Neck Pain & Radiculopathy

Neck pain is usually non-specific and improves over weeks; cervical radiculopathy is dermatomal arm pain from a compressed or irritated cervical nerve root.

Radiculopathy usually comes from disc herniation in younger adults and foraminal stenosis from spondylosis in older adults, and most cases improve without surgery. Degenerative cervical myelopathy, compression of the cord itself, is the diagnosis not to miss: it is often recognised late, and established deficits recover poorly.

The cervical spine has 7 vertebrae and 8 nerve roots. Roots C1 to C7 exit above their vertebra and C8 exits below C7, so a posterolateral C5/6 disc compresses the C6 root. The vertebral artery usually enters the transverse foramen at C6 and ascends to the foramen magnum.

Cervical spondylosis (degeneration of discs and facet joints) increases with age and is often asymptomatic, but is the usual cause of radiculopathy and myelopathy in older adults. C6 and C7 are the roots most often affected.

Myelopathy is compression of the spinal cord by a central disc, spondylotic canal stenosis, ossification of the posterior longitudinal ligament or another lesion. Severity is graded with the modified Japanese Orthopaedic Association (mJOA) score.

Whiplash-associated disorders follow acceleration-deceleration injury, usually road traffic collisions, and are graded 0 to IV by the Quebec Task Force classification.