Current Reviews in Musculoskeletal Medicine

, Volume 9, Issue 3, pp 272–280 | Cite as

Cervical radiculopathy

  • Sravisht Iyer
  • Han Jo KimEmail author
Cervical Injuries and Treatment (HJ Kim, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cervical Injuries and Treatment


Cervical radiculopathy is a common clinical scenario. Patients with radiculopathy typically present with neck pain, arm pain, or both. We review the epidemiology of cervical radiculopathy and discuss the diagnosis of this condition. This includes an overview of the pertinent findings on the patient history and physical examination. We also discuss relevant clinical syndromes that must be considered in the differential diagnosis including peripheral nerve entrapment syndromes and shoulder pathology. The natural history of cervical radiculopathy is reviewed and options for management are discussed. These options include conservative management, non-operative modalities such as physical therapy, steroid injections, and operative intervention. While the exact indications for surgical intervention have not yet been elucidated, we provide an overview of the available literature regarding indications and discuss the timing of intervention. The surgical outcomes of anterior cervical decompression and fusion (ACDF), cervical disc arthroplasty (CDA), and posterior cervical foraminotomy (PCF) are discussed.


Cervical radiculopathy Physical examination Non-operative management ACDF Cervical disc arthroplasty Posterior cervical foraminotomy 


Compliance with ethical standards

Conflict of interest

Sravisht Iyer declares that he has no conflict of interest.

