A 45-year-old female presents with 6 weeks of left neck pain radiating to the left lateral forearm and thumb. Pain is 8/10, worse with left cervical extension and ipsilateral rotation. She is a software engineer and reports difficulty typing due to arm pain. She has completed 4 weeks of physical therapy with minimal improvement and failed a methylprednisolone dose pack.

Limited cervical range of motion, especially extension and left lateral rotation. Positive Spurling test on the left. Left biceps weakness (4+/5) and diminished biceps reflex. Sensation decreased over the left lateral forearm and thumb. Negative Hoffman sign bilaterally. Normal gait without myelopathic features.

MRI cervical spine shows a left paracentral disc herniation at C5-6 compressing the left C6 nerve root. No cord signal change. No significant central canal stenosis. Mild disc desiccation at C4-5 without neural compression.