What is Cervical Radiculopathy
Cervical radiculopathy is a syndrome of pain and/or sensorimotor deficits caused by dysfunction, compression, or irritation of a cervical spinal nerve root as it exits the cervical spine. 1, 2
Clinical Presentation
The hallmark presentation combines:
- Neck pain with unilateral arm pain radiating in a dermatomal distribution 1, 2
- Varying degrees of sensory loss (paresthesias, numbness) in the affected nerve root distribution 1, 3
- Motor weakness in specific muscle groups corresponding to the compressed nerve root 1, 4
- Reflex changes, most commonly diminished deep tendon reflexes (particularly triceps) 5
The arm pain may occur with or without accompanying neck pain, though the combination is most typical. 3, 6
Epidemiology
- Annual incidence is approximately 83.2 per 100,000 people, making it substantially less common than general neck pain 1, 2
- Most prevalent in persons aged 50-54 years 5
- Affects both genders, though female gender is associated with poorer prognosis 1
Pathophysiology
The most common causes of nerve root compression are:
- Facet or uncovertebral joint hypertrophy causing neural foraminal narrowing 1, 2
- Intervertebral disc herniation or bulging 1, 3
- Degenerative spondylosis 1, 6
These compressive and inflammatory processes lead to nerve root dysfunction, producing the characteristic radicular symptoms. 6, 7
Diagnostic Considerations
Physical examination has limited correlation with MRI findings, with high rates of both false-positive and false-negative imaging results. 1, 2 The Spurling test, shoulder abduction test, and upper limb tension test can help confirm the clinical diagnosis. 5
Red Flag Symptoms Requiring Immediate Attention
The American College of Radiology identifies critical warning signs that demand urgent evaluation: 1, 2
- Trauma or prior neck surgery
- Suspected malignancy or infection
- Spinal cord injury or progressive myelopathy
- Systemic diseases (ankylosing spondylitis, inflammatory arthritis)
- History of intravenous drug use
- Intractable pain despite therapy
- Tenderness to palpation over vertebral body
- Concomitant vascular disease in patients >50 years
- Abnormal laboratory values (elevated ESR, CRP, WBC)
- Progressive neurological deficits
Natural History and Prognosis
Most cases resolve spontaneously or with conservative treatment, with non-operative management successful in 75-90% of patients. 1, 2 However, nearly 50% may experience residual or recurrent pain episodes up to 1 year after initial presentation. 1
Factors associated with poorer outcomes include female gender, older age, coexisting psychosocial pathology, and the presence of radicular symptoms themselves. 1
Initial Management Approach
In the absence of red flag symptoms, imaging is not required at initial presentation since spondylotic changes are commonly found in asymptomatic patients >30 years of age and correlate poorly with neck pain. 1, 2 Conservative management should be initiated first, as most patients will significantly improve without surgery. 3, 5