Nerve Root Injury (Radiculopathy)

How nerve roots work

Thirty-one pairs of spinal nerve roots leave the spinal cord: 8 in the neck (cervical), 12 in the mid-back (thoracic), 5 in the lower back (lumbar), 5 in the sacrum and 1 at the tailbone. Each root supplies a strip of skin (dermatome) and specific muscles (myotome). Symptoms follow these patterns, which helps doctors identify the level.

Common patterns

Lower back roots (L5 and S1) are the most common cause of sciatica. Neck roots C6 and C7 are the most commonly affected in cervical radiculopathy.

Causes

Compression (most common)

• Herniated disc: the soft center of a disc bulges and presses on a root; most common in people aged 30 to 50.
• Spinal stenosis: narrowing of the spinal canal or the exit holes from arthritis and thickened ligaments; common after 60. Leg pain often worsens with walking and eases on sitting or bending forward.
• Bone spurs and degenerative disc disease.
• Spondylolisthesis: one vertebra slipping forward.

Other causes

• Trauma: fractures, and nerve root avulsion from high-energy injuries, especially motorcycle crashes affecting the arm roots (brachial plexus injury)
• Infections: shingles (often in the thoracic roots), Lyme disease, spinal abscess
• Tumors pressing on roots
• Diabetes: diabetic radiculopathy, often in the thighs or trunk
• Inflammation: after surgery or with certain autoimmune conditions

Symptoms

• sharp, burning or electric pain spreading along the nerve's path into an arm or leg
• numbness, tingling or pins and needles
• muscle weakness in specific movements
• reduced reflexes
• pain worse with coughing, sneezing, sitting or certain neck or back positions

Diagnosis

1. Examination: strength, sensation and reflexes, plus tests such as the straight leg raise (for lower back roots) or Spurling's test (for neck roots).
2. MRI: shows discs, nerves and stenosis. Usually done if symptoms persist beyond about 6 weeks, or sooner with red flags or significant weakness.
3. CT or CT myelogram: if MRI is not possible or for bony detail.
4. Nerve conduction studies and EMG: confirm nerve root involvement and rule out other nerve problems such as carpal tunnel syndrome.

Treatment

Non-surgical

• Stay active: gentle walking and normal activities as tolerated; bed rest is not recommended.
• Physical therapy: exercises, posture and nerve mobilization.
• Pain relief: NSAIDs at the label dose (avoid with kidney disease or stomach ulcers), short courses of oral steroids in some cases, and nerve pain medicines. Evidence for gabapentinoids in sciatica is limited.
• Epidural steroid injections: can reduce pain for weeks to months while the nerve recovers.
• Cervical collar or traction: limited short-term use for neck radiculopathy.

Surgery

Surgery is considered for:

• cauda equina syndrome or spinal cord compression (urgent)
• severe or progressive weakness
• persistent disabling pain after 6 to 12 weeks of non-surgical treatment

Options include discectomy or microdiscectomy, laminectomy, foraminotomy, and anterior cervical discectomy and fusion or disc replacement in the neck. Nerve root avulsion may need nerve transfers or grafts by a specialist surgeon.

Outlook

Most people with radiculopathy from a herniated disc improve within 6 to 12 weeks, as the disc material shrinks and inflammation settles. Weakness often recovers more slowly than pain. Avulsion injuries carry a poorer outlook, but surgical nerve reconstruction can restore some function.

Frequently asked questions

What is a nerve root injury?

It is damage to a nerve root as it leaves the spinal cord, usually from compression by a herniated disc or bone spurs (radiculopathy). It causes pain, numbness, tingling and weakness along that nerve's path into an arm or leg.

How long does a pinched nerve take to heal?

Most pinched nerves in the neck or back improve within 6 to 12 weeks with conservative treatment. Numbness and weakness may take longer to recover. Persistent symptoms may need injections or surgery.

When does radiculopathy need surgery?

Surgery is considered when there is cauda equina syndrome, spinal cord compression, severe or worsening weakness, or disabling pain that has not improved after 6 to 12 weeks of non-surgical treatment.

Is radiculopathy the same as sciatica?

Sciatica is a type of radiculopathy affecting the lower lumbar and sacral nerve roots that form the sciatic nerve, causing pain down the back of the leg. Radiculopathy can also affect nerve roots in the neck or mid-back.