Neck Pain and Cervical Radiculopathy

Symptoms and warning signs

The typical patient has a sharp or burning pain that starts in the neck and shoots down one arm. Pins and needles or numbness settle in a few fingers, and their pattern tells the doctor which nerve root is involved. The pain is often worse on looking up or turning the head to the painful side. Weakness follows if the nerve stays compressed: a weak grip or trouble lifting the arm.

Some signs mean the spinal cord itself is under pressure, called cervical myelopathy, and these need prompt assessment by a neurosurgeon: clumsy hands that struggle with buttons or writing, an unsteady or wide-based walk, heaviness in the legs, and new problems with bladder control. Myelopathy can progress quietly, so never put these changes down to age.

Causes and who gets it

A herniated cervical disc is the usual cause in younger and middle-aged adults. The soft centre of the disc pushes out through a weak spot and presses on the nerve root next to it. In older patients the cause is more often wear and tear, called cervical spondylosis: the discs dry out and lose height, and small bone spurs grow at the edges of the joints and narrow the opening the nerve passes through. Long hours at a desk or over a phone, carrying loads on the head, jerks in a road accident and heavy manual work all add to the strain.

How it is diagnosed

The examination matters as much as the scan. Dr. Salman Falak tests the power in each muscle group of the arm and the reflexes at the elbow and wrist. He then maps the numb areas and sees whether tilting the head brings the arm pain on. An MRI of the cervical spine is the main test, because it shows the discs and the nerves and whether anything is pressing on them. X-rays show the alignment of the neck and any bone spurs. When the numbness is mainly in the hand, a nerve conduction study may be added to rule out carpal tunnel syndrome, which can look very similar.

Treatment: conservative care first, then surgery

Most pinched nerves in the neck settle without an operation. Dr. Salman Falak usually starts with medicine to calm the inflamed nerve and a short rest from the movements that provoke the pain. Physiotherapy follows once the sharp pain eases. A soft collar, if used at all, is for days rather than weeks, or the neck muscles weaken. In some patients an injection around the nerve root gives relief while the disc heals.

Surgery is advised when the arm pain or weakness has not settled after a proper trial of conservative care, or whenever there are signs of myelopathy. The usual operation is cervical disc herniation surgery, most often an anterior cervical discectomy and fusion, or ACDF, in which the disc is removed through a small cut at the front of the neck and the space is filled with a cage so the two vertebrae heal together. The nerve is freed directly and arm pain often eases soon after.

What recovery looks like

With conservative treatment, the shooting arm pain usually improves first, over a few weeks, while numbness and tingling take longer to fade. Strength returns last. Dr. Salman Falak reviews patients during this period to confirm the nerve is recovering.

After ACDF, most patients are walking the same day or the next morning and go home within a day or two. Desk work is usually possible within a few weeks and heavier work later, once X-rays show the fusion is maturing. Follow-up for patients from other cities is mostly by video, with X-rays sent on WhatsApp.

When to see a neurosurgeon

See a neurosurgeon if arm pain or numbness has lasted more than a few weeks despite treatment, or if the arm or hand is getting weaker. Neck pain that began after a road accident or fall should also be assessed. Go without delay if your hands have become clumsy or your walking has changed, and do not ignore any new bladder problem. Many patients first reach Dr. Salman Falak through an online consultation; they send the MRI on WhatsApp and he tells them whether a visit to Lahore is needed or treatment can continue at home.

Related procedures and conditions

Cervical disc herniation surgery is described in full on its own page, linked above. The other spine operations Dr. Salman Falak performs, including endoscopic and microscopic techniques for the lower back, are listed on the spine surgery page. Pain that runs down the leg rather than the arm is a lower back problem, covered under sciatica.