In which cases of cervical radiculopathy should I refer a patient to a specialist for further evaluation or intervention?

Refer a patient with cervical radiculopathy to a specialist for further evaluation or intervention if:

• Symptoms have remained stable for 6 weeks or more but pain is not controlled with analgesics.
• Symptoms are disabling.
• Any of the following neurological signs or risk factors are present: age under 20 years, gait disturbance, clumsy or weak hands or legs, brisk deep tendon reflexes (especially triceps and lower limbs), extensor plantar responses, or new-onset disturbance of bladder or bowel function.

Do not routinely refer patients with stable symptoms for 6 weeks or more if none of the above apply.

Reference: NICE guideline NG127 - Suspected neurological conditions: recognition and referral ¹.