Polyradiculopathy: Spinal stenosis, infectious, carcinomatous, and inflammatory nerve root syndromes
- Seward B Rutkove, MD
Seward B Rutkove, MD
- Professor of Neurology
- Harvard Medical School
- Andrew Tarulli, MD
Andrew Tarulli, MD
- Assistant Professor of Neurology
- Harvard Medical School
Polyradiculopathy refers to damage to multiple nerve roots sufficient to produce neurologic symptoms and signs such as pain, weakness, and sensory loss. This topic will review the signs and symptoms of polyradiculopathy by spinal region, and provide an overview of the most common etiologies. Diagnostic testing and the differential diagnosis are also discussed.
Cervical and lumbosacral radiculopathy are discussed in greater detail separately. (See "Clinical features and diagnosis of cervical radiculopathy" and "Lumbosacral radiculopathy: Pathophysiology, clinical features, and diagnosis".)
PRESENTATION BY SPINAL LEVEL
The main feature that distinguishes radiculopathy from other neurologic disorders is that the symptoms and signs of radiculopathy follow sensory and motor nerve root distributions (figure 1 and figure 2 and figure 3 and table 1). However, since polyradiculopathy by definition affects multiple nerve roots, it can mimic conditions such as polyneuropathy, plexopathy, and mononeuropathy multiplex, making the diagnosis quite challenging. Often, objective signs such as weakness, sensory loss, and reflex change are mild in comparison to complaints of pain and paresthesia. Although there are certainly exceptions to this rule, the subtlety of physical examination findings in polyradiculopathy is a consequence of collateral motor and sensory innervation and incomplete nerve root damage.
Although precise details as to the prevalence of polyradiculopathy by spinal region are not readily available, 60 to 90 percent of single-level radiculopathies occur in the lumbosacral levels. Cervical radiculopathy accounts for most of the balance, with thoracic radiculopathy representing only a small minority of cases . It is likely that polyradiculopathy also follows a similar prevalence by region.
Cervical polyradiculopathy presents with neck pain radiating unilaterally or bilaterally into the arms with associated paresthesia, weakness, and sensory loss. The most common cause of cervical polyradiculopathy is degenerative cervical spondylosis, which can be accompanied by signs of cervical myelopathy such as spasticity and weakness in the lower extremities and bladder incontinence. (See "Clinical features and diagnosis of cervical radiculopathy" and "Cervical spondylotic myelopathy".)
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- PRESENTATION BY SPINAL LEVEL
- Spinal stenosis
- Tethered cord syndrome
- Primary tumors
- Leptomeningeal metastases
- Diabetic thoracic radiculopathy
- Diabetic amyotrophy
- Diabetic cervical radiculoplexus neuropathy
- Lyme disease
- Polyradiculopathy in HIV and AIDS
- DIAGNOSTIC TESTING
- Electrodiagnostic studies
- Lumbar puncture
- DIFFERENTIAL DIAGNOSIS