Cervical, thoracic, and lumbosacral radiculopathies: update in diagnosis and management

Abstract

In the evaluation of patients with neck pain, back pain, or limb symptoms, clinicians must use a rational approach to evaluation and management. Cervical and lumbosacral radiculopathies, common causes of limb and spine symptoms, can have various causes: compression from herniated discs, invasion from tumors and infections, or inflammation due to complex physiological processes. This issue of the Physical Medicine and Rehabilitation Clinics of North America deals with one set of clinical conditions—radiculopathies—facilitating discussion of the many aspects of diagnosis and clinical decisionmaking that arise when such conditions are suspected. A broad clinical perspective is presented in the early articles on anatomy, pathophysiology, and differential diagnosis formulation for patients with limb and spine symptoms. Other diagnostic tools available to clinicians—diagnostic selective nerve root blocks, electrodiagnosis, and spinal imaging—are then presented in detail. Once a radiculopathy is identified, management options are chosen carefully and customized to the individual’s symptoms, functional limitations, and specific needs. The articles on conservative care provide both a solid foundation of background information about the natural history of radiculopathies, as well as useful guidelines for conservative approaches to management. For both lumbosacral and cervical radiculopathies, the clinical Timothy R. Dillingham, MD, MS