondylosis typically begins at age 40 years to 50 years and is more common in men than in women. The most commonly affected levels are C5-C6 and C6-C7, as these levels have the greatest motion with neck flexion and extension.1

A person with cervical spondylosis may present with neck pain with or without neurologic symptoms. It is important to note that radiographic findings do not always correlate with patient complaints. For instance, degenerative changes are seen on radiographs in 70% of people by age 70 years, but not all people will be symptomatic.

 

Radiculopathy occurs when the nerve root is compressed by foraminal stenosis and/or a posterior lateral disk herniation. Cervical nerve roots 1 through 7 exit above the corresponding cervical vertebra, and the eighth cervical root exits below the C7 vertebrae. Therefore, a C5-C6 disk herniation affects the C6 nerve root, a C6-C7 disk herniation affects the C7 nerve root, and a C7-T1 herniation affects the C8 nerve root. This patient presented with weak intrinsic muscles and decreased sensation to the little finger of the hand, which most likely indicates a C8 radiculopathy.2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA). 

References

  1. Moore D. Cervical Spondylosis. Orthobullets website. http://www.orthobullets.com/spine/2029/cervical-spondylosis. Updated May 17, 2016. Accessed August 9, 2016.
  2. Hoppenfeld S. Physical Examination of the Spine and Extremities. Norwalk, CT: Appleton-Century-Crofts; 1976. 
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