Diagnosing and Treating Radiculopathy

Most people with radiculopathy will seek medical attention from a primary care physician first for the pain. The doctor will begin with a thorough history of the patient and physical exam. Once the doctor identifies the exact location of the symptoms, he or she can determine which nerves are responsible for the condition. Tests ordered may include:

• X-ray: an X-ray can show the presence and cause of trauma, including osteoarthritis and other causes.
• Magnetic resonance imaging (MRI): An MRI uses magnetic fields and radio-frequency waves to create an image of the spine, and can reveal fine details of the spine, including tumors, nerves, and any damage to the spine. An MRI scan can show details in the spine that can’t normally be seen on an x-ray. Sometimes a contrast agent is injected into a vein in the hand or arm during the test, which highlights certain tissues and structures to make details even clearer. In cases of radiculopathy, the affected nerves will be revealed.
• Computerized tomography (CT) is a noninvasive procedure that uses x-rays to produce a three-dimensional image of the spine.  A CT shows more detail than an X-ray, and is sometimes used in addition to an MRI to reveal compression to the nerves.

Treatment Options:

Medication: Many cases of radiculopathy can be treated successfully with conservative measures. These include the use of over-the-counter pain relievers and anti-inflammatories such as acetaminophen, and ibuprofen, as well as steroid injections administered in a doctor’s office. (Och Spine at NewYork-Presbyterian at the Weill Cornell Medicine Center for Comprehensive Spine Care offers a wide range of these treatments, offered by neurologists, pain management specialists, sports medicine specialists, and rehabilitation medicine specialists.) In 95% of cases, these simple treatments are effective. But for the remaining 5%, the excruciating pain caused by compressed nerves and nerve damage requires more aggressive treatments.

Surgery: If the symptoms of the compressed nerves have not improved with conservative measures, then surgery may be the most effective option. With surgery, the herniated disc or damaged portion of the spine is operated on to relieve the pressure on the affected nerves. (See Surgery for Radiculopathy.)

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