Do you have a feeling of “pins and needles” in your hands or fingers with weakness and/or a loss of sensation in your arm, shoulder or hand muscles? You may have Cervical Radiculopathy, better known as a pinched nerve. In this podcast, spine expert Dr. Steven Ludwig, will address the causes, treatments (both surgical and non-surgical) and ways to prevent getting a pinched nerve.
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Relieving Cervical Radiculopathy: Treatments for a Pinched Nerve
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Steven Ludwig, MD
Steven C. Ludwig, MD, is a professor of orthopaedics at the University of Maryland School of Medicine, a spine surgeon with the University of Maryland Medical System, and part of the UM Spine Network. He was named a “Top Doctor” in the specialty of Spine Surgery by Baltimore Magazine in 2020. His special interests include adult reconstructive spine surgery, degenerative diseases of the cervical and lumbar spine, disc herniation and replacement, spinal stenosis, spinal tumors and infections, sports-related spine injuries and traumatic injuries to the cervical spine. He obtained his Doctor of Medicine degree from the University of Medicine and Dentistry of New Jersey, completed his internship and residency at Thomas Jefferson University, and was a fellow at Emory University School of Medicine. He is certified in Orthopaedic Surgery by the American Board of Orthopaedic Surgery. He sees patients at University of Maryland Medical Center, UM Upper Chesapeake Health, UM St. Joseph Medical Center, and is a member of UM Faculty Physicians, Inc.Learn more about Dr. Ludwig and watch video
Transcription:
Relieving Cervical Radiculopathy: Treatments for a Pinched Nerve
Prakash Chandran: cervical radiculopathy is most commonly referred to as a pinched or irritated nerve in the neck that can cause pain, numbness, or weakness radiating into the chest or arm. Today, we'll be talking about how to identify if you have it, treatment options and prevention measures.
Joining us is Dr. Steven Ludwig, a professor of orthopedics and neurosurgery at the University of Maryland School of Medicine, Chief of the Division of Spine Surgery and director of the University of Maryland Spine Fellowship Program.
Welcome to the Live Greater, a podcast series information for a healthier you from the University of Maryland Medical System. My name is Prakash Chandran. Dr. Ludwig, thanks so much for your time and for joining us today. Let's get started with the basics. What exactly is cervical radiculopathy?
Dr Steven Ludwig: Sure. And thanks for having me. Cervical radiculopathy is a pain that develops in a patient's neck from pinching of the nerve that travels in a very specific nerve or dermatomal distribution down the arm into the hand. Now, each nerve in your neck is wired to a specific region in the arm and in the hand. And based upon the way patients present, we can often determine based upon their history, their physical examination, and then correlate it to an advanced imaging studies to hone in on the diagnosis.
Prakash Chandran: So when someone actually has cervical radiculopathy, what are the symptoms they might be experiencing that tell them that they have it?
Dr Steven Ludwig: Sure. They typically present with pain in the neck, pain that travels down the arm, once again in a very specific anatomic distribution. That pain may be associated with weakness in the arm or in the hand, and that pain may also be associated with numbness and tingling.
Prakash Chandran: Okay. And then, when you talk about how someone gets this in the first place or a pinched nerve in the first place, is there a certain event that causes a pinched nerve or is this something that just gradually comes on over time?
Dr Steven Ludwig: There's multitudes of etiologies or presentations for somebody with a pinched nerve in their neck. Often, it's preceded by trauma. It can be some minor trauma or some incidental trauma where you're bending down or twisting and picking something up or major even near-catastrophic trauma, like a major motor vehicle collision.
Typically, patients can present after an incident or something that incited the problem and sparked the problem. And they can note the onset of pain in the neck, pain down the arm in that specific anatomic distribution, and it may be associated with the weakness, the numbness and tingling. But you don't necessarily need to have trauma to cause the pinched nerve. A pinched nerve can also occur as a result of age, time, genetics wear and tear, and the degenerative conditions that affect all with age. And wear and tear over years can cause progression of the pinching of the nerve and progression of the symptoms.
Rarely can you have really bad problems that are associated with pinching in the nerves. An infection in your spine or a tumor that can cause pinching of the nerves, but those are rarer conditions. Most often, the problem associated with pinching of the nerve is related to the disc with the shock absorber in between the bones or bony stenosis or arthritic stenosis that pinches the nerve and causes the pain down the arm and then from the neck.
Prakash Chandran: Now, I know one of the things that you mentioned is that it doesn't necessarily need to be brought on by trauma. Can someone's position in terms of sitting in front of a computer for a long period of time, or just sitting in an awkward position, can that bring this on as well?