Han Jo Kim reports personal fees from Medtronic, Biomet, K2M, Stryker and Depuy, as well as grants from CSRS, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.•
    Radhakrishnan K, Litchy WJ, O’Fallon WM, et al. Epidemiology of cervical radiculopathy. A population-based study from rochester, minnesota, 1976 through 1990. Brain. 1994;117(Pt 2):325–35. The most widely cited epidemiologic study describing the incidence of cervical radiculopathy.CrossRefPubMedGoogle Scholar
  2. 2.
    Schoenfeld AJ, George AA, Bader JO, et al. Incidence and epidemiology of cervical radiculopathy in the united states military: 2000 to 2009. J Spinal Disord Tech. 2012;25:17–22.CrossRefPubMedGoogle Scholar
  3. 3.
    Kelsey JL, Githens PB, Walter SD, et al. An epidemiological study of acute prolapsed cervical intervertebral disc. J Bone Joint Surg Am. 1984;66:907–14.PubMedGoogle Scholar
  4. 4.
    Woods BI, Hilibrand AS. Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment. J Spinal Disord Tech. 2015;28:251.CrossRefGoogle Scholar
  5. 5.
    Wong JJ, Cote P, Quesnele JJ, et al. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J. 2014;14:1781–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Rhee JM, Yoon T, Riew KD. Cervical radiculopathy. J Am Acad Orthop Surg. 2007;15:486–94.CrossRefPubMedGoogle Scholar
  7. 7.
    Kang JD, Stefanovic-Racic M, McIntyre LA, et al. Toward a biochemical understanding of human intervertebral disc degeneration and herniation. Contributions of nitric oxide, interleukins, prostaglandin E2, and matrix metalloproteinases. Spine (Phila Pa 1976). 1997;22:1065–73.CrossRefGoogle Scholar
  8. 8.
    Van Boxem K, Huntoon M, Van Zundert J, et al. Pulsed radiofrequency: a review of the basic science as applied to the pathophysiology of radicular pain: a call for clinical translation. Reg Anesth Pain Med. 2014;39:149–59.CrossRefPubMedGoogle Scholar
  9. 9.
    Nakki A, Battie MC, Kaprio J. Genetics of disc-related disorders: current findings and lessons from other complex diseases. Eur Spine J. 2014;23(3):354.CrossRefGoogle Scholar
  10. 10.
    Sampath P, Bendebba M, Davis JD, et al. Outcome in patients with cervical radiculopathy. Prospective, multicenter study with independent clinical review. Spine (Phila Pa 1976). 1999;24:591–7.CrossRefGoogle Scholar
  11. 11.
    LEES F, TURNER JW. Natural history and prognosis of cervical spondylosis. Br Med J. 1963;2:1607–10.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Wainner RS, Gill H. Diagnosis and nonoperative management of cervical radiculopathy. J Orthop Sports Phys Ther. 2000;30:728–44.CrossRefPubMedGoogle Scholar
  13. 13.
    Viikari-Juntura E, Takala E, Riihimaki H, et al. Predictive validity of symptoms and signs in the neck and shoulders. J Clin Epidemiol. 2000;53:800–8.CrossRefPubMedGoogle Scholar
  14. 14.
    YOSS RE, CORBIN KB, MACCARTY CS, et al. Significance of symptoms and signs in localization of involved root in cervical disk protrusion. Neurology. 1957;7:673–83.CrossRefPubMedGoogle Scholar
  15. 15.•
    Rubinstein SM, Pool JJ, van Tulder MW, et al. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J. 2007;16:307–19. An excellent overview of the clinical tests for radiculopathy and their diagnostic utility.CrossRefPubMedGoogle Scholar
  16. 16.
    Eubanks JD. Cervical radiculopathy: nonoperative management of neck pain and radicular symptoms. Am Fam Physician. 2010;81:33–40.PubMedGoogle Scholar
  17. 17.
    Tong HC, Haig AJ, Yamakawa K. The spurling test and cervical radiculopathy. Spine (Phila Pa 1976). 2002;27:156–9.CrossRefGoogle Scholar
  18. 18.
    Alrawi MF, Khalil NM, Mitchell P, et al. The value of neurophysiological and imaging studies in predicting outcome in the surgical treatment of cervical radiculopathy. Eur Spine J. 2007;16:495–500.CrossRefPubMedGoogle Scholar
  19. 19.
    Caridi JM, Pumberger M, Hughes AP. Cervical radiculopathy: a review. HSS J. 2011;7:265–72.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Saal JS, Saal JA, Yurth EF. Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine (Phila Pa 1976). 1996;21:1877–83.CrossRefGoogle Scholar
  21. 21.
    Dreyer SJ, Boden SD. Nonoperative treatment of neck and arm pain. Spine (Phila Pa 1976). 1998;23:2746–54.CrossRefGoogle Scholar
  22. 22.
