Radiculopathy
Radiculopathy is dysfunction of a spinal nerve root causing radiating pain, sensory change, weakness or reflex loss in a root distribution; most lumbar sciatica improves with conservative care, but cauda equina, cord compression, progressive deficit, infection and malignancy require urgent escalation.
Definition
Radiculopathy is dysfunction of a spinal nerve root causing pain, sensory disturbance, weakness or reflex change in a root-related distribution. It is commonly caused by a prolapsed intervertebral disc or degenerative foraminal or canal narrowing, but infection, tumour, trauma, inflammatory disease and other structural lesions can produce the same syndrome. Lumbosacral radiculopathy presenting as leg pain is commonly called sciatica.
First principles
Localise the root clinically before imaging
A root syndrome combines radiating pain, sensory change, myotomal weakness and a corresponding reflex change, although not every feature is present. Compare the distribution with a peripheral nerve and with a length-dependent polyneuropathy. A careful neurological examination can identify whether the concern is lumbar, cervical, thoracic, root, cord or non-neurological disease before an incidental MRI finding distracts from the clinical picture.
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