Convenient Location

8054 Yonge St. Thornhill. Just south of the intersection of Yonge and HWY 7/407

About Referrals

You need to be referred by your physician. Click here for information.

Covered by OHIP?

Most services are covered by the Ontario Health Insurance Plan (OHIP)

Convenient Location

8054 Yonge St. Thornhill. Just south of the intersection of Yonge and HWY 7/407

Patient Referral Form

You need to be referred by your physician. Click to download your form here.

Waiting Time

Your timeframe depends on the type of procedure.

OHIP Covered Services

Most services are covered by the Ontario Health Insurance Plan (OHIP)

WILDERMAN MEDICAL CLINIC

About Radiculopathy

The nerve roots are an essential part of the nervous system, responsible for transmitting information between the brain and the rest of the body.

They are located in the spinal cord, which runs through the vertebral column and is protected by the vertebral bones.

The spinal cord is divided into different segments, with each segment responsible for a specific part of the body. At each segment, nerve roots emerge from the spinal cord and exit the vertebral column through small openings.

These nerve roots then branch out into multiple smaller nerves, which supply different regions of the body.

The nerve roots are made up of both sensory and motor fibers.

Sensory fibers transmit information from the peripheral nerves back to the spinal cord and brain, while motor fibers carry signals from the brain and spinal cord to the muscles.

Disease of nerve roots: Radiculopathy

When the nerve roots (branching out from the spine) become damaged or compressed, it can lead to a condition called radiculopathy, commonly referred to as a pinched nerve. This can occur due to a variety of factors, such as a herniated disc, spinal stenosis, or degenerative disc disease.

Radiculopathy can cause a range of symptoms, depending on which nerve roots are affected, including pain, numbness, tingling, and weakness.

Types of radiculopathy

There are several types of radiculopathy, which are classified based on the location of the affected nerve roots in the spinal cord. The different types of radiculopathy include:

1.Cervical radiculopathy

This is a type of radiculopathy that affects the nerve roots in the cervical spine, which supply the arms, shoulders, and neck.

The cervical spine is made up of seven vertebrae and eight pairs of cervical nerve roots. These nerve roots emerge from the spinal cord at each level of the cervical spine and exit the vertebral column through small openings called foramina. The C1-C7 nerve roots exit above their corresponding vertebra, while the C8 nerve root exits below the C7 vertebra.

It can cause pain, numbness, and weakness that radiates down the arm and into the fingers.

The most common causes of cervical radiculopathy include herniated discs, degenerative disc disease, and spinal stenosis.

2. Lumbosacral radiculopathy

This is a type of radiculopathy that affects the nerve roots in the lumbar spine, which supply the legs and lower back.

The lumbar spine is made up of five (sometimes six) vertebrae and five pairs of lumbar nerve roots. The sacrum is formed by five fused vertebrae. These nerve roots emerge from the spinal cord at each level of the lumbar spine and exit the vertebral column through small openings. The L1-L5 and S1 nerve roots
exit below their corresponding vertebra.

It can cause pain, numbness, and weakness that radiates down the leg and into the foot.

The most common causes of lumbosacral radiculopathy include herniated discs, degenerative disc disease, and spinal stenosis.

3. Thoracic radiculopathy

This is a type of radiculopathy that affects the nerve roots in the thoracic spine, which supply the chest and abdominal muscles.

The thoracic spine is made up of twelve vertebrae and twelve pairs of thoracic nerve roots. These nerve roots emerge from the spinal cord at each level of the thoracic spine and exit the vertebral column through small openings.

It can cause pain, numbness, and weakness that radiates around the chest and abdomen.

It is often caused by trauma, spinal tumors, or degenerative disc disease.

Prevalence of radiculopathy

Radiculopathy is a relatively common condition. The prevalence of different types of radiculopathy varies based on various factors, including age, occupation, and underlying health conditions. However, in general, lumbosacral and cervical radiculopathies are the most common types, while thoracic radiculopathy is relatively rare.

Lumbosacral radiculopathy is the most common type of radiculopathy, accounting for approximately 60% of all cases. Cervical radiculopathy is the second most common type, accounting for approximately 25% of all cases. Thoracic radiculopathy is relatively rare, accounting for only about 1-2% of cases
(Deyo&Mirza, 2016).

