HLA-B27 Testing is NOT Warranted for Cervical Spondylosis with Radiculopathy and Bone Spurs
HLA-B27 testing should not be ordered for patients presenting with cervical spondylosis, radiculopathy, and bone spurs, as these findings represent typical degenerative disease rather than inflammatory spondyloarthropathy.
Clinical Distinction Between Degenerative and Inflammatory Disease
The clinical presentation described—cervical spondylosis with radiculopathy and bone spurs—represents classic degenerative disc disease, not inflammatory spondyloarthropathy:
Cervical spondylosis with radiculopathy results from mechanical nerve root compression caused by herniated disc material, calcified discs, or osteophytes (bone spurs), which are degenerative changes typical in middle-aged and elderly patients 1, 2
Bone spurs (osteophytes) are hallmarks of degenerative disease, not the syndesmophytes or bamboo spine characteristic of ankylosing spondylitis where HLA-B27 would be relevant 3
Radiculopathy from cervical spondylosis presents with neck pain radiating to the arm with sensory or motor deficits in a dermatomal distribution, which is mechanically mediated compression rather than inflammatory pathology 4, 2, 5
When HLA-B27 Testing Would Be Appropriate
HLA-B27 testing is indicated for suspected inflammatory spondyloarthropathies (ankylosing spondylitis, reactive arthritis, psoriatic arthritis), which present with distinctly different clinical features:
- Inflammatory back pain (insidious onset, age <40 years, morning stiffness >30 minutes, improvement with exercise, nocturnal pain in second half of night)
- Sacroiliitis on imaging
- Syndesmophytes (vertical bony bridges) rather than degenerative osteophytes
- Systemic inflammatory features (uveitis, inflammatory bowel disease, psoriasis, enthesitis)
Clinical Management Focus
For cervical spondylosis with radiculopathy and bone spurs, the appropriate diagnostic and therapeutic approach includes:
MRI of the cervical spine without contrast to confirm nerve root compression and evaluate soft tissue pathology 4
Conservative management as first-line therapy, since 75-90% of cervical radiculopathy patients achieve symptomatic relief with nonoperative treatment including activity modification, physical therapy, NSAIDs, and cervical immobilization 4, 2
Surgical consultation (posterior laminoforaminotomy or anterior approaches) only for progressive neurologic deficits, severe refractory pain, or myelopathy 1
Common Pitfall to Avoid
Do not confuse degenerative osteophytes with inflammatory syndesmophytes. The presence of bone spurs in cervical spondylosis represents wear-and-tear changes from disc degeneration, not the inflammatory new bone formation seen in HLA-B27-associated spondyloarthropathies 3. Ordering HLA-B27 in this degenerative context wastes resources and may lead to diagnostic confusion, as HLA-B27 is present in 6-8% of the general Caucasian population without disease.