Menu
Cervical radiculopathy is a neurological condition that affects the cervical spinal nerve roots through compression or irritation, leading to dysfunction. The condition manifests primarily through radiating pain, numbness, and weakness along the distribution of the affected nerve root.
The cervical spine’s anatomical structure comprises seven vertebrae (C1-C7) and eight pairs of cervical nerve roots (C1-C8) that exit through neural foramina. Several factors can trigger radiculopathy, including cervical disc herniation, degenerative disc disease, cervical spondylosis, foraminal stenosis, and trauma or injury.
Patients experiencing cervical radiculopathy typically report neck pain that radiates to the shoulder, arm, and hand, accompanied by sensory changes such as numbness, tingling, or paresthesias. They may also exhibit motor weakness in corresponding myotomes, reduced deep tendon reflexes, and symptom exacerbation with neck movements. Positive provocative tests, particularly Spurling’s test, often confirm the condition.
The diagnostic process involves a comprehensive clinical history and physical examination, including detailed neurological assessment, evaluation of dermatomal distribution, muscle strength testing, deep tendon reflex examination, and provocative maneuvers. Imaging studies play a crucial role, with X-rays serving as initial screening tools, MRI as the gold standard for soft tissue visualization, CT for detailed bone imaging, and EMG/NCS to confirm radiculopathy and identify the affected level.
Management strategies begin with conservative treatment, encompassing activity modification, physical therapy, NSAIDs, cervical traction, short-term use of soft cervical collars, and oral corticosteroids.
– Annual incidence: 83 per 100,000 population
– Peak incidence: 50-54 years of age
– Male to female ratio: 1.7:1
– Most commonly affected levels: C6 and C7 nerve roots
1. Degenerative changes:
– Cervical spondylosis
– Intervertebral disc herniation
– Foraminal stenosis
2. Trauma:
– Whiplash injuries
– Fractures or dislocations
3. Less common causes:
– Tumors (primary or metastatic)
– Infections (e.g., epidural abscess)
– Inflammatory conditions (e.g., rheumatoid arthritis)
– Nerve root compression leads to:
• Mechanical deformation
• Ischemia
• Inflammatory changes – Results in:
• Altered nerve conduction
• Sensitization of nociceptors
• Neurogenic inflammation
1. Pain:
– Neck pain radiating to the arm, forearm, or hand
– Often unilateral
– May be exacerbated by neck movements or Valsalva maneuver
2. Sensory symptoms:
– Numbness or paresthesia in the affected dermatome
– Altered sensation to light touch, pinprick, or temperature
3. Motor symptoms:
– Weakness in the muscles innervated by the affected nerve root
– Reduced deep tendon reflexes
4. Specific patterns based on affected nerve root:
– C5: Pain in shoulder and upper arm; weakness in deltoid and biceps
– C6: Pain in lateral forearm and thumb; weakness in biceps and wrist extensors
– C7: Pain in posterior arm and middle finger; weakness in triceps and wrist flexors
– C8: Pain in medial forearm and little finger; weakness in hand intrinsics
– Cervical myelopathy
– Brachial plexopathy
– Peripheral nerve entrapment syndromes (e.g., carpal tunnel syndrome)
– Shoulder pathology (e.g., rotator cuff tendinopathy)
– Thoracic outlet syndrome
– Cardiac referred pain
1. History and physical examination:
– Detailed neurological examination
– Provocative tests (e.g., Spurling’s test, shoulder abduction relief test)
2. Imaging studies:
– Plain radiographs: Assess for degenerative changes, alignment, and stability
– MRI: Gold standard for visualizing soft tissue structures and nerve root compression
– CT: Useful for evaluating bony anatomy and foraminal stenosis
3. Electrodiagnostic studies:
– EMG and nerve conduction studies: Help confirm diagnosis and localize the affected level
4. Additional tests (as indicated):
– Blood tests: To rule out inflammatory or infectious causes
– CT myelography: When MRI is contraindicated or inconclusive
1. Conservative treatment (first-line approach):
– Pain management:
• NSAIDs
• Short-term oral corticosteroids
• Opioids (for severe, acute pain)
– Physical therapy:
• Cervical traction
• Postural education
• Strengthening exercises
– Activity modification and ergonomic adjustments
– Cervical collar (short-term use only)
2. Interventional procedures:
– Epidural steroid injections:
• Transforaminal or interlaminar approach
• Provides short to medium-term pain relief
– Cervical medial branch blocks and radiofrequency ablation:
• For facet joint-mediated pain
3. Surgical intervention (for refractory cases or progressive neurological deficits):
– Anterior cervical discectomy and fusion (ACDF)
– Posterior cervical foraminotomy
– Artificial disc replacement
– Majority of patients (75-90%) improve with conservative management within 4-6 months
– Factors associated with poor prognosis:
• Older age
• Smoking
• Presence of myelopathy
• Duration of symptoms >6 months before treatment
Prevention and Patient Education:
– Maintain good posture and ergonomics
– Regular neck exercises and stretches
– Smoking cessation
– Weight management
– Stress reduction techniques
1. Regenerative medicine:
– Stem cell therapy for disc regeneration
– Platelet-rich plasma injections
2. Minimally invasive surgical techniques:
– Endoscopic foraminotomy
– Percutaneous disc decompression
3. Neuromodulation:
– Spinal cord stimulation for chronic radicular pain
4. Advanced imaging techniques:
– Diffusion tensor imaging (DTI) for better visualization of nerve roots
5. Personalized medicine:
– Genetic profiling to predict response to treatments and risk of chronic pain development
Cervical radiculopathy is a common condition that can significantly impact a patient’s quality of life. A thorough understanding of its pathophysiology, clinical presentation, and management options is crucial for optimal patient care. While most cases respond well to conservative treatment, a multidisciplinary approach involving pain management, physical therapy, and, in select cases, surgical intervention is often necessary. Ongoing research in regenerative medicine and minimally invasive techniques holds promise for improving outcomes in the future.
©2025 Dr Frank McCormick All Rights Reserved.
©2025 Dr Frank McCormick All Rights Reserved.
