Health Questions and Answers

Radiculopathies

What is the most common cause of radiculopathies on the medical ward?
Mechanical compression, as from spondylosis or a herniated disk. The common manifestations are neck or low back pain radiating into a limb.

How should the patient with a radiculopathy be evaluated?
The diagnostic evaluation generally begins with an MRI of the area where the root emerges from the spinal cord, since this is the most common site of disorders causing radiculopathies. If imaging studies are negative, showing no root compression, then nonmechanical causes such as inflammation or infection should be considered.

Discuss the treatment for radiculopathies.
For most mechanical radiculopathies, the recommended treatment consists simply of analgesics, such as aspirin or other NSAIDs. Avoid muscle relaxants and chronic opioid use. There are surprisingly few careful, controlled studies analyzing the value of bed rest, traction, spinal manipulation, or invasive procedures such as acupuncture or trigger point injection. At this time, these methods have no proven benefit in the treatment of radiculopathy.

What is the main indication for surgery in the treatment of a radiculopathy?
Many experts believe that the presence of focal neurologic findings-such as weakness, atrophy, or fasciculations in the muscles affected, an absent reflex, or dermatome sensory loss is a strong indication for surgery. Such hard findings are unlikely to improve spontaneously and may well progress unless pressure on the nerve is relieved.

Is surgery ever appropriate for patients without focal neurologic findings?
This issue is much more controversial. Even in well-chosen patients with clear lesions and no overlying complications (such as litigation or secondary gain), surgery to alleviate pain is effective in only about half the cases. It is therefore often reserved for patients who have “failed medical management,” which is a clinical decision and generally implies persistent, severe pain after an adequate trial of analgesics.

What are the most common causes of back pain?
Only about 20% of back pain is caused by a slipped disk or root compression. There are many other causes, such as arthritis of the facet joints, but most back pain is thought to be musculoskeletal, due to strain placed on the tendons, ligaments, and muscles of the back. Many experts feel that this pain is largely mechanical, secondary to the inherent instability of the lordotic spine required for the human upright posture and aggravated by the problems of obesity, lack of exercise, and other precipitating factors in the modern lifestyle. For most such pain, conservative therapy and patience are indicated.

References
WEB SITES
www.neuroguide.com
www.aan.com (American Academy of Neurology)
www.medmatrix.org
www.internets.com/mednets/sneurolo.htm
www.medwebplus.com/subject/Neurology.html

BIBLIOGRAPHY

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