Servikal Radikülopatiler
Özet
Servikal radikülopati, boyun, omuz veya kol ağrısı, kas güçsüzlüğü, duyusal semptomlar ve azalmış derin tendon refleksleri ile karakterize, en sık C7 ve C6 sinir köklerinin etkilendiği klinik bir tablodur. Gençlerde disk herniasyonu, ileri yaşlarda ise dejeneratif süreçler ve foraminal daralma en yaygın etiyolojik nedenlerdir. Teşhiste hasta öyküsü ve klinik muayene büyük bir paya sahip olup, Spurling manevrası ve omuz abduksiyon testi gibi provokatif testler tanıyı destekler. Görüntülemede yumuşak doku için MRG tercih edilirken, kemik yapılar ve foraminal kompresyon için BT miyelografi altın standarttır. Tanının iğne EMG'si ile doğrulanması yaygındır ve sinir ileti çalışmalarında duyusal sinir aksiyon potansiyellerinin normal bulunması, radikülopatiyi pleksopatiden ayırır. Ayırıcı tanıda karpal tünel, ulnar nöropati gibi tuzak nöropatileri, idiyopatik brakiyal pleksopati, miyelopati, motor nöron hastalığı (ALS) ve kardiyak ağrılar yer alır.
Cervical radiculopathy is a clinical condition characterized by neck, shoulder, or arm pain, muscle weakness, sensory symptoms, and diminished deep tendon reflexes, most frequently affecting the C7 and C6 nerve roots. While disc herniation is the most common cause in younger patients, degenerative processes and foraminal narrowing become prevalent with advancing age. Patient history and clinical examination account for a major part of the diagnosis, supported by provocative tests such as the Spurling maneuver and the shoulder abduction test. In neuroimaging, MRI is preferred for evaluating soft tissue structures, whereas CT myelography remains the gold standard for bone structures and foraminal compression. Diagnosis is commonly confirmed via needle EMG, and demonstrating normal sensory nerve action potentials in nerve conduction studies helps differentiate radiculopathy from plexopathy. The differential diagnosis includes entrapment neuropathies like carpal tunnel syndrome and ulnar neuropathy, as well as idiopathic brachial plexopathy, myelopathy, motor neuron disease (ALS), and cardiac pain.
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