Disease Description (Causes and Symptoms)
- Definition: Radiculopathy is a condition in which a nerve root branching from the spinal cord is compressed by a herniated disc, spinal canal stenosis, or other causes, resulting in pain, sensory disturbances, muscle weakness, and other symptoms along the affected nerve segment.
- Causes and pathophysiology: The most common cause is a herniated intervertebral disc (disc herniation), but degenerative spinal diseases (spinal canal stenosis, facet joint abnormalities), trauma, tumors, and inflammation may also be causes. Nerve root compression causes impaired blood flow to the nerve, inflammation, dehydration, and functional impairment, resulting in radicular pain and sensory and motor abnormalities. It is common in people in their 30s–50s.
- Main symptoms: Radicular pain (pain that radiates along the nerve segment to the ends of the arms or legs), localized lower back pain or neck pain, sensory disturbances (tingling and decreased sensation), reduced muscle strength, and, in severe cases, decreased reflexes and bladder or bowel dysfunction (when the lumbar puncture or sacral nerves are compressed). The distribution of symptoms varies depending on the affected nerve root (e.g., C5–C8, L4–S1).
Treatment Methods
- Conservative treatment (recommended as first-line treatment)
- Activity modification: Limit vigorous exercise and lifting heavy objects; short-term rest is recommended (prolonged immobilization is not recommended)
- Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics (such as acetaminophen), muscle relaxants, and gabapentinoids (gabapentin/pregabalin) for neuropathic pain
- Physical therapy and rehabilitation: Stretching and extension exercises, core strengthening, and correction of posture and work posture
- Injection treatment: Epidural steroid injections, selective nerve root blocks, facet joint injections, etc. (for symptom relief)
- Other procedures: Procedural approaches according to symptoms, such as radiofrequency nerve root blocks
- Surgical treatment (considered in the following cases)
- When there is no improvement despite conservative treatment and severe pain persists
- Progressively worsening muscle weakness or neurological deficits
- Emergency surgery when cauda equina syndrome is suspected, such as bladder or bowel dysfunction (including urinary incontinence) or loss of saddle sensation
- Examples of surgery: Microscopic discectomy (disc removal surgery), decompression surgery (laminectomy or foraminotomy), etc.
- Precautions, risk of complications, and self-management
- Emergency signs (immediate contact or medical attention required): Sudden muscle weakness, loss of saddle sensation, bladder or bowel dysfunction, high fever, etc.
- Lifestyle: Quit smoking (to improve healing and prognosis), manage weight, maintain proper posture, and gradually perform strength and flexibility exercises
- Complications: Chronic radicular pain (neuropathic pain), permanent sensory or motor impairment, recurrence, and surgery-related complications (infection, bleeding, nerve damage), etc.
Checklist Before an Outpatient Visit (Including Items to Bring and Sample Questions)
- Items to bring (recommended)
- List of medications and supplements currently being taken (including dosage and frequency)
- Previous test results and imaging (MRI, CT, or X-ray CD or images, and test reports)
- A record of when symptoms started and their characteristics (location, intensity, and frequency of pain), or a pain map (showing where the pain radiates)
- A record of previous treatments (physical therapy, injections, or surgery) and their effects
- History of allergies and underlying conditions (diabetes, bleeding disorders, etc.)
- Things to check in advance at the outpatient visit
- Factors that worsen symptoms (exercise, posture, or time of day), whether there have been changes in urination or bowel movements, and recent weight changes or fever
- Sample questions (things to ask yourself at the visit)
- "Which nerve root is compressed according to the MRI I brought?"
- "What can I do immediately to reduce the current pain?"
- "Are there any signs that mean I should go to the emergency room?"
Examples of General Questions to Ask the Doctor
- "What are the side effects and precautions for this medication (or injection)?"
- "What is the usual prognosis for my symptoms (recovery time and likelihood of complete recovery)?"
- "Are there any activities or exercises that I should especially avoid in my current lifestyle?"
- "What are the criteria for needing surgery, and what can I expect during the recovery process after surgery?"
Examples of Condition-Specific Questions
- "Which nerve root at which segment (e.g., L5, S1, or C6) is compressed on the MRI/test? How severe is the compression?"
- "Based on my current symptoms and test findings, is surgery (e.g., discectomy or decompression surgery) recommended? If so, what are the expected benefits and risks?"