Cervical Radiculopathy | Spine Specialist

Cervical Radiculopathy Overview

Cervical radiculopathy (also referred to as a pinched nerve in the neck) is a condition where the nerve root in the neck is compressed either by a herniated disc or by a bone spur. If a compressed nerve in the neck is caused by a herniation, please see the section on cervical herniated disc for a complete description. Many individuals sometimes refer to a compressed nerve as a “pinched nerve in the neck”. These are common reasons for ongoing neck pain.

The cause of this nerve compression lies with the design of the uncovertebral joint. As noted in the anatomy section, this joint is not present in the infant and slowly develops with maturity. The reason this joint develops lies with the design of the surfaces of the vertebral body.

Instead of having flat parallel surfaces that the disc attaches to (like the thoracic and lumbar vertebra), the sides of the body of the cervical vertebra are sloped upwards like a smile when viewed from the front. The disc is wedged in between the two vertebral bodies. Over time, the two surfaces of the vertebral bodies touch. Since they are lined with cartilage, they form an articulation-essentially a new joint!

The disc in many people becomes degenerative over time. Degenerative discs of the cervical spine are causes from aging, wear and tear, and injury. Discs become degenerative because a disc has no blood supply after the age of eight and can’t repair itself when injured. The central nucleus (the jelly in the donut) will eventually lose pressure. Just like letting air out of a car tire, the disc loses height. With this height loss, the two vertebral bodies approximate or come closer together. The uncovertebral joint sitting on each side of the disc space undergoes increased pressure and simply wear out.

The uncovertebral joint-like any other joint will develop bone spurs with this undue pressure. Since this joint makes up the front wall of the foramen or hole that the nerve exits, this bone spur can crowd out the nerve root that sits immediately behind the spur. If the nerve root becomes pinched it will swell which obviously compounds the problem. A swollen root won’t fit well into an already narrowed exit hole.

Biomechanics

The biomechanics of ICD radiculopathy/cervical radiculopathy (pinched nerve in the neck) are easy to understand. The nerve hole itself becomes larger with bending forward and away from the side that it is on. Bending the head backwards or to the side that the nerve hole or foramen is on will narrow this hole. Therefore, with this condition, arm and shoulder pain will normally become worse with bending the head backwards or bending the head to the side of the arm pain. Obviously avoid any head motions that increase the pain into the arm, as it is not a good idea to crush this nerve any further.

Cervical Radiculopathy Symptoms

Compression of one of the neck nerves normally causes shoulder and arm pain. There are many patients that have pain that also radiates to the area between the shoulders and this symptom is commonly misdiagnosed as thoracic or scapular (shoulder blade) pain when it is really referral pain from the compressed nerve

If the compression is more severe, not only pain and numbness can occur but also the muscles attached to the nerve can become weak. For example, if the C6 nerve is significantly compressed, the individual will have weakness of the biceps (the upper arm muscle that lifts a weight such as a suitcase) and the wrist extensor (weakness causes difficulty with holding objects).

Certain sports will make the pain worse because of neck positioning. Both swimming and cycling require neck extension and will typically aggravate this pain. Other sports have components of extension inherent, which will also cause momentary shoulder and arm pain. The follow through in the golf swing and the serve in tennis require momentary neck extension that can cause a “jolt” of pain during the maneuver. Volleyball and bowling are among many other sports that will also cause this pain.

(Click to Enlarge Image) This illustration is a side view of the cervical spine (neck). Here you can see the vertebral bodies with the discs in the front of the spine and the facets in the rear. The nerve roots exit through the sides of the spine.

(Click to Enlarge Image) This is a side view of a cervical spine (neck) with a degenerative disc at C5-6. The black arrow points to the narrowed disc and the white arrow points to the bone spur projecting off the back of the disc into the spinal canal.

(Click to Enlarge Image) This is a front to back view of a cervical spine (neck) X-ray. The black arrows point to the small pyramid shaped normal uncovertebral joints and the white arrows point to the degenerative uncovertebral joints. Compare the normal to the abnormal to see the enlargement of these joints with a “mushroom head” on one.

(Click to Enlarge Image) This is a side view picture of a patient who had significant compression of his C5 nerve for a period of time. You can see the “hollowing out” of the back of his shoulder where the deltoid muscle has undergone significant atrophy.

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Cervical Radiculopathy Treatment

Non-Surgical

Non-surgical treatment of cervical radiculopathy (pinched nerve in neck) includes medication, injections to reduce the swelling and irritability of the nerve root and a physical therapy program to strengthen the muscles that surround the neck.

Surgical

For bone spurs that compress the nerve, there are surgeries of the spine to help and there are two surgical treatments that are generally effective; an anterior cervical decompression and fusion (ACDF) or an artificial disc replacement (ADR). If the disc is too degenerative, an ADR would not work. Posterior cervical foramenotomy generally is not indicated in this disorder as the spur is not accessible by this approach. It’s important to understand all of the risks of spine surgery.

If you live in the Vail, Aspen, Denver and Grand Junction, Colorado communities and would like more information on cervical radiculopathy, please contact Dr. Donald Corenman, spine specialist and neck doctor.

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Donald Corenman, MD, DC

Average rating:

81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

Cervical Radiculopathy (Pinched Nerve in Neck)