Degenerative cervical spine disease

Last reviewed: 22 Aug 2023
Last updated: 23 Sep 2021



History and exam

Key diagnostic factors

  • spontaneous onset of neck pain
  • cervical muscle pain and spasm
  • headaches or occipital pain
  • weakness or numbness
  • presence of radiating arm pain
  • reflex changes
  • proximal arm weakness
  • distal hand weakness
  • gait ataxia
More key diagnostic factors

Other diagnostic factors

  • cervical muscle spasm
  • decreased cervical range of motion
  • sensory changes
Other diagnostic factors

Risk factors

  • age >40 years
  • head or neck trauma
  • previous cervical spine surgery
  • previous cervical myofascial strain
  • genetic predisposition
More risk factors

Diagnostic investigations

1st investigations to order

  • cervical MRI
  • cervical x-ray
More 1st investigations to order

Investigations to consider

  • cervical CT scan
  • cervical CT myelogram
  • cervical/upper extremity electromyography or nerve conduction velocity
  • cervical nerve root block
More investigations to consider

Treatment algorithm


axial neck pain

cervical spondylotic radiculopathy (CSR)

degenerative cervical myelopathy (DCM)



Dennis A. Turner, MA, MD
Dennis A. Turner


Neurosurgery and Neurobiology

Duke University Medical Center




DAT is an author of a reference cited in this topic.

Peer reviewers

Ricardo Pietrobon, MD, PhD, MBA

Associate Professor of Surgery

Associate Professor in Anesthesiology

Associate Vice-Chair, Systems Integration

Department of Surgery

Duke University Medical Center




RP is an author of a number of references cited in this topic.

Allan I. Binder, MD

Consultant Rheumatologist

Lister Hospital

East and North Hertfordshire NHS Trust




AIB is an author of a number of references cited in this topic.

  • Degenerative cervical spine disease images
  • Differentials

    • Whiplash injury (cervical myofascial strain)
    • Acute disk herniation
    • Metastatic malignancy
    More Differentials
  • Guidelines

    • ACR appropriateness criteria: cervical neck pain or cervical radiculopathy
    • A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression
    More Guidelines
  • Patient leaflets

    Back pain (lower back)

    More Patient leaflets
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