Dr Steven Ludwig: Yeah, I think having a great ergonomic workstation. People are doing a lot of computer work, you know, as a part of their daily routine and having a good workstation where your neck is not in an awkward position to your point can potentially mitigate some of the symptoms from occurring. So patients can have a lot of preexisting bony problems or disc-related problems, just as a result of time, age and genetics. And they may be living with it in an asymptomatic or it never bothers them. However, because of their work, because of their workstation, because of the position of the head for prolonged periods of times or bad body mechanics that can aggravate a pre-existing, pre-quiescent type of problem, that can cause the nerve pinching to become more symptomatic.
Prakash Chandran: So tell me about some of the different treatment options that are available if someone comes and presents with this pinched nerve in their neck.
Dr Steven Ludwig: Most people that present to us with a pinched nerve in their neck don't need spine surgery, potentially a very rare occurrence. And most pinched nerves in the neck that cause the pain in the neck and the symptoms that we discussed down the arms, even some subtle weakness and numbness and tingling will get better with time, anti-inflammatory medications, steroids. Perhaps some physical therapy is usually the initial treatment of choice for patients that present that are neurologically intact or neurologically stable, don't have any other red flags associated with their history or physical examination and can get along with just some conservative management like we just discussed.
Prakash Chandran: Got it. So most people don't need that spine surgery. It can be managed over time with some of the methods that you mentioned. When does surgery come into play?
Dr Steven Ludwig: So if somebody presents to our clinic with severe, progressive, intolerable pain in their neck, pain shooting down their arm associated with a devastating or progressive loss of function in their arm, that patient may be a candidate for surgery as long as their history, their physical examination matches up to their plain and advanced imaging studies. We may consider somebody that has just intractable and intolerable pain that we can't get comfortable, patients that have a significant neurologic deficit that we believe that is nonrecoverable in order to put everything in a best environment to recover neurologic function and hopefully improve their symptoms and their pain and their functionality, we'll recommend surgery.
Prakash Chandran: Now, what does surgery actually look like for someone with a pinched nerve?
Dr Steven Ludwig: So it depends on the location of the pinched nerve. It depends on the number of levels that are involved with the pinched nerves, but the surgery can involve something through the back of the neck called a cervical foraminotomy where we simply make more room for the nerve that's getting pinched. Sometimes an anterior cervical discectomy and fusion if the disc is the culprit and herniated back and pushing on the nerve may be required. And nowadays, we're also doing disc replacement surgery where instead of doing a fusion where you lose motion at a particular segment where the disc is herniated out or the arthritis or the bone spur is pressing against the nerve that needs to be fused, we could replace it with a disc prosthesis or replacement that maintains motion.
Prakash Chandran: Got it. And what is the recovery time like typically after a surgery like this?
Dr Steven Ludwig: All those three procedures that we discussed for a pinched nerve, a cervical posterior or in the back of the neck foraminotomy or an opening up of the window for the nerve, an anterior cervical discectomy and fusion, or a fusion of the neck or a disc replacement. They're all minimally invasive procedures, that means fast recovery, fast return to work, excellent return of function in nerves with really good outcomes.
Prakash Chandran: I think the best thing that we can do is to do things that prevent us from getting a pinched nerve in the first place. We talked briefly about making sure you have an ergonomic setup when it comes to your work setup. What are some other things that you can do to prevent from getting a pinched nerve?
Dr Steven Ludwig: Yeah, I think other than being in good physical shape, not smoking, which can be a detriment, not only to your lungs, but in general health wellbeing. The nicotine and the smoke can also destroy the disc spaces and make them more prone to herniating out and getting calcified. But there's really no other magic pill or exercise or vitamin that people can take that could prevent a lot of the age-related changes. And clearly, the traumatic events that we talked about that can be the inciting event for a pinched nerve, obviously, you know, that's not preventable, because those are typically accidents.
Prakash Chandran: Right. So just before we close here, are there any other takeaways that you would like to leave with our audience?
Dr Steven Ludwig: I think the symptoms to understand most importantly is that if you're having more progressive, more severe, intolerable pain in the neck, traveling down the arm into the hand associated with numbness and tingling and weakness, you should go to your physician to get evaluated. I think as long as the physician feels as though neurologically everything is stable and is intact, I think the public should understand that more often than, not that therapy, medications to reduce the inflammation, mitigates the pain and 90% of people by six to eight weeks, they're feeling better.
