Cervical Radiculomyelopathy: What Happens When Both the Nerve Roots and the Spinal Cord Are Compressed?
Cervical radiculomyelopathy is a condition in which the spinal cord and one or more nerve roots in the neck are compressed at the same time. It causes a mix of symptoms. These include arm pain, clumsy hands and trouble with balance or walking. Because both structures are involved, the pattern is more complex than either problem on its own.
Key points
- Cervical radiculomyelopathy combines nerve root compression (radiculopathy) with spinal cord compression (myelopathy) in the neck.
- Symptoms often include arm pain or tingling, along with balance problems, stiff legs or trouble with fine hand movements.
- It is usually caused by age-related wear in the neck, such as disc bulges and extra bone growth.
- Standing, weight-bearing imaging can show alignment problems that lying-down scans may miss.
- Some symptoms are warning signs that need urgent medical attention.
You may already have heard of radiculopathy, where a nerve root in the neck is pinched, or myelopathy, where the spinal cord itself is squeezed. Cervical radiculomyelopathy is the term used when both happen together. It is sometimes called cervical myeloradiculopathy. The cord and the roots share a tight space inside the spinal canal. So the same underlying problem, such as a bulging disc or a bony spur, can compress both at once.
It matters to understand this combination. Nerve root symptoms, like sharp arm pain, tend to grab your attention. Cord involvement can be more subtle. It may show up as clumsy fingers or a vague unsteadiness when walking. If the cord symptoms are missed, the condition can progress.
What are the symptoms of cervical radiculomyelopathy?
Symptoms come from two sources. The compressed nerve root causes pain, tingling or weakness in a specific part of the arm or hand. The compressed spinal cord causes wider problems with coordination, balance and fine motor control. You may notice some of these together.
The key feature of cervical radiculomyelopathy is this mix. Arm pain (from the nerve root) together with coordination or walking problems (from the cord) is the hallmark. Symptoms may develop slowly over months or years. This makes them easy to dismiss or to put down to normal ageing.
What causes radiculopathy and myelopathy together?
The most common cause is age-related wear and tear in the neck, often called cervical spondylosis. As the discs lose height and the joints stiffen, the space for the spinal cord and nerve roots becomes narrower. Several changes can happen at the same time.
- Disc bulges or herniations. A disc that pushes backwards into the spinal canal can press on the cord in the middle and on a nerve root to one side.
- Bony spurs (osteophytes). Extra bone growth around the joints narrows the canal and the small openings where the nerves exit.
- Thickened ligaments. The ligaments that line the canal can thicken with age, which reduces the space further.
- A naturally narrow canal. Some people are born with a spinal canal that is narrower than average. This makes them more prone to compression, even with mild degenerative changes.
Because these changes are gradual, spondylotic myeloradiculopathy is most common in adults over 50. However, earlier disc problems or an injury can bring it on sooner.
When should you get urgent help for neck and arm symptoms?
Some symptoms suggest the spinal cord is under significant pressure. If you notice any of the following, contact your doctor or go to the nearest emergency department straight away. Do not wait for a routine scan.
- Loss of bladder or bowel control, or new difficulty starting or stopping.
- Sudden weakness in both legs or difficulty standing.
- Numbness in the groin or saddle area.
- Rapidly worsening hand weakness or loss of grip.
These are medical emergencies. Most people with cervical radiculomyelopathy do not experience them, but it is important to know the warning signs.
How does standing imaging help assess compression of the cord and nerve roots in the neck?
Standing, weight-bearing imaging shows your spine under real-life load. When you lie down for a standard scan, gravity is removed and your muscles relax. The spaces in your spine can open up slightly. This means a lying-down image may underestimate the narrowing that actually happens when you are upright.
Your body is a connected chain. The tilt of your pelvis, the curve of your upper back (thoracic spine) and the position of your head all affect the load on your neck. A forward head posture, for example, increases the strain on the neck and can make compression worse. These alignment links only show up on a full-length standing image. They do not show on a scan of one small area taken lying down.
An EOS scan captures the full skeleton from head to feet while you stand, using about 90% less radiation than a standard X-ray, around ten times less. This whole-body view lets a specialist see how your overall alignment may be adding to the compression in your neck.
Wondering whether your neck symptoms could be linked to your wider alignment? A free video consultation can help you decide if standing imaging is the right next step before you plan a trip to London.
Book a free video consultationA note about MRI. EOS shows bones, joints and overall alignment clearly. For soft tissue detail, such as the discs, the spinal cord itself or the nerves, MRI is usually the better tool. In many cases of cervical radiculomyelopathy, both types of imaging are helpful. EOS shows the alignment picture, while MRI shows what is happening inside the canal. Your specialist may recommend one or both.
What helps if you think you have cervical radiculomyelopathy?
Getting clear imaging is an important first step. When both the spinal cord and the nerve roots are involved, your treating clinician needs to understand the full picture before suggesting any course of action. That means knowing not just where the compression is, but how your overall spinal alignment may be adding to it.
Before you start treatment, or change the one you are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in the pelvis, the legs or the spine changes what will actually help.
ScanAlign is a diagnostic imaging clinic. We do not provide treatment or diagnose conditions. What we do is provide detailed, standing, weight-bearing images and a full report. Your specialist, surgeon or physiotherapist can use these to plan your care.
You can learn more about how standing imaging works for spine conditions or read about the EOS scan itself.
No referral is needed. The price for patients travelling from abroad is confirmed during the free video consultation. For preparation and what to expect, visit the FAQs page.
Frequently asked questions
Radiculopathy means a nerve root is compressed. This causes pain, tingling or weakness in a specific area of the arm or hand. Myelopathy means the spinal cord is compressed. This causes wider problems such as balance trouble, stiff legs or clumsy hands. Cervical radiculomyelopathy is when both happen together.
It can. Myelopathy in particular tends to progress gradually if the pressure on the cord is not addressed. Early assessment is important so that any changes can be monitored and managed by your treating clinician.
Not exactly. Cervical spondylosis means age-related wear and tear in the neck. Radiculomyelopathy is one possible result of that wear. It happens when the narrowing becomes severe enough to compress the cord and nerve roots. Many people have spondylosis without developing myelopathy or radiculopathy.
When you lie down, gravity is removed and the spine can decompress slightly. Standing imaging shows the spine under your actual body weight. This may reveal narrowing or misalignment that relaxes away on a lying-down scan. It also shows how your whole alignment, from head to feet, affects the neck.
No. ScanAlign is a private, self-pay clinic. You can book directly, without a referral from your doctor or a consultant.
An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less. This makes it a very low-dose option for full-body imaging.
They show different things. EOS shows bone alignment and joint position while you are standing. MRI shows soft tissue detail such as the discs, the spinal cord and the nerves. For radiculomyelopathy, both are often useful and give complementary information.
The price for patients travelling from abroad is confirmed during the free video consultation. For what is included, please visit the FAQs page.
It is a short, no-obligation video call. You can discuss your symptoms and ask whether a standing EOS scan would be helpful for your situation. There is no pressure to book.
ScanAlign is based at 19 Harley Street, London. It operates under The Harley Street Hospital's CQC licence.
Not sure if your symptoms are connected?
A free, no-obligation video consultation can help you understand whether standing imaging would add to your clinical picture.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- NHS. Cervical spondylosis. nhs.uk (accessed 2024).
- Nouri A, Tetreault L, Singh A, et al. Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis. Spine. 2015;40(12):E675-E693.
- The Royal College of Radiologists. iRefer: Making the best use of clinical radiology. rcr.ac.uk (accessed 2024).
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.