Fundamentals of Cervical Neurological Exam

The neurological exam provides the foundation for clinical decision-making when treating patients with cervical degenerative disease. Clinicians should strive for a systematic and thorough approach, covering cervical alignment, skin, muscle bulk, range of motion, tone, motor, sensory modalities, reflexes, and gait. Special maneuvers are useful in confirming the diagnosis of cervical radiculopathy and/or myelopathy. Other maneuvers may be useful in distinguishing non-neurosurgical entities. Neurosurgeons should be adept in recognizing imitators of cervical pathology during the examination. Radiculopathy and myelopathy may present on a spectrum. Radiculopathy typically presents with pain, weakness, and/or paresthesias in a single or multiple nerve root distribution and has corresponding areas of deficit on examination. Myelopathy often presents with weakness, impaired coordination, and gait disturbance. Physical findings of severe cervical myelopathy include distal arm weakness, hyperreflexia, and gait instability. Radiculopathy and myelopathy are often encountered in neurosurgical practice; over the course of a clinician’s training, he or she should become adept in the cervical neurological exam.