Combined Radiculopathy and Myelopathy in Cervical Stenosis: Prevalence, Natural History, and Timing of Surgery

Prevalence of Combined Symptoms

Approximately 51 % of patients with cervical myelopathy present with both radiculopathy and myelopathy 1.
The presence of clinical radiculopathy or abnormal electromyography (EMG) in cervical stenosis patients is associated with subsequent development of symptomatic myelopathy, indicating frequent coexistence or progression of the two conditions 1.

Long periods of clinical quiescence are common in cervical spondylotic myelopathy (CSM); many patients experience a slow, stepwise decline rather than an abrupt deterioration [1][2].
About three‑quarters (≈ 75 %) of patients experience episodic emergence of new symptoms, separated by intervals of relative stability 2.

In younger patients with mild CSM (age < 75 years, modified Japanese Orthopaedic Association score > 12), both operative and non‑operative strategies are acceptable because measurable acute deterioration is rare [1][2].
For patients with severe and/or long‑lasting symptoms, operative treatment should be offered because the probability of meaningful improvement with non‑operative measures is low [1][2].
Prolonged severe stenosis over many years can cause demyelination and possible necrosis of spinal‑cord tissue, leading to potentially irreversible neurological deficits; this underscores the need for timely intervention [1][2].
In cervical stenosis patients without overt myelopathy but with abnormal EMG findings or clinical radiculopathy, decompressive surgery should be considered because these findings predict the future development of symptomatic myelopathy [1][2].

Delaying surgery excessively in patients who have both radiculopathy and myelopathy may result in irreversible spinal‑cord damage. While a one‑year symptom duration aligns with the typical natural history, continued postponement increases the risk of permanent neurological deficit, especially when combined symptoms are present [1][2].