Risk factors associated with radiculopathy

There are several risk factors associated with the development of radiculopathy, including:

Age – Radiculopathy is more common in adults over the age of 50.

Occupation – Jobs involving repetitive or heavy lifting, twisting, or bending may increase the risk of radiculopathy, particularly in the lumbar spine.

Genetics – Certain genetic factors may increase the risk of developing radiculopathy.

Smoking – Smoking has been shown to increase the risk of developing radiculopathy, likely due to its effects on blood flow and tissue oxygenation.

Obesity – Obesity has been associated with an increased risk of lumbar radiculopathy, likely due to the additional stress placed on the spine and nerve roots.

Spinal degeneration – Degenerative changes in the spine, such as herniated discs, spinal stenosis, or osteoarthritis may increase the risk of radiculopathy.

Trauma – Traumatic injuries to the spine or nerve roots, such as from a fall or car accident may increase the risk of radiculopathy.

Medical conditions – Other medical conditions, such as diabetes or autoimmune disorders, may increase the risk of radiculopathy by affecting nerve function or causing inflammation of the spine.

It is important to note that having one or more of these risk factors does not necessarily mean that a person will develop radiculopathy, and many people with radiculopathy may not have any identifiable risk factors. However, understanding these risk factors can help individuals take steps to reduce their risk and manage any underlying medical conditions that may contribute to the development of radiculopathy.

Causes of radiculopathy

Radiculopathy can be caused by a variety of factors, including:

Herniated or bulging discs: When the gel-like material inside a spinal disc herniates or bulges out of place, it can compress nearby nerve roots and cause radiculopathy.
Spinal stenosis: This condition occurs when the spinal canal narrows, putting pressure on the nerve roots as they exit the spinal cord.
Degenerative disc disease/Osteoarthritis: Over time, the discs in the spine can degenerate and lose their cushioning ability, leading to compression of the nerve roots. The degeneration of joints in the spine due to osteoarthritis can cause bony growths that put pressure on nerve roots.
Trauma: Injuries to the spine or neck can cause radiculopathy if they damage or compress the nerve roots.
Tumors: Spinal tumors can grow and compress nerve roots, leading to radiculopathy.
Infections: Certain infections, such as shingles or spinal infections, can inflame or damage the nerve roots, causing radiculopathy.
Autoimmune disorders: In rare cases, autoimmune disorders can attack the nerve roots, causing radiculopathy.
Idiopathic causes: In some cases, radiculopathy may occur without a clear cause or trigger.

Symptoms

The symptoms of radiculopathy can vary depending on the location and severity of the nerve root compression, but some common symptoms include:

Pain: Radiculopathy often causes sharp or shooting pain that may be intermittent or constant and radiates along the path of the affected nerve root.
Numbness or tingling: Compression of the nerve root can cause numbness, tingling, or a “pins and needles” sensation in the affected area.
Weakness: Radiculopathy can cause weakness or difficulty moving the affected limb, particularly in more severe cases.
Reflex changes: Compression of the nerve root can affect reflexes, causing them to be reduced or absent.
Sensory changes: In addition to numbness and tingling, radiculopathy can cause other sensory changes, such as a burning sensation, hypersensitivity, or loss of sensation in the affected area.

Severe symptoms of radiculopathy may include:

Extreme pain: Radiculopathy can cause severe, shooting pain that can be difficult to manage with pain medication.
Muscle weakness: Compression of the nerve root can cause significant muscle weakness or paralysis in the affected limb.
Loss of bladder or bowel control: In rare cases, compression of the lower lumbar or sacral nerve roots can lead to loss of bladder or bowel control. This is a medical emergency and requires immediate medical attention.
Sensory loss: In severe cases, radiculopathy can cause complete loss of sensation in the affected area.
Difficulty standing or walking: Severe radiculopathy in the lumbar or sacral regions can make it difficult to stand or walk due to muscle weakness, numbness, or pain.

The specific symptoms of radiculopathy are dependent on the location of the affected nerve root. For example, lumbar radiculopathy may cause pain, numbness, or weakness in the lower back, buttocks, legs, or feet, while cervical radiculopathy may cause symptoms in the neck, shoulders, arms, or hands.

