Neck pain can originate from any number of factors. Perhaps the most difficult symptom complex to resolve is axial neck pain arising from upper cervical nerve root compression. The purpose of this study is to report the results of surgical intervention in a series of patients with neck pain from C4 radiculopathy. Twelve consecutive patients who were diagnosed with C4 radiculopathy were retrospectively reviewed (follow-up, 22+/-16.3 months). Patients underwent either anterior cervical discectomy and fusion or posterior laminoforaminotomy at the C3-C4 segment. The results show that a good to excellent clinical result can be achieved in most patients (92% in our series). The importance of identifying patients with C4 radiculopathy lies in the fact that surgery can alter the natural history of neck pain secondary to upper cervical root radiculopathy, unlike axial neck pain from degenerative disk disease.