    Cheng CH, Tsai LC, Chung HC, et al. Exercise training for non-operative and post-operative patient with cervical radiculopathy: a literature review. J Phys Ther Sci. 2015;27:3011–8.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kuijper B, Tans JT, Beelen A, et al. Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial. BMJ. 2009;339:b3883.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Diab AA, Moustafa IM. The efficacy of forward head correction on nerve root function and pain in cervical spondylotic radiculopathy: a randomized trial. Clin Rehabil. 2012;26:351–61.CrossRefPubMedGoogle Scholar
  25. 25.
    Jellad A, Ben Salah Z, Boudokhane S, et al. The value of intermittent cervical traction in recent cervical radiculopathy. Ann Phys Rehabil Med. 2009;52:638–52.CrossRefPubMedGoogle Scholar
  26. 26.
    Fritz JM, Thackeray A, Brennan GP, et al. Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. J Orthop Sports Phys Ther. 2014;44:45–57.CrossRefPubMedGoogle Scholar
  27. 27.
    Young IA, Michener LA, Cleland JA, et al. Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Phys Ther. 2009;89:632–42.CrossRefPubMedGoogle Scholar
  28. 28.
    Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev. 2015;9, CD004249.PubMedGoogle Scholar
  29. 29.
    Ke JQ, Yin B, Fu FW, et al. A case report of locked-in syndrome due to bilateral vertebral artery dissection after cervical spine manipulation treated by arterial embolectomy. Medicine (Baltimore). 2016;95:e2693.CrossRefGoogle Scholar
  30. 30.
    Nakao Y, Terai H. Embolic brain infarction related to posttraumatic occlusion of vertebral artery resulting from cervical spine injury: a case report. J Med Case Rep. 2014;8:344.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Biller J, Sacco RL, Albuquerque FC, et al. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2014;45:3155–74.CrossRefPubMedGoogle Scholar
  32. 32.
    Mimata Y, Murakami H, Sato K, et al. Bilateral cerebellar and brain stem infarction resulting from vertebral artery injury following cervical trauma without radiographic damage of the spinal column: a case report. Skelet Radiol. 2014;43:99–105.CrossRefGoogle Scholar
  33. 33.
    Albuquerque FC, Hu YC, Dashti SR, et al. Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management. J Neurosurg. 2011;115:1197–205.CrossRefPubMedGoogle Scholar
  34. 34.
    Stav A, Ovadia L, Sternberg A, et al. Cervical epidural steroid injection for cervicobrachialgia. Acta Anaesthesiol Scand. 1993;37:562–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Carragee EJ, Hurwitz EL, Cheng I, et al. Treatment of neck pain: injections and surgical interventions: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. J Manip Physiol Ther. 2009;32:176.CrossRefGoogle Scholar
  36. 36.•
    Manchikanti L, Nampiaparampil DE, Candido KD, et al. Do cervical epidural injections provide long-term relief in neck and upper extremity pain? A systematic review. Pain Physician. 2015;18:39–60. A review of various recent trials (cited below) examining the impact of epidural injections on neck and upper extremity pain. The authors summarize the results of their various clinical trails in this manuscript as well.PubMedGoogle Scholar
  37. 37.
    Manchikanti L, Cash KA, Pampati V, et al. A randomized, double-blind, active control trial of fluoroscopic cervical interlaminar epidural injections in chronic pain of cervical disc herniation: results of a 2-year follow-up. Pain Physician. 2013;16:465–78.PubMedGoogle Scholar
  38. 38.
    Diwan S, Manchikanti L, Benyamin RM, et al. Effectiveness of cervical epidural injections in the management of chronic neck and upper extremity pain. Pain Physician. 2012;15:405.Google Scholar
  39. 39.
    Manchikanti L, Malla Y, Cash KA, et al. Fluoroscopic cervical interlaminar epidural injections in managing chronic pain of cervical postsurgery syndrome: preliminary results of a randomized, double-blind, active control trial. Pain Physician. 2012;15:13–25.PubMedGoogle Scholar
  40. 40.
    Castagnera L, Maurette P, Pointillart V, et al. Long-term results of cervical epidural steroid injection with and without morphine in chronic cervical radicular pain. Pain. 1994;58:239–43.CrossRefPubMedGoogle Scholar
  41. 41.
    Benny B, Azari P, Briones D. Complications of cervical transforaminal epidural steroid injections. Am J Phys Med Rehabil. 2010;89:601–7.CrossRefPubMedGoogle Scholar
  42. 42.•
