Can Cervical Degenerative Arthritis Cause Nerve Root Compression?
Yes, cervical degenerative arthritis directly causes nerve root compression through multiple mechanisms, including facet joint hypertrophy, uncovertebral joint hypertrophy, and associated disc bulging or herniation. 1
Mechanisms of Nerve Root Compression
Cervical radiculopathy results from compressive causes related to narrowing of the neural foramina through the following degenerative processes:
Facet joint hypertrophy from degenerative arthritis directly narrows the neural foramina, compressing exiting nerve roots 1
Uncovertebral joint hypertrophy (also called "hard disc" pathology) creates bony spurs that impinge on nerve roots as they exit the spinal canal 1, 2
Associated disc bulging or herniation ("soft disc" pathology) frequently accompanies the degenerative spondylotic changes and contributes to nerve root compression 1, 2
Degenerative spondylosis represents the overall arthritic process that combines these elements to create foraminal stenosis 1
Clinical Presentation
The nerve root compression from cervical degenerative arthritis manifests as:
Cervical radiculopathy syndrome: combination of neck pain with arm pain, accompanied by varying degrees of sensory or motor function loss in the affected nerve root distribution 1
Dermatomal sensory changes: numbness, tingling, or paresthesias following the specific nerve root distribution 2, 3
Motor weakness: affecting specific muscle groups corresponding to the compressed nerve root 2, 3
Reflex changes: diminished deep tendon reflexes, particularly of the triceps 4
Important Clinical Caveats
Imaging findings correlate poorly with symptoms in many cases. Spondylotic changes are commonly identified on radiographs and MRI in patients >30 years of age and correlate poorly with the presence of neck pain 1. This creates both false-positive and false-negative findings on MRI 1, 2.
Physical examination has limited predictive value. A recent meta-analysis found limited evidence for correlation between physical examination findings and MRI evidence of cervical nerve root compression 1. This means you cannot rely on physical exam alone to confirm nerve root compression.
Most cases resolve with conservative treatment. Despite the presence of nerve root compression from degenerative arthritis, 75-90% of patients achieve symptomatic improvement with nonoperative management 1, 2, 4.
Diagnostic Approach
MRI is the preferred imaging modality for evaluating suspected nerve root compression, with 88% accuracy in predicting lesions causing radiculopathy 1, 2
CT provides superior visualization of bony elements (facet and uncovertebral joint hypertrophy) but is less sensitive than MRI for nerve root compression overall 1
Imaging should always be correlated with clinical symptoms before attributing radiculopathy to degenerative findings, given the high rate of asymptomatic degenerative changes 1, 2