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Additional benefit of ultrasonography to evaluate nerve root condition of degenerative cervical spine disease


Study design

A cross-sectional explanatory study.


To clarify the nerve root condition and the association between nerve root cross-sectional area (CA) on ultrasonography (US) and other examinations such as MRI or compound muscle action potentials (CMAPs) in degenerative cervical spine diseases.


A university hospital in Japan.


Fifty-one patients diagnosed with proximal cervical spondylotic amyotrophy (CSA) (13 patients), cervical radiculopathy of C5 or C6 nerve root (CR) (26 patients), or cervical spondylotic myelopathy (CSM) (12 patients), and twenty-nine healthy volunteers were included in this study. Neurological findings, US findings and CMAPs of deltoid and biceps muscles of all participants were evaluated. In addition, CSA, CR, and CSM patients underwent MRI.


A significant correlation was not observed between CA and CMAP amplitude or foraminal diameter on MRI (P > 0.05). In the US examination, the C6 CA of the affected side of the CR group was significantly larger than that of both the normal side and the other groups (P < 0.001). The C5 CA of the affected side of the CSA group clearly showed a bimodal distribution: enlarged and small CA groups. In the CMAP findings, CSA cases respectively showed the lower amplitude of deltoid and bicep CMAPs on both the normal and the affected side (P 0.01). CSM and healthy volunteers were nearly identical in CA and CMAPs.


Utilizing US in addition to NCS and MRI can contribute towards an evaluation of the nerve root condition of degenerative cervical spine disease.


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Fig. 1: Cross sectional area of C5 and C6 nerve root of each groups.
Fig. 2: A C6CR case.
Fig. 3: A CSA case.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.


  1. Kato F, Yukawa Y, Suda K, Yamagata M, Ueta T. Normal morphology, age-related changes and abnormal findings of the cervical spine. Part II: Magnetic resonance imaging of over 1,200 asymptomatic subjects. Eur Spine J. 2012;21:1499–507.

    Article  Google Scholar 

  2. Meacock J, Schramm M, Selvanathan S, Currie S, Stocken D, Jayne D, et al. Systematic review of radiological cervical foraminal grading systems. Neuroradiology. 2021;63:305–16.

    Article  Google Scholar 

  3. Takeuchi M, Wakao N, Kiyama M, Hirasawa A, Murotani K, Takayasu M, et al. Simple presurgical method of predicting C5 palsy after cervical laminoplasty using C5 nerve root ultrasonography. J Neurosurg Spine. 2018;29:365–70.

    Article  Google Scholar 

  4. Takeuchi M, Wakao N, Hirasawa A, Murotani K, Kiyama M, Osuka K, et al. Ultrasonography has a diagnostic value in the assessment of cervical radiculopathy; A prospective pilot study. Eur Radio. 2017;27:3467–73.

    Article  Google Scholar 

  5. Kim E, Yoon JS, Kang HJ. Ultrasonographic cross-sectional area of spinal nerve roots in cervical radiculopathy: a pilot study. Am J Phys Med Rehabil. 2015;94:159–64.

    Article  Google Scholar 

  6. Sheng DJ, Lei SJ, Li YD. Cervical spondylotic amyotrophy. Eur Spine J. 2011;20:351–7.

    Article  Google Scholar 

  7. Seichi A, Takeshita K, Kawaguchi H, Matsudaira K, Higashikawa A, Ogata N, et al. Neurologic level diagnosis of cervical stenotic myelopathy. Spine 2006;31:1338–43.

    Article  Google Scholar 

  8. Kokubun S. Neurological localization of the symptomatic level of lesion in cervical spondylotic myelopathy. Rinsho Seikeigeka (Jpn). 1984;19:417–24.

    Google Scholar 

  9. Gu Y. Functional motor innervation of brachial plexus roots. An intraoperative electrophysiological study. J Hand Surg Br. 1997;22:258–60.

    Article  CAS  Google Scholar 

  10. Takeuchi M, Wakao N, Kiyama M, Osuka K, Matuo N, Terasawa T, et al. Morphological distinction of cervical nerve roots associated with motor function in 219 healthy volunteers. Spine. 2014;39:E944–949.