Rarely do symptoms progress to the point where they become so intolerable and the neurologic loss is concerning and devastating that patients require surgery. But lastly, if surgery is indicated, it's a very low risk, but high reward surgery, meaning although surgery is everybody's last choice to have, they should be rest assured that the surgical procedures have an excellent outcome.
Prakash Chandran: Well, Dr. Ludwig, I think that is the perfect place to end. Thank you so much for your time today.
Dr Steven Ludwig: Great. Thank you so much.
Prakash Chandran: That was Dr. Steven Ludwig, a professor of orthopedics and neurosurgery at the University of Maryland School of Medicine, Chief of the Division of Spine Surgery and director of the University of Maryland Spine Fellowship Program.
. Thanks for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. For more information, you can visit umms.org/podcast. I'm Prakash Chandran, and we look forward to you joining us again.
Relieving Cervical Radiculopathy: Treatments for a Pinched Nerve
Prakash Chandran: cervical radiculopathy is most commonly referred to as a pinched or irritated nerve in the neck that can cause pain, numbness, or weakness radiating into the chest or arm. Today, we'll be talking about how to identify if you have it, treatment options and prevention measures.
Joining us is Dr. Steven Ludwig, a professor of orthopedics and neurosurgery at the University of Maryland School of Medicine, Chief of the Division of Spine Surgery and director of the University of Maryland Spine Fellowship Program.
Welcome to the Live Greater, a podcast series information for a healthier you from the University of Maryland Medical System. My name is Prakash Chandran. Dr. Ludwig, thanks so much for your time and for joining us today. Let's get started with the basics. What exactly is cervical radiculopathy?
Dr Steven Ludwig: Sure. And thanks for having me. Cervical radiculopathy is a pain that develops in a patient's neck from pinching of the nerve that travels in a very specific nerve or dermatomal distribution down the arm into the hand. Now, each nerve in your neck is wired to a specific region in the arm and in the hand. And based upon the way patients present, we can often determine based upon their history, their physical examination, and then correlate it to an advanced imaging studies to hone in on the diagnosis.
Prakash Chandran: So when someone actually has cervical radiculopathy, what are the symptoms they might be experiencing that tell them that they have it?
Dr Steven Ludwig: Sure. They typically present with pain in the neck, pain that travels down the arm, once again in a very specific anatomic distribution. That pain may be associated with weakness in the arm or in the hand, and that pain may also be associated with numbness and tingling.
Prakash Chandran: Okay. And then, when you talk about how someone gets this in the first place or a pinched nerve in the first place, is there a certain event that causes a pinched nerve or is this something that just gradually comes on over time?
Dr Steven Ludwig: There's multitudes of etiologies or presentations for somebody with a pinched nerve in their neck. Often, it's preceded by trauma. It can be some minor trauma or some incidental trauma where you're bending down or twisting and picking something up or major even near-catastrophic trauma, like a major motor vehicle collision.
Typically, patients can present after an incident or something that incited the problem and sparked the problem. And they can note the onset of pain in the neck, pain down the arm in that specific anatomic distribution, and it may be associated with the weakness, the numbness and tingling. But you don't necessarily need to have trauma to cause the pinched nerve. A pinched nerve can also occur as a result of age, time, genetics wear and tear, and the degenerative conditions that affect all with age. And wear and tear over years can cause progression of the pinching of the nerve and progression of the symptoms.
Rarely can you have really bad problems that are associated with pinching in the nerves. An infection in your spine or a tumor that can cause pinching of the nerves, but those are rarer conditions. Most often, the problem associated with pinching of the nerve is related to the disc with the shock absorber in between the bones or bony stenosis or arthritic stenosis that pinches the nerve and causes the pain down the arm and then from the neck.
Prakash Chandran: Now, I know one of the things that you mentioned is that it doesn't necessarily need to be brought on by trauma. Can someone's position in terms of sitting in front of a computer for a long period of time, or just sitting in an awkward position, can that bring this on as well?
Dr Steven Ludwig: Yeah, I think having a great ergonomic workstation. People are doing a lot of computer work, you know, as a part of their daily routine and having a good workstation where your neck is not in an awkward position to your point can potentially mitigate some of the symptoms from occurring. So patients can have a lot of preexisting bony problems or disc-related problems, just as a result of time, age and genetics. And they may be living with it in an asymptomatic or it never bothers them. However, because of their work, because of their workstation, because of the position of the head for prolonged periods of times or bad body mechanics that can aggravate a pre-existing, pre-quiescent type of problem, that can cause the nerve pinching to become more symptomatic.
Prakash Chandran: So tell me about some of the different treatment options that are available if someone comes and presents with this pinched nerve in their neck.