    Levine MJ, Albert TJ, Smith MD. Cervical radiculopathy: diagnosis and nonoperative management. J Am Acad Orthop Surg. 1996;4:305–16. Notable for being one of the few papers to provide an algorithmic approach to managing cervical radiculopathy. This algorithm has been adopted by various subsequent publications.CrossRefPubMedGoogle Scholar
  43. 43.•
    Burneikiene S, Nelson EL, Mason A, et al. The duration of symptoms and clinical outcomes in patients undergoing anterior cervical discectomy and fusion for degenerative disc disease and radiculopathy. Spine J. 2015;15:427–32. One of the only papers providing a guideline for the timing of intervention in cervical radiculopathy.CrossRefPubMedGoogle Scholar
  44. 44.
    Engquist M, Lofgren H, Oberg B, et al. Factors affecting the outcome of surgical versus nonsurgical treatment of cervical radiculopathy: a randomized, controlled study. Spine (Phila Pa 1976). 2015;40:1553–63.CrossRefGoogle Scholar
  45. 45.
    van Geest S, Kuijper B, Oterdoom M, et al. CASINO: surgical or nonsurgical treatment for cervical radiculopathy, a randomised controlled trial. BMC Musculoskelet Disord. 2014;15:129.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Shriver MF, Lewis DJ, Kshettry VR, et al. Pseudoarthrosis rates in anterior cervical discectomy and fusion: a meta-analysis. Spine J. 2015;15:2016–27.CrossRefPubMedGoogle Scholar
  47. 47.
    Bertalanffy H, Eggert HR. Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. A follow-up of 164 cases. Acta Neurochir (Wien). 1988;90:127–35.CrossRefGoogle Scholar
  48. 48.
    Donaldson JW, Nelson PB. Anterior cervical discectomy without interbody fusion. Surg Neurol. 2002;57:5.CrossRefGoogle Scholar
  49. 49.
    Yamamoto I, Ikeda A, Shibuya N, et al. Clinical long-term results of anterior discectomy without interbody fusion for cervical disc disease. Spine (Phila Pa 1976). 1991;16:272–9.CrossRefGoogle Scholar
  50. 50.
    Watters WC, Levinthal R. Anterior cervical discectomy with and without fusion. Results, complications, and long-term follow-up. Spine (Phila Pa 1976). 1994;19:2343–7.CrossRefGoogle Scholar
  51. 51.
    Lehmann CL, Buchowski JM, Stoker GE, et al. Neurologic recovery after anterior cervical discectomy and fusion. Global Spine J. 2014;4:41–6.CrossRefPubMedGoogle Scholar
  52. 52.
    Burkus JK, Traynelis VC, Haid Jr RW, et al. Clinical and radiographic analysis of an artificial cervical disc: 7-year follow-up from the prestige prospective randomized controlled clinical trial: clinical article. J Neurosurg Spine. 2014;21:516–28.CrossRefPubMedGoogle Scholar
  53. 53.
    Coric D, Nunley PD, Guyer RD, et al. Prospective, randomized, multicenter study of cervical arthroplasty: 269 patients from the Kineflex|C artificial disc investigational device exemption study with a minimum 2-year follow-up: clinical article. J Neurosurg Spine. 2011;15:348–58.CrossRefPubMedGoogle Scholar
  54. 54.
    Davis RJ, Nunley PD, Kim KD, et al. Two-level total disc replacement with mobi-C cervical artificial disc versus anterior discectomy and fusion: a prospective, randomized, controlled multicenter clinical trial with 4-year follow-up results. J Neurosurg Spine. 2015;22:15–25.CrossRefPubMedGoogle Scholar
  55. 55.
    Phillips FM, Geisler FH, Gilder KM, et al. Long-term outcomes of the US FDA IDE prospective, randomized controlled clinical trial comparing PCM cervical disc arthroplasty with anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 2015;40:674–83.CrossRefGoogle Scholar
  56. 56.
    Sasso RC, Anderson PA, Riew KD, et al. Results of cervical arthroplasty compared with anterior discectomy and fusion: four-year clinical outcomes in a prospective, randomized controlled trial. J Bone Joint Surg Am. 2011;93:1684–92.CrossRefPubMedGoogle Scholar
  57. 57.•
    Hu Y, Lv G, Ren S, et al. Mid- to long-term outcomes of cervical disc arthroplasty versus anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease: a systematic review and meta-analysis of eight prospective randomized controlled trials. PLoS One. 2016;11, e0149312. A systematic-review of the longest-term outcomes of cervical disc arthroplasty showing consistently lower re-operation rates and greater clinical success with disc arthroplasty vs. ACDF. CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Peolsson A, Peolsson M. Predictive factors for long-term outcome of anterior cervical decompression and fusion: a multivariate data analysis. Eur Spine J. 2008;17:406–14.CrossRefPubMedGoogle Scholar
