What is a cervical herniated disc?
A cervical herniated disc is a condition when the inner core of the disc (nucleus pulposus) protrudes through a weakened portion of the tougher outer layer (annulus fibrosus). The cervical herniated disc can be a cause of neck pain. The pain will typically worsen with neck flexion as this places more pressure on the disc. The disc herniation may result in compression of the spinal cord or a nerve root. When the disc compresses the nerve, it can lead to pain radiating into the shoulder blade and into the arm, sometimes as far as the hand and fingers. In addition, weakness and numbness of the arm could also be present. If the herniated disc compresses the spinal cord, it may result in arm or leg weakness, numbness, and loss of positional sense leading to an unsteady walk. It could also lead to difficulty with fine motor manipulation of the hands making it difficult to write or button shirts. Sometimes, symptoms in the arms or legs could be present without neck pain.
How is a cervical herniated disc diagnosed?
A cervical herniated disc will produce symptoms of neck pain/headache, arm pain and arm or leg weakness/numbness. The medical term for a herniated disc pinching a nerve producing symptoms (pain/numbness/weakness) into the arm is radiculopathy. The medical term for herniated disc producing symptoms from spinal cord compression is myelopathy. The neck will be examined for range of motion and physical examination will look for any signs of weakness or numbness in the arms or legs. Furthermore, reflexes in the arms and legs will be tested to look for abnormally weak reflexes (a sign of radiculopathy) or abnormally strong reflexes (a sign of myelopathy). The best imaging study to diagnose herniated disc is a cervical MRI study.
What is the treatment for a cervical herniated disc?
The majority of cases are treated conservatively (without surgery) with medications and physical therapy. Medications including Tylenol, anti-inflammatory medications, and oral steroid can be effective to relieve inflammation. Physical therapy should be initiated within several weeks if pain persists. Neck injections including epidural steroid injections and facet injections can reduce pain by delivering steroids to the nerve or joint space.
Surgery is a good option if conservative treatment options mentioned above have failed to relieve pain or if there is arm/leg weakness. The most common surgery for a herniated cervical disc is called anterior cervical discectomy and fusion (ACDF) which removes the herniated disc and places a spacer with bone fusion material to maintain the disc space. A small titanium plate fixates the vertebra above and below the disc for additional stability.