Cervical Radiculopathy

Our Specialists for Cervical Radiculopathy

Choosing the right operation for cervical radiculopathy depends on whether you have a soft disc herniation, bony foraminal stenosis, how many levels are involved, and whether you want motion preserved. Our spine team performs all three modern options — ACDF, cervical disc arthroplasty, and posterior cervical foraminotomy — and we match the procedure to your anatomy rather than the other way around.

Mohamad Bydon, M.D.

Chair, Department of Neurological Surgery

Dr. Bydon is the Chair of Neurological Surgery at UChicago and a pioneer in minimally invasive and robotic spine surgery. He led the stem cell trial, the first-in-human stem cell therapy for spinal cord injury, and holds 12 medical device patents with over 600 peer-reviewed publications. He was recruited to UChicago from Mayo Clinic. Dr. Bydon's published long-term series of posterior cervical foraminotomy patients helped establish the procedure's durability, with an 85% rate of arm pain improvement and a very low adjacent-segment reoperation rate of 1.3% (J Neurosurg Spine, 2014). He has also led Quality Outcomes Database analyses comparing posterior foraminotomy head-to-head with ACDF for cervical radiculopathy (J Neurosurg Spine, 2024).

Martin Herman, M.D., Ph.D.

Program Director, Neurological Surgery Residency

Dr. Herman is Program Director of the Neurological Surgery Residency and a complex spine surgeon who practices the full spectrum of spine and neurorestoration procedures. He co-developed a fully implantable wireless intraspinal microstimulation device for restoring motor function after spinal cord injury, with publications in Artificial Organs and Scientific Reports. He has been named a Top Chicago Doctor for over a decade. Dr. Herman sees cervical radiculopathy patients weekly at UChicago and performs the full range of modern options — ACDF, cervical disc arthroplasty, and posterior foraminotomy — matching the procedure to each patient's specific pathology rather than defaulting to one approach.

Timothy F. Witham, M.D., FACS

Section Chief, Spine Surgery

Dr. Witham is Section Chief of Spine Surgery at UChicago and a pioneer in augmented reality-guided spine surgery. In 2020 he performed the first FDA-cleared AR-guided spine surgery on a living patient using the xvision system, and he has published extensively on AR-assisted pedicle screw placement. He came to UChicago from Johns Hopkins, where he was Professor of Neurological Surgery and Orthopaedic Surgery and served as co-program director of the neurosurgery residency. Dr. Witham co-authored the long-term outcomes study of posterior cervical foraminotomy that remains one of the most cited series on the procedure (J Neurosurg Spine, 2014), and has spent his career refining minimally invasive and navigation-guided approaches to the cervical spine.

What Is Cervical Radiculopathy?

Cervical radiculopathy is what happens when one of the nerve roots exiting your spinal cord in the neck gets compressed or irritated. Each of those nerve roots carries signals to a specific zone of your shoulder, arm, and hand — so when one is pinched, you don't just feel neck pain. You feel pain, numbness, tingling, or weakness traveling down the arm, often in a specific pattern that tells us which nerve is involved.

It's more common than people realize. A classic population study from Rochester, Minnesota found an annual incidence of about 83 cases per 100,000 people, with the peak age between 50 and 54. The C7 nerve root (from the C6-7 disc) is by far the most commonly affected, followed by C6 and C8.

The two main ways a nerve root gets pinched in the neck are very different, and they point toward different treatments:

• Soft disc herniation — a piece of the jelly-like disc center pushes out and compresses the nerve. More common in younger adults. Often resolves on its own as the herniation shrinks.
• Spondylotic foraminal stenosis — bony arthritis and thickened ligaments gradually narrow the tunnel the nerve travels through. More common after age 50. Doesn't resolve on its own, though symptoms can wax and wane.

What Does It Feel Like?

The hallmark is arm pain that's worse than the neck pain. Many patients describe it as electric, burning, or like a deep ache — and it usually follows a specific path depending on which nerve is compressed.

Typical patterns by nerve root

• C5 (from C4-5) — pain and weakness in the shoulder and upper arm; difficulty lifting the arm out to the side
• C6 (from C5-6) — pain down to the thumb and index finger; weakness bending the elbow or extending the wrist
• C7 (from C6-7) — pain down the back of the arm into the middle finger; weakness straightening the elbow or pushing down
• C8 (from C7-T1) — pain into the ring and small fingers; weakness in the grip and small hand muscles

Other common features

• Pain that's worse when you look up or turn your head toward the painful side
• Relief when you put the affected arm behind your head (the 'shoulder abduction sign')
• Numbness and tingling in the fingers
• Waking at night with arm pain
• A weak grip, dropping things, or trouble with buttons

If you develop trouble walking, loss of hand dexterity on both sides, or new bowel or bladder changes, that's a sign the spinal cord itself may be involved (myelopathy), not just a nerve root — and that needs urgent evaluation.

How Is It Diagnosed?

Most of the diagnosis comes from the story you tell and a careful physical exam. Your doctor will test strength, sensation, and reflexes in both arms and may perform provocative maneuvers like Spurling's test — tilting and compressing the head — to try to reproduce your arm pain.

Imaging

An MRI of the cervical spine is the gold standard. It shows the discs, nerve roots, and spinal cord in detail, and will typically reveal the soft disc herniation or bony stenosis causing your symptoms. A cervical X-ray is often done first or alongside MRI to assess overall alignment, instability, and the degree of arthritis.

Here's an important caveat: MRI findings in the neck are extremely common even in people without symptoms. Your surgeon's job is to confirm that what's on the scan actually matches what's happening in your arm.

