Would a neurosurgeon consider surgery for cervical radiculopathy based on an MRI showing a small posterior disc‑osteophyte complex at C6‑7 with minimal spinal canal stenosis and no nerve‑root compression?

Surgical Candidacy for Cervical Radiculopathy with Minimal Stenosis and No Nerve Root Impingement

A neurosurgeon would not recommend surgery for this MRI finding, as the absence of nerve root compression on imaging combined with only minimal stenosis does not meet the threshold for surgical intervention, regardless of clinical symptoms. 1, 2

Critical Imaging-Clinical Mismatch

The MRI findings present a fundamental problem for surgical candidacy:

• No demonstrable nerve root impingement means there is no structural target for surgical decompression, which is the primary goal of cervical spine surgery for radiculopathy 1, 3
• The small posterior disc-osteophyte complex with minimal spinal canal stenosis does not meet the "moderate, moderate-to-severe, or severe stenosis" threshold required for surgical intervention 1
• MRI has 88% accuracy in predicting surgical lesions, and when no nerve root compression is visualized, surgery is unlikely to address the patient's symptoms 1

Why Surgery Would Not Be Offered

Lack of Surgical Target

• Surgical decompression requires identifiable nerve root compression that correlates with clinical symptoms 1, 3
• Even with clinical radiculopathy symptoms, 24-57% of asymptomatic patients have disc abnormalities on MRI, making clinical-radiographic correlation essential 1
• Without visible nerve root impingement, there is no anatomic structure to decompress surgically 3

Insufficient Stenosis Grade

• The "minimal spinal canal stenosis" designation falls below the moderate stenosis threshold that guidelines establish for surgical consideration 1, 2
• Cervical disc replacement and fusion procedures are indicated when moderate-to-severe pathology is documented with corresponding nerve root compression 1, 2

Conservative Management Pathway

Since surgery is not indicated, the appropriate pathway is:

• Minimum 6 weeks of structured conservative therapy including physical therapy, NSAIDs, and activity modification, as 75-90% of cervical radiculopathy resolves with conservative care 1, 2
• Physical therapy demonstrates statistically significant clinical improvement and achieves comparable outcomes to surgical interventions at 12 months 2
• Only the 10-25% of patients who fail conservative management and have confirmatory imaging findings would be surgical candidates 1

Important Clinical Caveat

If radiculopathy symptoms are severe and persistent despite this MRI, consider:

• Repeat MRI with attention to foraminal views, as conventional myelography has 93-95% accuracy in detecting lateral recess compression that MRI may underestimate in 28-29% of cases 4
• Clinical examination findings (positive Spurling's maneuver, dermatomal sensory deficits) may warrant EMG to confirm nerve root irritation even when MRI is equivocal 1
• Symptoms may originate from dynamic compression not visible on static MRI, though this would still require demonstrable pathology before surgery 5

The fundamental principle: surgical intervention requires both clinical symptoms AND radiographic confirmation of nerve root compression—this case lacks the latter. 1, 3