  59. 59.
    Bolesta MJ, Rechtine GR, Chrin AM. Three- and four-level anterior cervical discectomy and fusion with plate fixation: a prospective study. Spine (Phila Pa 1976). 2000;25:6.CrossRefGoogle Scholar
  60. 60.
    Jho HD, Kim MH, Kim WK. Anterior cervical microforaminotomy for spondylotic cervical myelopathy: part 2. Neurosurgery. 2002;51:54.Google Scholar
  61. 61.
    Kotil K, Bilge T. Prospective study of anterior cervical microforaminotomy for cervical radiculopathy. J Clin Neurosci. 2008;15:749–56.CrossRefPubMedGoogle Scholar
  62. 62.
    Cornelius JF, Bruneau M, George B. Microsurgical cervical nerve root decompression via an anterolateral approach: clinical outcome of patients treated for spondylotic radiculopathy. Neurosurgery. 2007;61:80. discussion 980.CrossRefGoogle Scholar
  63. 63.
    Park YK, Moon HJ, Kwon TH, et al. Long-term outcomes following anterior foraminotomy for one- or two-level cervical radiculopathy. Eur Spine J. 2013;22:1489–96.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Hacker RJ, Miller CG. Failed anterior cervical foraminotomy. J Neurosurg. 2003;98:126–30.PubMedGoogle Scholar
  65. 65.
    Zhang Y, Liang C, Tao Y, et al. Cervical total disc replacement is superior to anterior cervical decompression and fusion: a meta-analysis of prospective randomized controlled trials. PLoS One. 2015;10, e0117826.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Janssen ME, Zigler JE, Spivak JM, et al. ProDisc-C total disc replacement versus anterior cervical discectomy and fusion for single-level symptomatic cervical disc disease: seven-year follow-up of the prospective randomized U.S. Food and drug administration investigational device exemption study. J Bone Joint Surg Am. 2015;97:1738–47.CrossRefPubMedGoogle Scholar
  67. 67.
    Gao Y, Liu M, Li T, et al. A meta-analysis comparing the results of cervical disc arthroplasty with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease. J Bone Joint Surg Am. 2013;95:555–61.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Ren C, Song Y, Xue Y, et al. Mid- to long-term outcomes after cervical disc arthroplasty compared with anterior discectomy and fusion: a systematic review and meta-analysis of randomized controlled trials. Eur Spine J. 2014;23:1115–23.CrossRefPubMedGoogle Scholar
  69. 69.
    Upadhyaya CD, Wu JC, Trost G, et al. Analysis of the three united states food and drug administration investigational device exemption cervical arthroplasty trials. J Neurosurg Spine. 2012;16:216–28.CrossRefPubMedGoogle Scholar
  70. 70.
    Wu AM, Xu H, Mullinix KP, et al. Minimum 4-year outcomes of cervical total disc arthroplasty versus fusion: a meta-analysis based on prospective randomized controlled trials. Medicine (Baltimore). 2015;94:e665.CrossRefGoogle Scholar
  71. 71.
    Qureshi SA, McAnany S, Goz V, et al. Cost-effectiveness analysis: comparing single-level cervical disc replacement and single-level anterior cervical discectomy and fusion: clinical article. J Neurosurg Spine. 2013;19:546–54.CrossRefPubMedGoogle Scholar
  72. 72.
    Bydon M, Mathios D, Macki M, et al. Long-term patient outcomes after posterior cervical foraminotomy: an analysis of 151 cases. J Neurosurg Spine. 2014;21:727–31.CrossRefPubMedGoogle Scholar
  73. 73.
    Skovrlj B, Gologorsky Y, Haque R, et al. Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy. Spine J. 2014;14:2405–11.CrossRefPubMedGoogle Scholar
  74. 74.
    Kwon YJ. Long-term clinical and radiologic outcomes of minimally invasive posterior cervical foraminotomy. J Korean Neurosurg Soc. 2014;56:224–9.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Faught RW, Church EW, Halpern CH, et al. Long-term quality of life after posterior cervical foraminotomy for radiculopathy. Clin Neurol Neurosurg. 2016;142:22–5.CrossRefPubMedGoogle Scholar
  76. 76.
    Church EW, Halpern CH, Faught RW, et al. Cervical laminoforaminotomy for radiculopathy: symptomatic and functional outcomes in a large cohort with long-term follow-up. Surg Neurol Int. 2014;5:536.CrossRefGoogle Scholar
  77. 77.
    Mansfield HE, Canar WJ, Gerard CS, et al. Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis. Neurosurg Focus. 2014;37, E9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Hospital for Special SurgeryNew YorkUSA

Personalised recommendations