Cervical radiculopathy occurs when a compressed nerve in your neck sends waves or jolts of radiating pain through your upper body—from your neck to your shoulders, arms, and even fingers. Radicular neck pain and symptoms may be episodic—occurring periodically or continual—and vary from mild to intense.
Fortunately, several nonsurgical treatments (conservative care) are effective at managing and preventing this type of neck pain. However, some cases of nerve-related cervical pain require spine surgery.
When Is Surgery Considered for Cervical Radiculopathy?
Most people find that conservative treatments and/or epidural steroid spinal injections relieve their symptoms of cervical radiculopathy. However, a small percentage of people don’t respond to those treatments. In those cases, cervical spine surgery may become part of the treatment conversation.
Spine surgery for a compressed nerve root in the neck is a last resort treatment option, as it is not a guaranteed solution and bears certain risks and complications.
However, if you’re still experiencing radiating neck, shoulder, and arm pain after many weeks of nonsurgical treatment—or if your symptoms are getting worse or you’ve developed new symptoms—you may be a candidate for cervical spine surgery.
Types of Surgery for Radiating Neck Pain
Different types of surgical approaches are available to treat radiating neck pain. These include anterior cervical discectomy and fusion (ACDF), posterior cervical foraminotomy, and cervical artificial disc replacement. These procedures may be performed minimally invasively in a traditional hospital setting and/or in an outpatient spine surgery center.
When discussing surgical options, your doctor explains whether you are or are not a candidate for minimally invasive cervical spine surgery, or other types of neck surgery (eg, artificial disc). It is important to understand no two patients are the same and some patients have coexisting medical conditions that can increase surgical risks and complications.
Anterior Cervical Discectomy and Fusion (ACDF)
This approach is the most widely used surgical approach to relieve nerve compression in the neck. During the surgical procedure, the surgeon makes an incision through the front of the neck (anterior cervical), relieves nerve compression by removing the damaged intervertebral disc (discectomy), fills the empty disc space with interbody spacers to restore height between the vertebral bodies, and affixes spinal instrumentation (eg, plate, screws) to stabilize the cervical spine. Bone graft (eg, autograft or allograft) is packed into and around the interbody spacers to facilitate bony ingrowth and healing (fusion).
Posterior Cervical Foraminotomy
In this surgery, the surgeon accesses one or more levels of the cervical spine through an incision made in the back of the neck (posterior cervical). Foraminotomy decompresses the cervical nerve root by removing what is compressing the nerve, such as bone (osteophyte) or soft tissue and opens/widens the neural foramen—the nerve passageway where the nerve root exits the spinal canal.
Cervical Artificial Disc Replacement (C-ADR)
Instead of spinal fusion after cervical discectomy, an artificial disc device is implanted into the empty disc space. Unlike spinal fusion that eliminates motion at the operative level, C-ADR acts as a shock absorber and enables healthy movement just as a biological disc does.
Non-Surgical Treatment Options
First-Line Conservative Treatments
Like most types of spine pain, your doctor will likely recommend trying one or more conservative treatments first for your cervical radiculopathy. Conservative treatments are nonsurgical means to relieve your pain.
It’s important to understand that just because a treatment is considered conservative does not mean it is ineffective. In fact, it’s quite the opposite. Most people with nerve compression in their neck respond well to conservative therapies. Though research on the efficacy of conservative treatments for cervical radiculopathy has produced mixed results, findings show that these therapies help eliminate pain and other nerve-related symptoms (like numbness and muscle weakness) in 40% to 80% of people.
The following conservative treatments are commonly used to treat cervical radiculopathy:
Over-the-counter oral pain relievers, such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (ibuprofen, Motrin)
Prescription medications, such as oral steroids (prednisone), neuropathic agents (gabapentin, pregabalin), and muscle relaxants (baclofen, cyclobenzaprine)
Wearing a neck brace or collar
Physical therapy and exercise, which helps strengthen the neck muscles and improve your range of motion
Cervical spinal traction, which may be performed during physical therapy
Avoiding strenuous activity, though many medical professionals will advise against avoiding all activity, as too much rest may hinder your recovery
If you try a combination of conservative treatments for 6 to 8 weeks and experience no improvement—or even a worsening—of your cervical radiculopathy symptoms, your doctor may want to step you up to the next level of treatment. This may include epidural steroid injections.
Second-Line Spinal Injections for Radiating Neck Pain
Cervical epidural steroid injections are typically considered a second-line treatment for cervical radiculopathy that does not respond to conservative therapies. These injections send a potent dose of anti-inflammatory medicine into a specific nerve root’s epidural space (the space through which the spinal nerves travel), which may relieve the pain caused by the compressed nerve.
To accurately administer the injection, your doctor uses fluoroscopy—a type of medical imaging—to guide the injection to the proper injection site (taking care not to hit the spinal nerves). Once the needle is in the correct position, your doctor injects the medication into the spine’s epidural space, which then spreads to the compressed nerve roots.
The number of injections needed is different from patient to patient. Your doctor makes a recommendation based on your condition and response to the first injection. If the first epidural steroid injection effectively reduces your pain and symptoms, a second or third injection may be recommended should your symptoms recur. Most people have more than one injection, with approximately three weeks between each injection.
While the injection will help manage pain and inflammation, it cannot strengthen or improve flexibility in your cervical muscles to prevent future neck pain. For that reason, your doctor may also prescribe a course of physical therapy and/or an exercise program designed to condition your neck muscles.
A compressed nerve in your neck can lead to radiating pain from your neck to your shoulders, arms, and all the way down to your fingers. This pain can make it challenging to do the simplest actions, such as moving your neck from side to side or opening jars. Fortunately, conservative treatment like medication and exercise can ease the pain of this spinal condition and restore function—and surgery is rarely necessary.
