Summary:Optimal management of cervical myelopathy, radiculopathy, or both remains controversial. Recent reviews of the literature have stated that surgical and nonsurgical management of cervical myelopathy is equal in outcome. Cervical spondylosis causing myelopathy/radiculopathy can be difficult to diagnose, and the incidence of misdiagnosis remains high. We believe that conservative care is important but that nonsurgical and surgical care are not equal in outcome and outline a systematic approach to both myelopathy and radiculopathy. The importance of correlating radiological studies with the clinical presentation is stressed, as well as their use to determine the extent of decompression, because the high rate of surgical failures appears to be related to inadequate decompression in the majority of the cases.