Cervical Disc Herniation

The symptoms of a cervical herniated disc can vary based on the location and severity of the herniation and which nerve is affected. Commonly, individuals experience severe neck pain that is localized to the neck. Another frequent symptom is radiculopathy, which is pain, numbness, or tingling that radiates down the shoulder, arm, and into hand, often on one side. Cervical spinal stenosis refers to pressure or pinching of the nerves in the neck. These are the same nerves which eventually become your arm nerves, so that is why patients might experience arm pain when the problem is in fact in the neck. If the problem is at C4/5, I would expect a patient to have outside of shoulder pain/numbness and potentially trouble lifting their shoulder like a “wing.” Likewise, at C5/6, I would expect pain or numbness to the back of the forearm and thumb, with possible biceps weakness or trouble extending the wrist. Finally, at C6/7, I would expect pain/numbness down the arm to the first few fingers, along with potentially triceps weakness or difficulty flexing the wrist.

Muscle weakness in the shoulder, arm, or hand can occur, as well as sensory changes like tingling or a pins-and-needles feeling in the arm or hand. Some people may also experience a loss of coordination, particularly in fine motor skills in the hands.

Between each vertebrae is an intervertebral disc that acts as a cushion absorbing stress and shock caused by movement and keeps the vertebrae from rubbing against each other. Each intervertebral disc has a tough outer layer that encases a soft gel-like substance. One of the effects of aging is disc degeneration at one or more levels. With age the discs lose water content and elasticity, limiting the ability to absorb shock, and increasing the risk of a tear or rupture.

• Degenerative disc disease is a primary cause of a herniated cervical disc.
• Trauma, such as from car accidents or falls, can also cause a disc to herniate.
• Repetitive stress from activities that involve frequent neck movements or heavy lifting increases the strain on the cervical spine, raising the risk of herniation.
• Additionally, genetics can play a role, as a family history of spinal problems can predispose individuals to disc herniation.

Diagnosing a cervical herniated disc involves a combination of medical history, clinical examination, imaging studies including x-rays, MRI and CT scans; and nerve conduction studies, called Electromyography, can assess nerve function and pinpoint the affected nerves.

Treatment for a cervical herniated disc can be conservative or surgical, depending on the severity of symptoms and the response to initial treatments.

• Conservative treatments include rest, which helps alleviate acute pain.
• Medications such as Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) reduce inflammation and pain, while over-the-counter or prescribed pain relievers manage discomfort. Muscle relaxants may be used to alleviate muscle spasms. Neuromodulatory agents such as gabapentin or pregabalin may reduce nerve pain.
• Physical therapy plays a significant role in treatment, involving exercises to strengthen neck muscles, improve flexibility, and reduce pain.
• Corticosteroid injections, particularly epidural steroid injections, can reduce inflammation around the affected nerve and relieve pain.
• Lifestyle modifications, such as avoiding activities that exacerbate symptoms and making ergonomic adjustments, are also crucial.

When conservative treatments do not relieve symptoms and when there is significant nerve compression causing severe pain or neurological deficits, surgery may be considered.

Surgical options include:

• Posterior foraminatomy and discectomy, which involves removing the herniated portion of the disc through a small incision on the back of the neck. This technique may be done endoscopically.
• Anterior Cervical Discectomy and Fusion (ACDF) is another surgical option where the herniated disc is removed, and the adjacent vertebrae are fused to stabilize the spine.
• Alternatively, cervical artificial disc replacement (c-TDA) involves replacing the damaged disc with an artificial implant one to maintain motion at the disc space.

Early diagnosis and appropriate management of a cervical herniated disc can significantly improve outcomes and reduce the risk of long-term complications.