Cervical radiculopathy
Cervical nerve root compression from disk herniation or degenerative spondylosis causes neck pain with dermatomal arm pain, paresthesia, weakness, and reduced reflexes, diagnosed clinically with the Spurling test and treated conservatively with NSAIDs and exercise before imaging or surgery.
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What this article covers
- Overview
Nerve root compression syndrome: cervical radiculopathy is neck pain accompanied by radiating arm pain, dermatomal paresthesia, weakness, and diminished deep tendon reflexes caused by compression of a cervical spinal nerve root.
- Epidemiology
Degenerative disease dominates with age: cervical spondylosis is a common cause of nerve root compression as intervertebral disks lose height and facet and uncovertebral joints hypertrophy with age.
- Risk factors
Age-related degenerative change: advancing age with resultant disk desiccation, osteophyte formation, and facet arthropathy is the dominant risk factor for spondylotic radiculopathy.
- Pathophysiology
Foraminal or central narrowing: osteophyte formation at the uncovertebral and facet joints, combined with disk height loss, narrows the neural foramen through which the nerve root exits, mechanically compressing the root.
- Clinical features
Neck pain with dermatomal arm radiation is the hallmark and establishes the clinical pattern: cervical radiculopathy is suggested by the combination, singly or together, of neck, shoulder, or arm…
- Differential diagnosis
Compressive cervical myelopathy: bilateral upper and lower extremity involvement, hyperreflexia, clonus, a positive Lhermitte sign, and bladder or bowel dysfunction, rather than an isolated dermatomal pattern.
- Diagnosis
This is primarily a clinical diagnosis, not an imaging diagnosis: it is made when dermatomal arm pain, paresthesia, weakness, or diminished reflexes accompany neck pain, supported by a positive…
- Management
First, treat conservatively for 6 to 8 weeks with a multimodal, individualized program of range-of-motion exercise, physical therapy, stretching and strengthening exercises, and ice or heat…
- Complications
Persistent or progressive motor weakness: refractory root compression can progress from paresthesia and reflex change to fixed motor deficit if decompression is delayed.
- Prognosis
Favorable natural history: most patients experience resolution or near-resolution of symptoms within 6 to 8 weeks of conservative therapy.
- Prevention
Avoid prolonged cervical collar use, since regular collar use delays rather than hastens recovery and should not be recommended as a preventive measure.
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