Is motor weakness in cervical radiculopathy an indication for surgery? Analysis of risk factors for poor recovery.

Abstract

To investigate the natural course of motor weakness in cervical radiculopathy and analyze risk factors associated with poor recovery. A cohort of prospectively enrolled patients presenting with motor weakness due to cervical radiculopathy between March 2024 and March 2025 was retrospectively analyzed. All patients were initially managed conservatively, with surgery reserved for persistent weaknesses or intolerable symptoms. Demographic, clinical, and imaging data were reviewed. Motor strength was assessed using the modified Medical Research Council (mMRC) scale. Patients achieving a motor grade 4 or higher were classified as the recovery group; those who did not were assigned to the non-recovery group. We compared both groups and evaluated possible risk factors for non-recovery. A total of 52 patients were included; 38 (73.1%) recovered to a motor grade above 4-, while 14 (26.9%) did not. The non-recovery group was significantly older and had more severe initial motor deficits and persistent arm pain. Age was negatively correlated with motor recovery, while higher initial motor grade and arm pain improvement were positive predictors. Univariate logistic regression, penalized regression, and Bayesian analysis identified age, initial motor grade, and arm pain improvement as significant predictors of recovery. Using ROC analysis, we identified thresholds for higher risk of 6-month non-recovery: age ≥ 59 years, initial mMRC ≤ 2, and < 2-point improvement in arm-pain NRS at 2 months. Most patients with motor weakness due to cervical radiculopathy recovered functional strength (≥ 4) within 2-3 months of conservative treatment. However, older age, severe initial motor deficits, and persistent pain were associated with a higher risk of incomplete recovery.