Cervical Herniated Disc
What Is It?
A cervical herniated disc is a degenerative disease of the spine in the neck. Herniated discs occur most frequently in the neck, the cervical spine, and in the lower back, the lumbar spine.
The intervertebral disc is a unique form of cartilage which connects the spinal bones and acts as a form of cushion for weight-bearing and movement of the spine. With degenerative aging processes the disc can start to fail, leading sometimes to pain, and eventually can rupture. Rupture results from a tearing of the outer, fibrous ring of the disc, allowing the soft internal parts to bulge or herniate out through the opening. This often occurs at a location which leads to the disc pressing on a spinal nerve adjacent to the spine which can cause the symptoms in the arm.
What Types of Symptoms Are Typical?
One of the common symptoms of a cervical herniated disc is pain. Pain can occur in the neck, but as the disc herniates and compresses nerves it can cause pain which radiates into the arm. While this pain in the arm can vary, it is very commonly described as a shooting pain that radiates into a part of the arm..
As the nerves to the arm get compressed by the cervical herniated disc, it can lead to other neurological symptoms, including muscle weakness, numbness and/or tingling in the distribution of that nerve. If only one level is affected, this generally involves only one arm in a particular distribution of muscles and skin which are normally supplied by that nerve. This is because the disc most commonly herniates to one side or the other, not both. In the case of multiple herniated discs, both arms and different parts of the arm can be involved.
Rarely, if a cervical herniated disc location is central, rather than the more common lateral herniation, one disc can affect both arms at once. Additionally, because of the limited room for the spinal cord in the region of the cervical spine, large disc herniations can contribute to cervical stenosis, a narrowing of the spinal canal which can cause other symptoms, or even compress the spinal cord itself, which can result in spastic symptoms of the arms and can affect the legs and bowel and bladder function as well.
If a herniated disc has been present for a long time, muscle weakness can eventually lead to atrophy of the involved muscles and/or complete numbness of the area of skin supplied by the nerve.
How Is The Diagnosis Typically Made?
Neck pain can be caused by many different things. A cervical herniated disc is just one of them. However, most people who are diagnosed with a herniated disc have additional symptoms, including arm pain, numbness, tingling and/or muscle weakness. This typical presentation makes the diagnoses much more likely than if a patient only has neck pain.
After a neurological evaluation, imaging studies such as a CT scan or MRI scan may be done. MRI is very effective at demonstrating a herniated disc and can even show the nerve root which is compressed by the disc. The MRI can also reveal other spinal disease problems which may co-exist with the disc disease such as cervical stenosis. The scans can also help rule out other causes of arm pain or numbness originating from the spine, such as a spinal tumor.
If there is a question of whether the disc is responsible for the patient's symptoms, occasionally tests such as a nerve conduction study may be performed to evaluate the function of the nerves.
What Are Some Common Treatments?
Treatment for cervical herniated disc varies considerably from patient to patient depending on many factors. However, many patients who initially present with this disease will be recommended to undergo a trial of rest and anti-inflammatory pain killers and later physical therapy. In many cases, this conservative treatment will lead to resolution of the symptoms.
Other treatments may include injections that help decrease the inflammation and thus the symptoms.
If these more conservative measures fail to control symptoms, or if the symptoms are very severe, some patients will undergo a surgical procedure. The most common surgery is called a discectomy, which is surgical removal of the herniated disc. The aim is to remove the herniated tissue so that the nerve is not irritated by it anymore. In many patients this is effective and reversing or lessening their symptoms.
For the cervical spine, this procedure is typically done from the front of the neck. A microdiscectomy as is done for lumbar disc disease cannot be performed for the cervical region. Because of the large spinal cord in the cervical region, the anterior disc cannot easily be reached from the back of the neck without injuring the cord. The most common form of this procedure is called an anterior cervical discectomy and fusion. It involves removing the disc, usually replacing it with a piece of bone graft or other material, and screwing a metal plate into the bone to stabilize the area. The goal is to reduce the pressure of the disc on the nerves and to form a fusion of bone across the disc space.
In more complex cases, a more involved procedure may be required, such as multiple level fusions or a laminectomy.
Because each patient is different, treatment suggestions and decisions should be made with their own treating physician and cannot be generalized.
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This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.