What criteria should I use to decide when to refer a patient with cervical spondylosis for specialist assessment?

Criteria for referral of a patient with cervical spondylosis for specialist assessment include:

• Presence of red flags suggesting a serious spinal abnormality, which requires urgent referral or immediate assessment depending on clinical judgement.
• Severe or progressive motor weakness or severe or progressive sensory loss, which necessitates immediate specialist advice.
• Cervical radiculopathy symptoms persisting for 4–6 weeks or more, or the presence of objective neurological signs such as nerve root compression.
• Unremitting radicular pain despite 6–12 weeks of conservative treatment, disabling symptoms, or progressive motor weakness confirmed by MRI showing nerve root compression.

In the absence of these criteria, initial management is conservative with reassurance, analgesia, physiotherapy, and monitoring for progression of neurological signs.

Referral aims to confirm diagnosis with MRI and consider invasive procedures or surgery if indicated.

These criteria are based on NICE CKS guidelines for cervical radiculopathy and neck pain management.

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