How is radiculopathy diagnosed?

Some common diagnostic methods used to diagnose radiculopathy include:

Medical history review: The healthcare provider will review the patient’s medical history, including any symptoms they are experiencing, any past injuries or illnesses, and any family history of similar conditions.

Physical examination: The healthcare provider will perform a physical exam to assess the patient’s range of motion, reflexes, and strength. They may also perform specific tests to evaluate the nerves and determine if there is any nerve root compression.

Diagnostic tests: Imaging tests such as X-rays, MRI scans, or CT scans may be ordered to help identify the underlying cause of the radiculopathy. Electromyography (EMG) and nerve conduction studies may also be performed to measure the electrical activity of muscles and nerves.

Provocative testing: Certain physical tests, such as the Spurling test or straight leg raise test, may be performed to reproduce or worsen the patient’s symptoms and help confirm the diagnosis.

Differential diagnosis: It is essential to rule out other conditions that can mimic radiculopathy, such as peripheral neuropathy, myopathy, or other spinal conditions.

Treatment

Treatment options are dependent on an individual’s circumstances, including the severity of symptoms, the underlying cause, and the patient’s concurrent medical conditions and other lifestyle factors. It is important to discuss treatment options with a healthcare provider to determine the most appropriate course of action.

Conservative management options for radiculopathy include:

  • Rest
  • Physical therapy
  • Chiropractic therapy
  • Massage therapy
  • Acupuncture and acupressure
  • Occupational therapy (including improving the ergonomics of your workstation, if applicable)
  • Aqua/pool therapy
  • Non-steroidal anti-inflammatory medications (NSAIDs)
  • Muscle relaxants and tricyclic antidepressants
  • Gabapentinoids
  • Selective norepinephrine reuptake inhibitors
  • There is some evidence that medical cannabis alleviates neuropathic pain
  • Targeted exercises for weight loss, improved posture, and improved body mechanics
  • Smoking cessation
  • Diet and lifestyle changes to promote maintenance of healthy weight, regular activity, and reduced inflammation
  • Medical devices such as posture braces
  • Management of other medical conditions that could be contributing to radiculopathy

What we offer at WMC:

At the Wilderman Medical Clinic, we offer a variety of interventional and non-interventional pain management options, including:

Interventional pain management for radiculopathy:

  • Caudal epidural cortisone injections for radiculopathy
  • Lumbar epidural cortisone injections for radiculopathy
  • Facet joint injections for radiculopathy
  • Medial branch block injections for radiculopathy

Non-interventional pain management for radiculopathy:

  • Psychotherapy
  • Kinesiology education sessions

When is surgery required?

Surgery may be considered if conservative management is ineffective, or if the patient’s symptoms are severe and impact their quality of life. Surgical options may include decompression surgery to alleviate nerve root compression or spinal fusion to stabilize the spine.

Resources

Berkowitz AL. Clinical Neurology and Neuroanatomy: A Localization-Based Approach,2nd edition,2022,McGraw Hill publisher.

Cervical Herniated Disc Causes and Diagnosis by Dr Richard Staehler, 2019,Spine-Health.Avialable from https://www.spine-health.com/conditions/herniated-disc/cervical-herniated-disc-causes-and-diagnosis

Deyo RA, Mirza SK. Lumbar Radiculopathy. The New England Journal of Medicine. 2016. Available from: https://www.nejm.org/doi/full/10.1056/NEJMra1515762

Frontera WR, Silver JK, Rizzo TD. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th edition, 2019.

Greenberg D, Aminoff MJ, Simon RP. Clinical Neurology,5th edition,2002,McGraw-Hill/Appleton & Lange publisher.

Lumbar Herniated Disc: Causes and Risk Factors by Dr Roger Hartl, 2016,Spine-Health.Avialable from https://www.spine-health.com/conditions/herniated-disc/lumbar-herniated-disc-causes-and-risk-factors

Rhee JM, Yoon T,Riew KD.Cervical Radiculopathy.Journal of the American Academy of Orthopaedic Surgeons. 15(8):486-494, August 2007. Available from
https://journals.lww.com/jaaos/Abstract/2007/08000/Cervical_Radiculopathy.5.aspx