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Degenerative cervical spine disease

Last reviewed: 8 Sep 2025
Last updated: 19 Sep 2025

Summary

Definition

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 shoulder and upper extremity pain
  • reflex changes
  • proximal arm weakness
  • distal hand weakness
  • gait ataxia
Full details

Other diagnostic factors

  • cervical muscle spasm
  • decreased cervical range of motion
  • sensory changes
Full details

Risk factors

  • age >50 years
  • head or neck trauma
  • previous cervical spine surgery
  • genetic predisposition
  • smoking
  • participation in contact sports
  • occupation
  • heavy load bearing
Full details

Diagnostic tests

1st tests to order

  • cervical MRI
  • cervical x-ray
Full details

Tests to avoid

  • dermatomal somatosensory evoked potentials (SEPs)
Full details

Tests to consider

  • cervical CT scan
  • cervical CT myelogram
  • cervical/upper extremity electrodiagnostic testing
  • cervical nerve root block
Full details

Treatment algorithm

ACUTE

axial neck pain

cervical spondylotic radiculopathy (CSR)

degenerative cervical myelopathy (DCM)

Contributors

Authors

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

Professor

Neurosurgery, Neurobiology, and Biomedical Engineering

Duke University Medical Center

Durham

NC

Disclosures

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

Peer reviewers

Richard G. Chang, MD, MPH, FAAPMR

Associate Program Director

Sports Fellowship

Assistant Professor

Icahn School of Medicine

Mount Sinai

NY

Disclosures

RGC is a member of the AAPM&R Health Policy & Legislative Committee, and receives reimbursement for travel to in person once a year Capitol Hill meeting and annual AMA State Advocacy Summit conference.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Bono CM, Ghiselli G, Gilbert TJ, et al; North American Spine Society. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J. 2011 Jan;11(1):64-72. Abstract

Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons. Guidelines for the surgical management of cervical degenerative disease. 2009 [internet publication].Full text

American College of Radiology. ACR appropriateness criteria: cervical neck pain or cervical radiculopathy. 2024 [internet publication].Full text

Nikolaidis I, Fouyas IP, Sandercock PA, et al. Surgery for cervical radiculopathy or myelopathy. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD001466.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Degenerative cervical spine disease images
  • Differentials

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

    • ACR appropriateness criteria: cervical 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 information

    Back pain (lower back)

    More Patient information
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