Management of Cervical Radiculopathy

Diagnostic Approach

The American College of Radiology recommends MRI of the cervical spine without contrast as the appropriate initial imaging study for patients with cervical radiculopathy, characterized by neck pain radiating to the arm with tingling 1
Cervical radiculopathy has an annual incidence of 83 per 100,000 persons and frequently presents with neck and upper limb pain with varying degrees of sensory or motor deficits 1
The presence of radicular symptoms, such as arm radiation and hand tingling, distinguishes cervical radiculopathy from simple mechanical neck pain and warrants advanced imaging 1, 2

MRI is the most sensitive imaging modality for assessing soft tissue abnormalities, including disc herniations, nerve root compression, and spinal cord pathology 1
In the presence of radiculopathy symptoms, MRI is considered first-line imaging, even though it would not be recommended for isolated neck pain without neurologic symptoms 1, 2
Contrast is not necessary unless there is concern for infection or malignancy, which are not suggested by the clinical presentation of cervical radiculopathy 2

The American College of Radiology states that cervical radiculopathy is frequently self-limiting, with 75-90% of patients achieving symptomatic relief with nonoperative therapy 1
Approximately 30-50% of patients with chronic neck pain will develop symptoms or disability lasting more than one year 1

Progressive motor weakness or neurological deficits require urgent evaluation 4
Bilateral symptoms suggesting myelopathy require urgent evaluation 4
New bladder or bowel dysfunction requires urgent evaluation 4
Loss of perineal sensation requires urgent evaluation 4
Symptoms affecting both upper and lower extremities, which may indicate cervical myelopathy rather than simple radiculopathy, require urgent evaluation 4