Back and Neck Pain: The Neurological Evaluation

Why see a neurologist for back or neck pain?

A neurologist's role is to determine whether a nerve or the spinal cord is involved, which nerve is affected, and how severely. That answer shapes treatment and determines whether additional imaging or a surgical opinion is needed.

• Pain that radiates into the arm, hand, leg, or foot
• Numbness or tingling in a specific distribution
• Weakness, dropping objects, or foot dragging
• Pain that has not improved as expected
• Symptoms following a fall, accident, or work injury
• Imaging findings that do not match your symptoms

Other neurological causes considered

• Disc herniation and degenerative disc disease
• Spinal stenosis (narrowing of the spinal canal)
• Spinal cord compression (myelopathy)
• Peripheral neuropathy mimicking radiating pain
• Nerve entrapment outside the spine
• Muscular and joint-related pain without nerve involvement

Treatment approach

Many patients with nerve-related back and neck pain improve without surgery. Treatment is directed by the diagnosis and may involve activity modification, physical therapy, medications for nerve pain, and coordination with other specialists. Referral for a surgical or interventional opinion is made when the findings warrant it.

Frequently asked questions

When should back or neck pain be seen by a neurologist?

Neurological evaluation is helpful when pain radiates into an arm or leg, or when there is numbness, tingling, weakness, or loss of coordination — findings that suggest a nerve, nerve root or the spinal cord is involved.

What is radiculopathy?

Radiculopathy means a nerve root leaving the spine is irritated or compressed. It typically causes pain, numbness or weakness following the path of that nerve into the arm or leg.

Is this a spine surgery practice?

No. This is neurological evaluation of symptoms associated with back and neck disorders — identifying whether nerves are involved and how severely — with referral for surgical or orthopedic opinion when that is appropriate.

What testing may be involved?

Evaluation begins with history and neurological examination. EMG and nerve conduction studies, and review of existing or new imaging, may be used when they are likely to change understanding of the problem.

Watch: Why Is My Foot Numb or Tingling? — a short neurologist-reviewed video on how a pinched nerve in the lower back differs from neuropathy, from our Neurology Video Library.