Synopsis
Diagnose cervical and lumbar nerve-root syndromes clinically, identify cord and cauda-equina emergencies and use imaging, medicines, activity and surgery according to disability and concordant anatomy.
- Radiculopathy is a nerve-root syndrome producing dermatomal pain or sensory symptoms, myotomal weakness and a corresponding reflex change; pain without objective deficit may still be radicular.
- Disc prolapse is one cause among foraminal stenosis, osteophyte, tumour, infection, inflammation and postoperative scar; an MRI disc bulge is common and does not prove symptom causation.
- Cervical roots cause neck-to-arm pain, paraesthesia and segmental weakness; lumbar roots cause back-to-leg sciatica, with L5 and S1 common but clinically overlapping.
Key red flags
Bilateral sciatica or progressive weakness accompanies saddle, genital, urinary flow, bowel fullness or sexual dysfunction and requires emergency MRI rather than routine conservative care.
Investigation priorities
Demonstrate a coherent myotomal, dermatomal and reflex pattern and exclude myelopathy or cauda-equina disease.
Management branches
Neck-to-arm or back-to-leg pain suggests a nerve-root syndrome.
- Define distribution, onset, cough or movement provocation and functional loss, then test myotomes, reflexes, sensation and tension signs and screen cord, cauda-equina, cancer, infection and trauma features.
- Use emergency MRI and specialist routes for red flags; otherwise explain the favourable natural history, encourage normal activity and avoid routine non-specialist imaging.
Key medicines
NSAIDUse the lowest effective formulary dose for the shortest possible period after risk assessment.
Short-course weak opioidConsider only for selected acute low-back pain when an NSAID is contraindicated, not tolerated or ineffective.