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Neurological Conditions

Cervical Radiculopathy

Cervical Radiculopathy · M54.12

Cervical radiculopathy is a condition in which cervical spinal nerve roots are compressed or irritated, causing pain, sensory disturbance, and muscle weakness in the affected nerve distribution territory.

2026-03-29

At a Glance

Cervical radiculopathy, commonly referred to as a "neck disc problem," is primarily caused by nerve root compression from cervical disc herniation or osteophyte formation. It has an annual incidence of approximately 83 per 100,000 population and is most common in the 40-50 age group [1]. Characteristic features include pain, numbness, and muscle weakness radiating to the arm and hand. Approximately 80-90% of patients improve with conservative treatment [2]. Surgery is considered when neurological deficits progress or there is no response to conservative treatment.

Definition and Overview

Cervical radiculopathy is a condition in which cervical spinal nerve roots (C1-C8) are compressed, stretched, or inflamed, producing pain, sensory disturbance, and muscle weakness in the corresponding dermatome and myotome territories. While colloquially called a "neck disc," causes include not only disc herniation but also cervical spondylosis, osteophytes, and ossification of the posterior longitudinal ligament, among others.

It has an annual incidence of approximately 83 per 100,000 population, is slightly more common in men, and most frequently occurs in the 40-50 age group [1]. The C6 and C7 nerve roots are most commonly affected, accounting for approximately 70% of all cervical radiculopathy cases [3].

Etiology

Disc-Related Causes

Cervical disc herniation (herniated nucleus pulposus) is the most common cause of radiculopathy in younger patients. The nucleus pulposus protrudes through the annulus fibrosus, compressing adjacent nerve roots and inducing chemical inflammation.

Degenerative Changes

In patients over 50, degenerative changes from cervical spondylosis -- including osteophyte formation, foraminal stenosis, and ligamentum flavum hypertrophy -- are the primary causes. Since degenerative changes progress gradually, symptom onset is often gradual.

Other Causes

Trauma, tumors, infections, ossification of the posterior longitudinal ligament (OPLL), and atlantoaxial instability due to rheumatoid arthritis are rare causes of radiculopathy.

Symptoms

Key Symptoms by Cervical Level

Symptom distribution varies depending on the level of the compressed nerve root.

  • C5 nerve root: Deltoid area pain, shoulder abduction weakness, lateral upper arm sensory disturbance
  • C6 nerve root: Thumb and index finger numbness, wrist extension weakness, diminished biceps reflex
  • C7 nerve root: Middle finger numbness, triceps weakness, diminished triceps reflex
  • C8 nerve root: Ring and little finger numbness, hand intrinsic muscle weakness, diminished grip strength

Pain Characteristics

Characteristic pain radiates from the neck to the shoulder, interscapular area, down the arm, and to the fingers. It worsens with neck extension or rotation toward the affected side and may be relieved by raising the affected arm above the head (shoulder abduction relief sign).

Diagnosis

Physical Examination

  • Spurling test: Tilting the head toward the affected side and applying axial compression reproduces radicular pain. With a specificity of approximately 93%, a positive result has high diagnostic value [3].
  • Shoulder abduction test: Pain relief when the arm is raised above the head
  • Upper extremity strength testing and deep tendon reflex assessment

Imaging Studies

  • Cervical MRI: The most useful study, directly visualizing soft tissues (disc, ligaments) and nerve root compression.
  • Cervical X-ray: Evaluates bony changes including osteophytes, foraminal stenosis, and alignment abnormalities
  • CT: Used supplementally when detailed evaluation of bony lesions is needed.

Electrodiagnostic Studies

Nerve conduction studies (NCS) and electromyography (EMG) are useful for objective confirmation of radiculopathy, determining the affected level, and differentiating from peripheral nerve entrapment. Since denervation findings do not appear until 3-4 weeks after symptom onset, the timing of testing should be considered.

Treatment

Conservative Treatment

Approximately 80-90% of patients improve with conservative treatment [2][4].