    Article  Google Scholar 

  11. Sugimoto T, Ochi K, Hosomi N, Takahashi T, Ueno H, Nakamura T, et al. Ultrasonographic nerve enlargement of the median and ulnar nerves and the cervical nerve roots in patients with demyelinating Charcot-Marie-Tooth disease. J Neurol. 2013;260:2580–7.

    Article  Google Scholar 

  12. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15:155–63.

    Article  Google Scholar 

  13. Payne EE, Spillane JD. The cervical spine. An anatomico-pathological study of 70 specimens (using special technique) with particular reference to the problem of cervical spondylosis. Brain. 1957;80:571–96.

    Article  CAS  Google Scholar 

  14. Kim W, Ahn KS, Kang CH, Kang WY, Yang KS. Comparison of MRI grading for cervical neural foraminal stenosis based on axial and oblique sagittal images: Concordance and reliability study. Clin Imaging. 2017;43:165–9.

    Article  Google Scholar 

  15. Kobayashi S, Yoshizawa H, Yamada S. Pathology of lumbar nerve root compression. Part 1: Intraradicular inflammatory changes induced by mechanical compression. J Orthop Res. 2004;22:170–9.

    Article  Google Scholar 

  16. Daimon K, Fujiwara H, Nishiwaki Y, Okada E, Nojiri K, Watanabe M, et al. A 20-year prospective longitudinal study of degeneration of the cervical spine in a volunteer cohort assessed using MRI. J Bone Jt Surg Am. 2018;100:843–9.

    Article  Google Scholar 

  17. Takahashi T, Hanakita J, Minami M, Tomita Y, Sasagasako T, Kanematsu R. Cerv Spondylotic Amyotrophy: Case Ser Rev Lit Neurospine. 2019;16:579–88.

    Google Scholar 

  18. Kameyama T, Ando T, Yanagi T, Yasui K, Sobue G. Cervical spondylotic amyotrophy. Magnetic resonance imaging demonstration of intrinsic cord pathology. Spine. 1998;23:448–52.

    Article  CAS  Google Scholar 

  19. Shinomiya K, Komori H, Matsuoka T, Mutoh N, Furuya K. Neuroradiologic and electrophysiologic assessment of cervical spondylotic amyotrophy. Spine (Philos Pa 1976). 1994;19:21–25.

    Article  CAS  Google Scholar 

  20. Keegan J. The cause of dissociated motor loss in the upper extremity with cervical spondylosis. J Neurosurg. 1965;23:528–36.

    Article  CAS  Google Scholar 

  21. Grimm A, Vittore D, Schubert V, Rasenack M, Décard BF, Heiling B, et al. Ultrasound aspects in therapy-naive CIDP compared to long-term treated CIDP. J Neurol. 2016;263:1074–8.

    Article  Google Scholar 

  22. Nodera H, Takamatsu N, Shimatani Y, Mori A, Sato K, Oda M, et al. Thinning of cervical nerve roots and peripheral nerves in ALS as measured by sonography. Clin Neurophysiol. 2014;125:1906–11.

    Article  Google Scholar 

  23. Imajo Y, Kato Y, Kanchiku T, Suzuki H, Taguchi T. Pathology and prognosis of proximal-type cervical spondylotic amyotrophy: new assessment using compound muscle action potentials of deltoid and biceps brachii muscles. Spine (Philos Pa 1976). 2011;36:E476–481.

    Article  Google Scholar 

  24. Radhakrishnan K, Litchy WJ, O’Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain 1994;117:325–35.

    Article  Google Scholar 

  25. Fisse AL, Katsanos AH, Gold R, Pitarokoili K, Krogias C. Cross-sectional area reference values for peripheral nerve ultrasound in adults: a systematic review and meta-analysis-Part III: Cervical nerve roots and vagal nerve. Eur J Neurol. 2021;28:2319–26.

    Article  Google Scholar 

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Authors and Affiliations



HK and NT were responsible for designing the study protocols, conducting the research, analyzing data, interpreting results, and writing the manuscript. NT, KK, NA, and RT were involved in recruiting patients and editing the manuscript. NT, KK, NA, RT, and MI reviewed the manuscript.

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Correspondence to Hiroki Kozuki.

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Kozuki, H., Tadokoro, N., Aoyama, N. et al. Additional benefit of ultrasonography to evaluate nerve root condition of degenerative cervical spine disease. Spinal Cord 61, 69–75 (2023).

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