Cervical radiculopathy and cervical myelopathy: diagnosis and management in primary care

It is important in primary care to be able to differentiate between cervical spine disease that can be managed conservatively and that associated with neurological symptoms suggestive of more serious disease, which may require urgent surgery. This article will cover key points in the history, examination, and management of patients with neck and neurological symptoms, with particular reference to cervical myelopathy and radiculopathy. The prevalence of neck pain in the general population is high: it has been estimated that 30–50% of adults will experience neck pain in any given year,1 with the average GP estimated to consult with seven people per week for neck or upper extremity symptoms.2 Neck pain with abnormal neurology (usually cervical radiculopathy) is much less common: it has been estimated to affect around 100 per 100 000 males and 60 per 100 000 females.3 Cervical myelopathy is even rarer but is worthy of discussion given that it requires urgent management and needs to be identified from among the many cases of neck and neurological symptoms that a GP sees on a regular basis — the incidence of cervical myelopathy is poorly quantified but studies have estimated it to be around 4 per 100 000.4 Cervical radiculopathy is due to compression or irritation of either or both of the dorsal (sensory) and ventral (motor) roots of a cervical nerve at one or more vertebral levels. Compression can result from intervertebral disc herniation, osteophyte formation, or other mass effects near the exit foramen of the cervical spine. This results in lower motor neurone symptoms and often presents with arm pain, weakness, and/or sensory loss, with or without associated neck pain. Cervical myelopathy is spinal cord dysfunction due to compression caused by narrowing of the spinal canal. Common causes include disc herniation, spondylosis, and congenital …