Expertise · Diagnosis & treatment
Cervical Spine
Neck pain is common – but when it radiates into the shoulder, arm or hand, or is accompanied by numbness and loss of strength, it usually indicates involvement of the cervical spine. In rare cases, pressure can develop on the spinal cord itself – a situation that requires careful assessment.
What is behind cervical spine complaints?
The cervical spine is the most mobile yet most vulnerable region of the spine. Wear and tear can cause discs to bulge or herniate, the facet joints to degenerate, and bone spurs to form. It is important to distinguish two clinical pictures:
Cervicobrachialgia
A single nerve root is compressed by a disc herniation or bone spurs. Characteristic: pain radiating into one arm, accompanied by tingling and numbness in a specific finger distribution. Frequently self-limiting.
Cervical Myelopathy
Pressure on the spinal cord itself – a more serious situation. Symptoms can affect both arms and legs, with coordination problems, gait difficulties or bladder dysfunction. Without treatment, irreversible spinal cord damage may occur.
Symptoms
Nerve root compression (cervicobrachialgia)
- Pain radiating from the neck/shoulder into the arm and hand – often burning or electric in character
- Tingling and numbness in specific fingers (depending on the affected segment)
- Loss of strength in the arm or hand
- Increased pain with head movement in a particular direction
Spinal cord compression (myelopathy)
- Unsteady gait, balance problems, "waddling gait"
- Fine motor difficulties – buttoning clothes, writing and gripping become difficult
- Weakness or numbness in the arms and legs – affecting both sides
- Bladder weakness in advanced cases
Causes and risk factors
- Disc degeneration and herniation – most common cause, often at C5/6 or C6/7
- Cervical spondylosis – bone spurs from wear of the facet joints
- Prolonged work with the head bent forward ("tech neck" from smartphone and screen use)
- Trauma – acute disc herniations after a rear-end collision or fall
- Constitutionally narrow spinal canal – increased risk of myelopathy
Diagnosis
- Neurological examination – reflexes, strength testing, sensation, Lhermitte's sign
- MRI of the cervical spine – gold standard; shows the disc, nerve root and spinal cord
- CT myelography – where findings are unclear or for surgical planning
- Neurography / MEP / SEP – functional assessment of the spinal cord when myelopathy is suspected
- Dynamic (flexion-extension) radiographs – assessment of stability
Treatment
Conservative therapy
In cervicobrachialgia, 75–90% of cases resolve with conservative treatment. Measures:
- Physiotherapy – mobilisation, postural training, strengthening of the neck muscles
- Anti-inflammatory medication, short-term corticosteroids
- Periradicular therapy (selective nerve root block) – image-guided corticosteroid injection at the affected nerve root
- Ergonomic optimisation of the workplace
Important: once myelopathy is confirmed, conservative therapy has only very limited value – a surgical indication is generally present.
When is surgery indicated?
- Confirmed myelopathy – surgery prevents further spinal cord damage
- Relevant or progressive weakness in the arm
- Cervicobrachialgia resistant to treatment after 6 weeks of conservative care
Surgical procedures
ACDF – Anterior Cervical Discectomy and Fusion
The gold standard for cervical disc herniation and myelopathy. Through a small incision at the front of the neck: removal of the disc, decompression of the spinal cord and nerve root, followed by stabilisation with a cage and plate. Very high success rate.
Cervical Disc Replacement
An alternative to fusion in younger patients without bony instability: replacement of the disc with an artificial joint that preserves motion at the segment. Careful patient selection is essential.
My approach
The clear distinction between cervicobrachialgia and myelopathy fundamentally determines the further course of action. The former can often be observed; the latter requires prompt surgical assessment, because once spinal cord damage has occurred it is only partially reversible.
Where a surgical indication exists, ACDF is a reliable, well-studied procedure with a high success rate. The decision for a disc replacement is made on an individual basis – depending on age, number of segments involved, bone quality and the extent of degeneration.
More on degenerative conditions of the spine →What does the research say?
Surgery vs conservative therapy in mild myelopathy (PLoS ONE 2012)
Fehlings et al. (AOSpine North America) showed in a prospective cohort study that patients with mild cervical myelopathy who underwent surgery fared significantly better than those treated conservatively – both in functional scores and quality of life. The authors recommend surgery even in mild myelopathy. Fehlings MG et al., PLoS ONE 2012, PMID 22905159 →
Decompression vs fusion in cervical myelopathy (NEJM 2021)
Ghogawala et al. compared anterior cervical fusion (ACDF) with posterior laminoplasty decompression in multilevel myelopathy. Both procedures significantly improved function; ACDF was associated with better 2-year outcomes. The choice of approach depends on the location of the pathology and spinal alignment. Ghogawala Z et al., NEJM 2021, PMID 34289275 →
Disc replacement vs ACDF in one- to two-level disease (long-term outcomes)
Several randomised trials with 5–10 years of follow-up show comparable or slightly better outcomes for cervical disc replacement compared with ACDF – in carefully selected patients. The main advantage is a lower rate of adjacent segment degeneration. Rao RD et al., J Bone Joint Surg Am 2017, PMID 28245182 →
Questions about your situation?
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