  • Pharmacotherapy: NSAIDs, muscle relaxants, and gabapentin or pregabalin are effective for neuropathic pain.
  • Physical therapy: Includes cervical traction, manual therapy, and neck strengthening exercises.
  • Cervical brace: Short-term (1-2 weeks) cervical collar use during the acute phase may help alleviate pain [2].
  • Epidural steroid injection: Cervical epidural steroid injection is considered when there is no response to conservative treatment.

Surgical Treatment

Surgery is considered when there is no improvement after 6-12 weeks of conservative treatment, progressive muscle weakness, or signs of myelopathy (gait disturbance, fine motor impairment of the hands, bladder dysfunction).

  • Anterior cervical discectomy and fusion (ACDF): The most commonly performed surgical procedure.
  • Artificial disc replacement: An alternative method that preserves the motion segment.
  • Posterior foraminotomy: Can be applied for single-level soft disc herniation.

Course and Prognosis

Overall, the prognosis is favorable. With conservative treatment alone, most patients achieve meaningful symptom improvement within 4-6 months. Even among surgically treated patients, pain reduction and functional recovery are reported in more than 90% [5].

The recurrence rate is approximately 25-30%, as progressive degenerative changes in adjacent segments may produce new nerve root compression.

Lifestyle Guide

  • Regularly perform deep neck flexor strengthening exercises.
  • Avoid prolonged static postures and stretch the neck every 30-60 minutes.
  • Use a pillow of appropriate height that maintains the natural cervical lordosis.
  • Avoid lifting heavy objects with one hand.
  • When using a smartphone, raise the screen to eye level to reduce cervical flexion.

Frequently Asked Questions

Strictly speaking, they are different. "Neck disc" is a colloquial term referring to cervical disc herniation, while cervical radiculopathy is a clinical syndrome caused by nerve root compression from various causes, including but not limited to disc herniation. Even if disc herniation is present, it is not diagnosed as radiculopathy unless there are nerve root compression symptoms.

No, the causes of arm numbness are diverse. Carpal tunnel syndrome, peripheral neuropathy, thoracic outlet syndrome, and diabetic neuropathy can also cause arm numbness. Differential diagnosis is needed based on the distribution pattern, aggravating factors, and accompanying symptoms, and nerve conduction studies and MRI are used to distinguish the cause.

Most patients improve without surgery. According to systematic reviews, approximately 80-90% of patients show symptom improvement with conservative treatment alone, including medication, physical therapy, and cervical bracing [2]. Surgery is considered when there are signs of myelopathy such as progressive muscle weakness, gait disturbance, or bladder dysfunction.

Asymptomatic disc protrusion is very common. Approximately 25-30% of adults over 40 have cervical disc protrusions on MRI without symptoms [5]. If there are no symptoms, observation without specific treatment is appropriate, and neck strengthening exercises and maintaining proper posture are recommended.

Consistently perform neck strengthening exercises and avoid prolonged static postures (especially when using computers and smartphones). Proper sleeping posture (using a pillow that maintains the natural cervical curvature) and regular stretching help reduce the risk of recurrence.

References

  1. [1] Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT (1994). "Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990." Brain, 117: 325-335. DOI PubMed
  2. [2] Kuijper B, Tans JT, Beelen A, Nollet F, de Visser M (2009). "Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial." BMJ, 339: b3883. DOI PubMed
  3. [3] Iyer S, Kim HJ (2016). "Cervical radiculopathy." Current Reviews in Musculoskeletal Medicine, 9: 272-280. DOI PubMed
  4. [4] Thoomes EJ, Scholten-Peeters W, Windt DA, van der Heijden GJ, de Boer MR, Castien RF, Verhagen AP (2013). "The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review." Clinical Journal of Pain, 29: 1073-1086. DOI PubMed
  5. [5] Woods BI, Hilibrand AS (2015). "Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment." Journal of Spinal Disorders & Techniques, 28: E251-E259. DOI PubMed

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