Objective: Radicular symptoms of the cervical spine are usually effectively managed by cervical decompressive surgery when the symptomatic nerve root corresponds to the level of maximal radiological compression. The response is less predictable when the symptomatic level and the level of radiological compression are mismatched. The aim of this study was to retrospectively assess the efficacy of surgery in cases where symptom level and the level of radiological compression were mismatched.

Design: We conducted a casenote review of patients who underwent cervical decompressive surgery for radicular symptoms over a five year period with an average follow-up period of 3.5 years.

Subjects’ outcome: Three hundred and thirty-nine patients underwent cervical decompression during this period. Of these, 76 had surgery for isolated radicular symptoms. Nineteen of these patients had radiological and symptomatic mismatch.

Results: Seventy-five percent of those with mismatch initially had a good response to surgery, but 31% subsequently required a further operation. Comparable figures for those whose symptoms and radiology matched are 63% and 6%.

Conclusions: Patients who have radicular symptoms, which do not correspond to the level of radiological compression, do benefit from surgical decompression, but have an increased likelihood of requiring a second operation.