Dr Steven Ludwig: Most people that present to us with a pinched nerve in their neck don't need spine surgery, potentially a very rare occurrence. And most pinched nerves in the neck that cause the pain in the neck and the symptoms that we discussed down the arms, even some subtle weakness and numbness and tingling will get better with time, anti-inflammatory medications, steroids. Perhaps some physical therapy is usually the initial treatment of choice for patients that present that are neurologically intact or neurologically stable, don't have any other red flags associated with their history or physical examination and can get along with just some conservative management like we just discussed.
Prakash Chandran: Got it. So most people don't need that spine surgery. It can be managed over time with some of the methods that you mentioned. When does surgery come into play?
Dr Steven Ludwig: So if somebody presents to our clinic with severe, progressive, intolerable pain in their neck, pain shooting down their arm associated with a devastating or progressive loss of function in their arm, that patient may be a candidate for surgery as long as their history, their physical examination matches up to their plain and advanced imaging studies. We may consider somebody that has just intractable and intolerable pain that we can't get comfortable, patients that have a significant neurologic deficit that we believe that is nonrecoverable in order to put everything in a best environment to recover neurologic function and hopefully improve their symptoms and their pain and their functionality, we'll recommend surgery.
Prakash Chandran: Now, what does surgery actually look like for someone with a pinched nerve?
Dr Steven Ludwig: So it depends on the location of the pinched nerve. It depends on the number of levels that are involved with the pinched nerves, but the surgery can involve something through the back of the neck called a cervical foraminotomy where we simply make more room for the nerve that's getting pinched. Sometimes an anterior cervical discectomy and fusion if the disc is the culprit and herniated back and pushing on the nerve may be required. And nowadays, we're also doing disc replacement surgery where instead of doing a fusion where you lose motion at a particular segment where the disc is herniated out or the arthritis or the bone spur is pressing against the nerve that needs to be fused, we could replace it with a disc prosthesis or replacement that maintains motion.
Prakash Chandran: Got it. And what is the recovery time like typically after a surgery like this?
Dr Steven Ludwig: All those three procedures that we discussed for a pinched nerve, a cervical posterior or in the back of the neck foraminotomy or an opening up of the window for the nerve, an anterior cervical discectomy and fusion, or a fusion of the neck or a disc replacement. They're all minimally invasive procedures, that means fast recovery, fast return to work, excellent return of function in nerves with really good outcomes.
Prakash Chandran: I think the best thing that we can do is to do things that prevent us from getting a pinched nerve in the first place. We talked briefly about making sure you have an ergonomic setup when it comes to your work setup. What are some other things that you can do to prevent from getting a pinched nerve?
Dr Steven Ludwig: Yeah, I think other than being in good physical shape, not smoking, which can be a detriment, not only to your lungs, but in general health wellbeing. The nicotine and the smoke can also destroy the disc spaces and make them more prone to herniating out and getting calcified. But there's really no other magic pill or exercise or vitamin that people can take that could prevent a lot of the age-related changes. And clearly, the traumatic events that we talked about that can be the inciting event for a pinched nerve, obviously, you know, that's not preventable, because those are typically accidents.
Prakash Chandran: Right. So just before we close here, are there any other takeaways that you would like to leave with our audience?
Dr Steven Ludwig: I think the symptoms to understand most importantly is that if you're having more progressive, more severe, intolerable pain in the neck, traveling down the arm into the hand associated with numbness and tingling and weakness, you should go to your physician to get evaluated. I think as long as the physician feels as though neurologically everything is stable and is intact, I think the public should understand that more often than, not that therapy, medications to reduce the inflammation, mitigates the pain and 90% of people by six to eight weeks, they're feeling better.
Rarely do symptoms progress to the point where they become so intolerable and the neurologic loss is concerning and devastating that patients require surgery. But lastly, if surgery is indicated, it's a very low risk, but high reward surgery, meaning although surgery is everybody's last choice to have, they should be rest assured that the surgical procedures have an excellent outcome.
Prakash Chandran: Well, Dr. Ludwig, I think that is the perfect place to end. Thank you so much for your time today.
Dr Steven Ludwig: Great. Thank you so much.
Prakash Chandran: That was Dr. Steven Ludwig, a professor of orthopedics and neurosurgery at the University of Maryland School of Medicine, Chief of the Division of Spine Surgery and director of the University of Maryland Spine Fellowship Program.
. Thanks for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. For more information, you can visit umms.org/podcast. I'm Prakash Chandran, and we look forward to you joining us again.