Cervical Myelopathy vs. Radiculopathy

Cervical myelopathy and cervical radiculopathy are neurologic conditions. They both originate in the neck and cause a loss of function.

  • Cervical myelopathy is caused by compression of the spinal cord itself. It can cause symptoms in your arms, hands, and legs.
  • Cervical radiculopathy (sometimes called a “pinched nerve”) occurs when a nerve in your neck is compressed or irritated where it exits your spinal cord. This can cause pain that radiates into your shoulder. It can also cause muscle weakness and numbness that travels down your arm and into your hand.

Symptoms

Cervical Radiculopathy Symptoms

Symptoms of cervical radiculopathy vary from person to person. The condition usually causes sharp, shooting pain from your neck down to your arm and fingers. Some people with cervical radiculopathy also experience a dull ache in their shoulder blade. 

The location of your symptoms depends on which nerve or nerves are involved. 

What Does Cervical Radiculopathy Pain Feel Like?

Cervical radiculopathy pain can:

  • be intense,
  • worsen when you move or are active, and
  • come on gradually or suddenly.

Cervical Myelopathy Symptoms

Cervical myelopathy symptoms include:

  • problems with dexterity (difficulty doing tasks with your hands),
  • weakness in your hands,
  • difficulty with balance when walking, and
  • numbness and tingling down one or both arms.

Some people with cervical myelopathy experience neck pain, but this is less common.

Cervical Radiculopathy & Myelopathy Causes

Cervical radiculopathy and myelopathy is usually caused by wear and tear on your spine—also known as degenerative spine disease. This condition typically affects people ages 50 or older. The most common types of degenerative spine disease associated with cervical radiculopathy and myelopathy include:

  • arthritis,
  • a herniated disk, and
  • a bone spur (bony growths that form on the edge of a bone).

Other causes of cervical radiculopathy include:

  • trauma (such as a car crash),
  • a tumor, and 
  • an infection. 

Cervical Radiculopathy Treatment

If you are experiencing symptoms of cervical radiculopathy, make an appointment with your primary care provider. Your provider may recommend:

  • non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) or naproxen sodium (Aleve);
  • a corticosteroid injection to relieve pain and reduce inflammation; and
  • physical therapy.

Conservative (non-surgical) methods usually provide relief and return you to your daily activities. Many people with cervical radiculopathy do not need surgery to treat their condition. Sometimes symptoms go away on their own without any treatment. 

Cervical Radiculopathy Surgery

If conservative treatment hasn’t worked for cervical radiculopathy, your spine specialist may recommend spinal decompression surgery. Cervical radiculopathy surgery can take one to three hours, depending on the extent of the repair and what techniques your spine surgeon uses. Some surgeries happen on an outpatient basis. Others involve a one- to two-night hospital stay.

How Long Does It Take to Heal from Cervical Radiculopathy Surgery?

Nearly all patients who have surgery for cervical radiculopathy notice an immediate improvement in their symptoms. For others, progress is more gradual. The pain relief often happens first, followed by improvements in numbness and tingling. Your symptoms may continue to get better for weeks or months after surgery. Some patients still have lingering long-term symptoms, but most report doing much better than before surgery.

Cervical Myelopathy Treatment: Spine Surgery

Non-surgical methods are often not effective in relieving the symptoms of cervical myelopathy. Your spine specialist will make a treatment recommendation based on your symptoms and imaging results. If you have cervical myelopathy, you will likely need spinal decompression surgery.

About 90 percent of people with cervical myelopathy have spinal decompression surgery, but it isn’t right for everyone. If you have mild symptoms, your spine surgeon will suggest taking a “wait and see” approach.

The purpose of spinal decompression surgery is to relieve pressure on the spine by:

  • removing bone spurs, herniated disks, or other structural problems that are causing symptoms,
  • stabilizing the spine, and
  • restoring normal cervical (neck) alignment.

Your spine surgeon will plan your surgery based on many factors, including your anatomy and the extent of degenerative disease in your spine. Some surgeries involve an anterior approach (making an incision in the front of the neck), and others involve a posterior approach (making an incision in the back of the neck). The spine surgeon will customize your surgery to meet your unique needs and ensure the best outcome possible.

How Long Is Cervical Myelopathy Surgery?

Cervical myelopathy surgery can take one-and-a-half to five hours, depending on the extent of the repair and what techniques your spine surgeon uses. Most patients stay overnight at the hospital for one to three nights.

Spine Surgery Recovery

Your recovery from cervical myelopathy or radiculopathy surgery will depend primarily on whether your spine surgeon takes an anterior or posterior approach. 

Anterior Approach Recovery

An anterior approach involves:

    • a one- to two-night hospital stay,
    • neck muscle soreness,
    • difficulty swallowing that goes away in two weeks to three months, and
    • hoarseness that can last two weeks to two months.

Most patients can resume their usual activities in two to four weeks.

Posterior Approach Recovery

A posterior approach involves:

    • a two- to three-day hospital stay, and
    • pain at the incision site.

Most patients return to their normal activities in four to six weeks. 

Cervical Radiculopathy Physical Therapy

Your spine surgeon may recommend physical therapy after you have cervical radiculopathy surgery. This can help you:

  • build strength, 
  • improve coordination, posture, and balance,
  • increase range of motion,
  • reduce muscle pain in the neck, and
  • resume your usual activities more quickly.

Physical therapy can begin within a few weeks of surgery and continue two to three times a week for six to eight weeks. Your physical therapist will provide you with at-home exercises. 

Physical Therapy after Spine Surgery

 Your spine surgeon may recommend physical therapy after you have spine surgery. This can help you:

  • build strength, 
  • improve coordination, posture, and balance,
  • increase range of motion,
  • reduce muscle pain in the neck, and
  • resume your usual activities more quickly.

Physical therapy can begin within a few weeks of surgery and continue two to three times a week for six to eight weeks. Your physical therapist will provide you with at-home exercises.

What to Expect at Your First Surgical Appointment

The spine surgery care team at University of Utah Health includes neurosurgeons, orthopedic spine surgeons, surgical residents, and advanced practice providers. Your first appointment will consist of:

  • a physical exam to evaluate your neurologic symptoms,
  • a conversation about your medical history and symptoms,
  • a review of your MRI scans, and 
  • X-rays, if you have not already had them. 

If you haven’t had an MRI before your appointment at U of U Health, your spine surgeon will order one for you.

Learn What to Expect at Your Spine Surgery Appointment

Diagnostic Tests

Several tests help our spine specialists diagnose cervical radiculopathy and myelopathy. These tests include:

Your spine specialist may do other tests to decide whether to recommend surgery and what type of spinal decompression surgery to do. 

  • Electrodiagnostic tests measure the electrical activity that your muscles and nerves produce. These tests help identify the areas of degenerative disease in your spine.
  • Steroid injections pinpoint which nerves are compressed or irritated. Your provider will inject the corticosteroid medication to target specific nerve roots in your neck. If you experience significant pain relief after the injection, your provider will better know which nerves to target during surgery.

Make An Appointment

Talk with your primary care provider if you are concerned about symptoms that could be related to cervical radiculopathy or myelopathy. If your provider refers you to a spine surgeon at U of U Health, schedule an evaluation with one of our spine specialists.