Cervicobrachial syndrome

Cervikobrahijalni sindrom, poznat i kao cervikalna radikulopatija relativno je čest neurološki i degenerativni poremećaj koji proizlazi iz disfunkcije živčanog korijena, često zbog mehaničke kompresije. Međutim, upalni citokini oslobođeni iz oštećenih intervertebralnih diskova također mogu uzrokovati simptome. Cilj ovog preglednog rada je prikazati epidemiologiju i etiologiju bolesti, patofiziološke mehanizme, dijagnozu i diferencijalnu dijagnozu te metode liječenja simptoma bolesti. Incidencija cervikalne radikulopatije doseže svoj vrhunac u 4. i 5. desetljeću života. Glavna dva patofiziološka mehanizma nastanka bolesti uključuju akutnu herniju intervertebralnog diska cervikalne kralježnice i degenerativnu cervikalnu spondilozu. Bol je najčešći simptom. Može se opisati kao oštra, perzistirajuća i žareća, lokalizirana u vratu, ramenu, ruci ili prstima, ovisno o razini zahvaćenosti živčanih korijena. Ostali česti simptomi su: gubitak osjeta, mišićna slabost i hiporefleksija. Cervikalna radikulopatija često se može dijagnosticirati opsežnom anamnezom i fizikalnim pregledom, ali magnetska rezonancija i kompjuterizirana tomografija koriste se za potvrdu dijagnoze. U odsutnosti mijelopatije ili značajne mišićne slabosti svi bolesnici trebaju biti liječeni konzervativno najmanje 6 tjedana. Konzervativno liječenje sastoji se od imobilizacije, protuupalnih lijekova, fizikalne terapije i cervikalnih steroidnih injekcija. Oko 90% bolesnika dobro reagira na konzervativnu terapiju. Za bolesnike u kojih simptomi perzistiraju unatoč konzervativnoj terapiji ili one koji pokazuju značajne funkcionalne nedostatke, prikladan je kirurški tretman. Kirurške opcije uključuju prednju cervikalnu dekompresiju i fuziju, artroplastiku cervikalnog diska i stražnju foraminotomiju.Cervicobrachial syndrome, also known as cervical radiculopathy, is a relatively common neurological and degenerative disorder resulting from nerve root dysfunction, which is often duo to mechanical compression. However, inflammatory cytokines released from damaged intervertebral disks can also result in symptoms. The aim of this review is to present the epidemiology and etiology of the disease, its pathophysiological mechanisms, diagnostic procedures, and differential diagnosis and methods of treating the symptoms of the disease. The incidence of cervical radiculopathy reaches its peak in the fourth and fifth decades of life. The main two pathophysiological mechanisms of the disease include acute intervertbral disk herniation and degenerative cervical spondylosis. Pain is the most common symptom. It can be described as sharp, persistent and burning, localized in the neck, shoulder, arm or fingers, depending on the level of nerve root involvement. Other common symptoms include numbness, muscular weakness, and hyporeflexion. Cervical radiculopathy can often be diagnosed with a thorough history and physical examination, but a magnetic resonance imaging or computed tomography should be used to confirm the diagnosis. In the absence of myelopathy or significant muscle weakness all patients should be treated conservatively for at least 6 weeks. Conservative treatments consist of immobilization, anti-inflammatory medications, physical therapy, and epidural steroid injections. About 90% of patients respond well to conservative therapy. For patients who are persistently symptomatic despite conservative treatment, or those who have a significant functional deficiti surgical treatment is appropriate. Surgical options include anterior cervical decompresson and fusion, cervical disk arthroplasty, and posterior foraminotomy