A cervical disc herniation occurs when a disc between the neck vertebrae bulges out and presses on a nerve root or the spinal cord. Pain and numbness spreading into the arm are typical; most patients improve without surgery.
What is a cervical disc herniation?
A cervical disc herniation occurs when a disc between the neck vertebrae bulges out and presses on a nerve root running to the arm, or on the spinal cord. It most commonly occurs at the C5-C6 and C6-C7 levels. Age-related disc wear, prolonged work with the head bent forward, sudden strain and injury are the main causes.
Herniations pressing on a nerve root cause pain radiating into the arm (cervical radiculopathy), while large herniations compressing the spinal cord can cause reduced hand dexterity and gait disturbance (cervical myelopathy).
Symptoms
- Neck pain and stiffness
- Pain spreading to the shoulder, shoulder blade and arm
- Numbness or tingling in the arm, hand or fingers
- Weakness of the arm or hand
- With spinal cord compression: reduced hand dexterity (difficulty buttoning or writing) and unsteadiness when walking
Diagnosis
Neurological examination and cervical MRI are essential. CT may be used to assess the bony structures and EMG to assess nerve damage. It is important to distinguish it from conditions with similar symptoms, such as carpal tunnel syndrome.
Treatment Approach
Most patients with arm pain improve without surgery: medication, short-term use of a soft collar, physiotherapy and exercises, and interventional pain treatments in suitable patients.
Surgery is recommended for progressive weakness, spinal cord compression (myelopathy) or pain that persists and limits daily life despite non-surgical treatment. The main procedures are:
- Anterior cervical discectomy and fusion (ACDF): Through a small incision at the front of the neck, the herniated disc is removed and replaced with a cage that fuses the vertebrae.
- Cervical disc replacement: In selected patients, the removed disc is replaced with a motion-preserving artificial disc.
- Posterior foraminotomy: Through the back of the neck, the opening through which the nerve root exits is widened to relieve pressure.