Neck pain, cervical radiculopathy, and cervical myelopathy: pathophysiology, natural history, and clinical evaluation

Degenerative cervical disk disease is a ubiquitous condition that is, for the most part, asymptomatic. When symptoms do arise as a result of these degenerative changes, they can be easily grouped into axial pain, radiculopathy and myelopathy. While the pathophysiology of radiculopathy and myelopathy is better understood, the source of neck pain remains somewhat controversial. A discussion of the mechanisms of neck and suboccipital pain, and the chemical and mechanical factors responsible for neurologic symptoms is warranted. Examination of the patient with these symptoms will reveal variations in the clinical presentation. A thorough understanding of the natural history of these conditions will allow appropriate treatment to be carried out. The natural history of these conditions suggests that for the most part patients with axial symptoms are best treated without surgery, while some patients with radiculopathy will continue to be disabled by their pain, and may be candidates for surgery. Myelopathic patients are unlikely to show significant improvement, and in most cases will show stepwise deterioration. Surgical decompression and stabilization should be considered in these patients.