Can mild cervical disc height loss and facet arthropathy cause cervical radiculopathy?

Can Mild Cervical Disc Height Loss and Facet Arthropathy Cause Cervical Radiculopathy?

Yes, mild cervical disc height loss and facet arthropathy can cause cervical radiculopathy through nerve root compression or irritation, though the correlation between imaging findings and symptoms is often inconsistent. 1, 2

Pathophysiology of Cervical Radiculopathy

• Cervical radiculopathy occurs when a spinal nerve root becomes compressed or irritated, resulting in pain and neurological symptoms that follow the distribution of the affected nerve 2, 3
• Compression can be caused by either "soft disc" (herniated disc material) or "hard disc" (spondylarthrosis including facet or uncovertebral joint hypertrophy) or a combination of both 1, 2
• Facet arthropathy can lead to foraminal narrowing, which may compress the exiting nerve root 4
• Disc height loss can contribute to foraminal stenosis and subsequent nerve root compression 5

Diagnostic Challenges

• Degenerative findings on imaging are commonly observed in asymptomatic patients and correlate poorly with the presence of neck pain 1
• Approximately 65% of asymptomatic patients 50-59 years of age have radiographic evidence of significant cervical spine degeneration 1
• In a study of 1,581 patients between 18 and 97 years of age, 53.9% of individuals demonstrated disc degenerative changes, with prevalence and severity increasing with age 1
• MRI demonstrates frequent false-negative and false-positive findings in the setting of suspected cervical radiculopathy 1

Imaging Considerations

• MRI is the most sensitive imaging modality for assessment of soft tissue abnormalities and is useful for the assessment of suspected nerve root impingement 1
• CT offers superior depiction of bony elements relative to radiographs, particularly potential nerve-impinging osseous structures such as osteophytes, uncovertebral joints, and facet joints 1
• CT is less sensitive than MRI for evaluation of nerve root compression, particularly in cases of herniated disc 1
• MRI alone should not be used to diagnose symptomatic cervical radiculopathy and should always be interpreted in combination with clinical findings 1, 2

Clinical Correlation

• Diagnosis of cervical radiculopathy requires a combination of clinical history, physical examination, and imaging 1
• A systematic review assessing the value of physical tests in diagnosis of cervical radiculopathy found limited evidence for the accuracy of physical examinations compared to imaging or surgery 1
• Cervical radiculopathy typically presents with neck and/or upper limb pain with or without varying degrees of sensory or motor deficits 1, 4
• Abnormal levels on MRI do not always correspond to abnormal clinical-physical examination levels 1

Clinical Course and Management

• Cervical radiculopathy is frequently self-limiting, with 75% to 90% of patients achieving symptomatic relief with nonoperative conservative therapy 1, 6, 5
• Conservative treatment includes immobilization, anti-inflammatory medications, physical therapy, cervical traction, and epidural steroid injections 6, 5
• Surgical intervention should be considered for patients with persistent or progressive neurological deficits despite conservative management 2, 5
• Surgical options include anterior cervical decompression and fusion, cervical disk arthroplasty, and posterior foraminotomy 7, 5

Important Considerations

• The presence of mild degenerative changes on imaging does not necessarily indicate that these changes are the cause of a patient's symptoms 1
• Always evaluate for red flags that might indicate more serious pathology requiring urgent intervention 2, 8
• A multimodal approach to diagnosis and treatment is often necessary due to the complex relationship between imaging findings and clinical symptoms 6