Cervical Radiculopathy

Overview

Cervical radiculopathy is a condition caused by dysfunction of one or more nerve roots in the neck, most often from mechanical compression, chemical irritation, or both, at the point where the nerve exits the spine. Each cervical nerve root serves a predictable pattern in the arm, so the level involved determines where symptoms are felt. It is relatively common, with a peak in the fifth and sixth decades of life, and the C7 nerve root is affected most often, followed by C6.

What causes it

There are two dominant structural causes. A soft disc herniation that presses on the nerve tends to affect younger patients. Degenerative foraminal narrowing, from bone spurs, disc-space collapse, and thickened ligament, predominates in older patients. Compression alone does not fully explain the pain: inflammatory mediators released from the disc sensitize the nerve root, which contributes to the burning pain, altered sensation, and weakness that define the syndrome. Risk factors include advancing age with cervical spondylosis, prior neck trauma, heavy manual labor and repetitive lifting, vibration exposure, and tobacco use.

Symptoms and warning signs

The hallmark is one-sided neck pain radiating into the shoulder, arm, and hand in a specific nerve pattern, often with tingling, numbness, and variable weakness. Symptoms are frequently worsened by extending or rotating the neck toward the affected side and relieved by resting the arm up over the head. Most patients improve over weeks to months with non-operative care.

Certain features point beyond a straightforward pinched nerve. Symptoms in both arms, hand clumsiness, changes in balance or walking, or overactive reflexes can suggest pressure on the spinal cord itself (cervical myelopathy) and warrant prompt evaluation. Fever, night sweats, unexplained weight loss, a history of cancer, or unrelenting night pain should prompt assessment for infection or malignancy.

How it's diagnosed

Diagnosis is primarily clinical (the history and physical examination localize the affected nerve) with imaging used to confirm a lesion that matches the exam. MRI is the preferred study because it shows disc herniation, nerve-root and canal narrowing, and the spinal cord without radiation. CT, sometimes with myelography, is reserved for patients who cannot have an MRI or when fine bony detail is needed. Because harmless degenerative findings are extremely common on cervical MRI, imaging must be matched to the symptomatic nerve. Electrodiagnostic studies (EMG and nerve conduction studies) can confirm radiculopathy and distinguish it from nerve entrapment such as carpal or cubital tunnel syndrome.

Treatment options

Most patients are managed without surgery. Initial care includes relative activity modification, short courses of anti-inflammatory medication, neuropathic agents for stubborn pain, a structured physical therapy program, and clear education about the typically self-limited course. Selective cervical epidural steroid injections can confirm the level and provide meaningful relief in well-chosen patients when performed by experienced proceduralists.

When surgery is considered

Surgery is considered when radicular pain remains disabling despite six to twelve weeks of appropriate non-operative care, when there is significant or progressive weakness, or when imaging-confirmed compression matches the clinical picture. Any evolving sign of myelopathy strengthens the case for timely referral. Common procedures include anterior cervical discectomy and fusion, cervical disc replacement in appropriate candidates, and posterior foraminotomy for lateral soft-disc herniations.