Radiculopathies are classified into different categories according to their location and cause:

1. Cervical radiculopathy: Affects the nerve roots of the cervical spine and leads to pain and weakness in the arms and shoulders.

2. Lumbar radiculopathy: Affects the nerve roots of the lumbar spine with symptoms in the lower back, legs, and buttocks.

3. Thoracic radiculopathy: A rare form that causes pain along the ribs.

4. Mechanical radiculopathy: Triggered by herniated discs, spinal stenosis, or bony changes.

5. Inflammatory radiculopathy: Caused by infections or autoimmune processes such as multiple sclerosis.

The main causes of radiculopathies are diverse and can include mechanical, inflammatory, or degenerative processes:

• Herniated discs:
  • One of the most common causes, where disc material presses on the nerve root.
• Spinal canal stenosis:
  • Narrowing of the spinal canal that exerts mechanical pressure on the nerves.
• Degenerative changes:
  • Age-related changes such as osteoarthritis or osteophyte formation.
• Traumatic injuries:
  • Direct trauma or vertebral fractures that can damage nerves.
• Inflammatory processes:
  • Infections (e.g., Lyme disease) or autoimmune diseases.
• Tumors:
  • Space-occupying processes that constrict nerve roots.

The symptoms vary depending on the affected region and the severity of the nerve root irritation, but typically include:

• Pain: Stabbing or burning pain radiating along the affected nerve roots.
• Sensory disturbances: Numbness, tingling, or a "pins and needles" sensation in the affected regions.
• Motor weakness: Muscle weakness in the corresponding extremities, often associated with coordination problems.
• Reflex changes: Reduced or absent reflexes in the affected area.
• Localization of symptoms:
  • In cervical radiculopathy in arms and shoulders.
  • In lumbar radiculopathy in legs, buttocks, and lower back.

The diagnosis is made through a combination of medical history, clinical examination, and imaging techniques:

- Medical history:

- Collection of symptoms, disease progression, and risk factors such as occupation or injuries.

- Physical examination:

- Assessment of muscle strength, reflexes, and sensory abnormalities.

- Special tests like the Lasegue test or the Spurling test to locate nerve irritation.

- Imaging:

- MRI: Detailed depiction of herniated discs and nerve root compressions.

- CT: Particularly helpful for bony changes.

- X-ray: To detect degeneration or instability.

- Electroneurography (ENG):

- Measurement of nerve conduction velocity to assess nerve functions.

Conservative Therapy

Most cases of radiculopathy can be treated without surgical intervention:

• Medication Therapy:
  • NSAIDs: To relieve pain and inflammation.
  • Muscle relaxants: To relax tense muscles.
  • Cortisone injections: X-ray-guided infiltrations for effective reduction of pain and inflammation.
• Physiotherapy:
  • Strengthening of muscles and improvement of mobility.
  • Specific exercises to relieve the affected nerve roots.
• Pain management:
  • Heat or cold applications as well as alternative methods such as acupuncture.
• Ergonomic adjustments:
  • Avoidance of stressful movements and optimization of the workplace.

Surgical Therapy

In therapy-resistant or severe cases:

• Microdiscectomy: Removal of disc tissue to relieve pressure on the nerve root.
• Laminectomy: Expansion of the spinal canal in cases of spinal canal stenosis.
• Spinal stabilization: In cases of unstable spinal conditions.

To prevent radiculopathies, the following measures are recommended:

1. Improve posture: Ergonomic sitting and lifting techniques.
2. Regular exercise: Strengthening the back muscles through sports or targeted training.
3. Avoid overweight: Reducing the load on the spine.
4. Early treatment: Of back pain to prevent chronic damage.