Cervical Radiculopathy: Surgical Decision-Making

Cervical radiculopathy arises from foraminal narrowing due to disc-osteophyte complexes, uncovertebral and facet arthropathy, or soft disc herniation. Choice among ACDF, posterior cervical foraminotomy (PCF), and cervical disc arthroplasty depends on alignment, level count, facet status, and dynamic stability.

Clinical and Imaging Highlights

Arm pain with dermatomal radiation, Spurling positivity; motor weakness in myotomal pattern; diminished reflexes.
MRI: foraminal stenosis and root compression; CT: osteophytes, OPLL; dynamic films: instability and sagittal parameters.

Visual Aids

Sagittal cervical MRI degeneration — Sagittal degenerative changes; correlate with axial/foraminal imaging for side and level. Source: Wikimedia Commons (CC BY-SA 3.0).

Sagittal cervical MRI compressive myelopathy at C6-C7 — When myelopathy coexists, prioritize cord decompression. Source: Wikimedia Commons (CC BY-SA 3.0).

Dermatomes of right upper limb, anterior — Upper limb dermatomes (anterior). Source: Wikimedia Commons (Public Domain).

Cutaneous nerves/dermatomes of right upper limb, posterior — Upper limb dermatomes (posterior). Source: Wikimedia Commons (Public Domain).

Example of instrumented fusion (lumbar example shown) — Conceptual illustration of instrumentation and fusion (lumbar example). For cervical ACDF, similar principles of interbody support and fixation apply. Source: Wikimedia Commons (CC BY 4.0).

Lower limb dermatomes (anterior) for long-tract check — Long-tract check if myelopathy suspected. Source: Wikimedia Commons (Public Domain).

Lower limb dermatomes (posterior) — Posterior dermatomes for completeness in exam correlation. Source: Wikimedia Commons (Public Domain).

Choosing Between ACDF, PCF, and Arthroplasty

ACDF: focal anterior compression, kyphosis, multi-level anterior disease, facet arthropathy; pros: reliable decompression/realignment; cons: adjacent segment degeneration.
Posterior foraminotomy: posterolateral soft disc or focal foraminal stenosis, preserved lordosis, healthy facets; motion preservation; avoid if instability or significant anterior collapse.
Arthroplasty: 1–2 level soft-disc disease, preserved facet joints and alignment; avoid in kyphosis, severe spondylosis, OPLL, or osteoporosis.

Outcomes

High rates of arm pain relief across techniques when selection criteria are met; alignment and facet health are pivotal for motion-preserving options.

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