Electrodiagnostic testing

An EMG/nerve conduction study is sometimes used when the diagnosis isn't clear — for example, when the MRI shows multiple possible culprits, when symptoms don't fit a clean pattern, or to rule out other conditions like carpal tunnel syndrome, ulnar neuropathy, or brachial plexopathy.

Types of Cervical Radiculopathy

Not all pinched nerves in the neck are the same, and the underlying type shapes which surgery makes sense.

Soft disc herniation

A tear in the outer ring of the disc allows the softer inner material to push out and press on the nerve. These tend to happen more suddenly, often in people in their 30s and 40s, sometimes after lifting or an awkward movement. The body can actually resorb a herniated disc fragment over weeks to months, which is why conservative treatment works so well for many of these cases. When surgery is needed for a one-sided soft disc herniation, a posterior cervical foraminotomy can often remove the offending fragment without fusing the spine at all.

Spondylotic foraminal stenosis

With age, the discs dry out and lose height, the facet joints grow bone spurs, and the ligaments thicken. The small tunnel (foramen) where the nerve root exits gradually narrows. This is the more common cause in patients over 50, and because the problem is bony, the nerve doesn't decompress itself the way a soft herniation might. Conservative care still helps many people, but when surgery is needed, ACDF is often preferred because it restores disc height and indirectly opens the foramen.

Central versus foraminal pathology

Some patients have a disc or bone spur pressing toward the center of the canal (near the spinal cord), some have it pressing into the foramen (near the exiting nerve root), and some have both. Pure foraminal pathology on one side is the classic case for a posterior foraminotomy. Central or bilateral pathology, kyphotic alignment, or involvement of multiple levels usually point toward an anterior operation.

How Is It Treated?

Conservative care comes first — and usually works

Unless you have significant or progressive weakness, the first step is non-surgical treatment. Most people with cervical radiculopathy get better without an operation: roughly 75-90% improve within a few weeks to a few months with conservative management. A typical program includes:

• Short-term activity modification and a soft cervical collar for comfort in the first week or two
• NSAIDs or a short steroid taper for the acute flare
• Physical therapy — cervical traction, nerve glides, and posture work are the most evidence-supported components
• A cervical epidural steroid injection for patients whose arm pain is severe or not improving with oral medications and PT

We generally recommend 6 weeks of conservative care before talking about surgery, unless symptoms are severe or there's progressive weakness, signs of myelopathy, or unrelenting pain.

When surgery makes sense

The main reasons to consider surgery are: (1) severe arm pain that hasn't responded to several weeks of non-operative care, (2) progressive motor weakness, or (3) signs that the spinal cord itself is involved. There are three modern surgical options, and choosing between them is where experience matters.

Anterior cervical discectomy and fusion (ACDF)

This is the most common operation for cervical radiculopathy and has been the workhorse of spine surgery for decades. Through a small incision at the front of the neck, the surgeon removes the entire damaged disc, decompresses the nerve and spinal cord, and places a spacer (with a small plate or screws) to restore disc height and fuse that level. Arm pain relief is excellent — around 90% of patients in published series. Recovery is fast: many people go home the same day and return to desk work within a week or two. The tradeoff is that the fused level no longer moves, which places slightly more stress on the neighboring discs.

Cervical disc arthroplasty (disc replacement)

Instead of fusing the level, the damaged disc is replaced with an artificial disc that preserves motion. FDA investigational device exemption (IDE) trials comparing arthroplasty to ACDF have now followed patients out to 10 and even 20 years, and the results are consistent: arthroplasty is at least as good as ACDF for arm pain relief, and has lower rates of adjacent-segment disease and repeat surgery. The best candidates are younger patients with a soft disc herniation, good alignment, no instability, and minimal facet arthritis — the artificial disc needs a healthy joint environment to work.

Posterior cervical foraminotomy

For the right patient — typically one-sided arm pain from a lateral soft disc herniation or foraminal bone spur — a small incision is made at the back of the neck, and the surgeon removes a tiny piece of bone to uncover and decompress the nerve. No fusion, no plate, no hardware. The disc is preserved and motion is preserved. It can be done through a tubular minimally invasive approach. The FACET randomized trial out of the Netherlands showed that posterior foraminotomy was non-inferior to ACDF for arm pain relief and clinical success at 1 and 2 years. The tradeoff is that it's less suitable for central disc herniations, bilateral symptoms, or kyphotic alignment — and it's more technically demanding than it looks.

Which procedure is preferred when?

• ACDF — multilevel disease, central compression, kyphosis, bony spondylotic stenosis, or when arthroplasty isn't feasible
• Arthroplasty — younger patient, one or two levels, soft disc, good alignment, healthy facet joints, motion preservation is a priority
• Posterior foraminotomy — one-sided arm pain from a foraminal soft disc or spur, intact alignment, patient wants to avoid any fusion or anterior approach

What Are the Outcomes?

The good news about cervical radiculopathy is that results of treatment — whether conservative or surgical — are generally very good. Here's how the data breaks down:

The adjacent segment question

One concern with ACDF is adjacent segment disease — the idea that fusing one level puts extra stress on the discs above and below. The classic Hilibrand study found symptomatic adjacent segment disease developing at about 2.9% per year, with roughly 26% of patients affected by 10 years. That's a real number, but it's also important context: some of that likely reflects the natural progression of cervical spondylosis, not just the fusion itself. The FDA IDE trials comparing arthroplasty to ACDF suggest arthroplasty does reduce the risk of adjacent segment problems and reoperation at 10 years.

The bottom line

For most people with cervical radiculopathy, the outlook is genuinely good. Whether you heal with conservative care or need an operation, you should expect meaningful relief of your arm pain and return to your normal life. The decisions that matter most are which treatment fits your specific anatomy and goals, and who performs it if you need surgery.

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