On this page

Root symptoms and cord symptoms

A neck disc problem can affect an exiting nerve root, the spinal cord, or both. Cervical radiculopathy typically involves arm pain and may include changes in sensation or strength. Neck pain alone is an axial symptom and is not interchangeable with radiating arm pain. In FACET, people with single-level, one-sided radiculopathy were studied; people with purely axial pain or myelopathy were excluded.1

Myelopathy means spinal-cord dysfunction. In the cervical region, it can affect hand coordination, walking, balance and other functions below the neck. Degenerative cervical myelopathy is broader than a soft-disc herniation: bone and ligament changes can also contribute. A scan showing compression without clinical myelopathy belongs to a different assessment category. Root and cord findings can occur together.2

New functional difficulty needs assessment

New difficulty walking, sudden problems coordinating the hands or loss of bladder/bowel control with concerning neck or limb symptoms can be emergencies. Use local emergency services. New substantial or progressing weakness warrants urgent local assessment. Do not wait for an exercise course, a scheduled scan or an elective overseas consultation. These examples are not a requirement to have every symptom.34

The task for a clinician is to establish what is changing and why. A reader cannot distinguish all causes of hand weakness or imbalance from a webpage. The reference therefore does not offer neck-compression tests, a self-score or instructions for reading cord signals on MRI.

Assessment beyond the image

The examination and history help separate a root syndrome from cord dysfunction and other causes. The 2025 AO Spine review emphasizes neurological function, pain, quality of life, frailty and imaging together. It is a critical appraisal of selected studies with clinical recommendations, rather than a replacement guideline applying one answer to every neck disc.5

The 2026 mild-DCM review gives conditional recommendations based on low or very low evidence. It does not recommend routine MRI parameters alone to predict deterioration or decide surgical timing. That uncertainty calls for clinical follow-up and informed discussion, not a reassurance rule based on a scan word.6

Why lumbar treatment advice cannot be copied

For established moderate or severe DCM, the original AO Spine/CSRS guideline strongly recommends surgery. For mild disease it suggests surgery or a supervised structured rehabilitation trial, with deterioration requiring operative assessment. This is different from routine management of uncomplicated lumbar leg pain. Even when decompression is appropriate, recovery of every sensory or motor symptom is not guaranteed.2

For selected radiculopathy, several procedures may be discussed. FACET informs a specific foraminotomy-versus-ACDF decision and does not determine treatment for all myelopathy, multilevel disease or replacement candidates. The question begins with the clinical target, anatomy and individual risk, then moves to the procedure.1

References

  1. Simões de Souza NF et al. Two-year FACET randomized noninferiority study. J Bone Joint Surg Am. 2024;106:1653–1663. PubMed ↩
  2. Fehlings MG et al. AO Spine/CSRS DCM guideline. Global Spine J. 2017;7(Suppl):70S–83S. Source ↩
  3. NHS. Cervical spondylosis: symptoms, urgent assessment and treatment. Source ↩
  4. NICE. NG127: Suspected neurological conditions. Adult recommendations 1.7 and 1.10. Source ↩
  5. Fehlings MG et al. AO Spine DCM critical review and recommendations. Global Spine J. 2025. doi:10.1177/21925682251331050. Source ↩
  6. Neal CJ et al. Mild DCM: contemporary concepts. Global Spine J. 2026 (online September 24). doi:10.1177/21925682261492222. PubMed ↩