Cervical Disc Herniation

What is it?

The discs between the vertebrae of the neck give the head its flexibility while spreading the load. A cervical disc herniation occurs when the gel-like centre of a disc pushes out through a tear in its outer ring. If the herniated material presses on a nerve root to the side, it causes pain spreading into the arm (cervical radiculopathy); if it presses on the spinal cord in the centre, it can cause symptoms of spinal cord involvement (cervical myelopathy).

Herniations occur most often at the C5-C6 and C6-C7 levels. Depending on the nerve root affected, pain and numbness spread to the shoulder, the outer or inner side of the arm and particular fingers. For example, symptoms usually extend towards the thumb when the C6 root is involved, and towards the middle finger with the C7 root. Symptoms are usually one-sided, and in some people the arm pain is more troublesome than the neck pain itself.

What causes it?

A cervical disc herniation usually develops against a background of age-related water loss and wear in the disc. Triggers and risk factors include:

• Age-related disc degeneration and bony outgrowths (cervical spondylosis)
• Long periods working with the head bent forward, heavy lifting or sudden neck movements
• Injuries such as road traffic accidents
• Smoking
• Family history

Arm pain is not always caused by a herniated disc. Narrowing of the nerve openings by bony outgrowths produces a similar picture and is more common in older people. Shoulder problems and nerve compression at the wrist (carpal tunnel syndrome) also need to be considered (shoulder and arm pain).

How is it diagnosed?

The history and a neurological examination are central. Where the pain spreads, which fingers are numb, and changes in muscle strength and reflexes show which nerve root is involved. Arm pain reproduced when the head is turned towards the painful side, tilted slightly back and gently pressed (the Spurling test) supports nerve root compression. Signs of spinal cord involvement, such as clumsy hands, unsteady walking and brisk reflexes, are also specifically looked for.

MRI shows the herniation and its relationship to the nerve root or spinal cord in detail. X-rays can show bony outgrowths and the alignment of the spine, but they do not show the herniated disc itself. EMG can be used to assess the degree of nerve damage and to rule out other causes, such as nerve compression at the wrist.

Treatment options

Arm pain from a cervical disc herniation eases within a few weeks to a few months in many people. When there are no signs of spinal cord compression, treatment usually begins without surgery.

Conservative care

• Information and activity changes: avoiding positions that clearly worsen the pain for a while, without becoming completely inactive.
• Physiotherapy and exercise: programmes that strengthen the neck and upper back muscles and correct posture.
• Heat and short-term rest: can be soothing in the first few days when pain is at its worst. Wearing a neck collar for long periods is generally not advised, as it can weaken the muscles.
• Medication: short courses of painkillers can be used. When nerve pain is prominent, additional medicines are considered by the doctor, weighing their benefits against possible side effects.

Interventional pain treatments

If pain still significantly limits daily life after several weeks of treatment, interventional options are considered. An overview is given on the non-surgical cervical disc treatment page:

• Epidural steroid injection: performed under fluoroscopy to reduce inflammation and swelling around the nerve root. In the neck, because of the closeness of the spinal cord and blood vessels, the technique and route are chosen with safety as the priority.
• Nucleoplasty: aims to reduce pressure inside the disc in certain contained herniations; it is not suitable for every herniation.
• Radiofrequency treatment: for long-standing arm pain, pulsed radiofrequency can be applied next to the affected nerve root.

In suitable patients these methods can provide a meaningful reduction in pain. Results vary from person to person, and the possible risks are discussed in detail beforehand.

When is surgery needed?

If there are signs of spinal cord compression, progressive weakness, or severe arm pain that does not settle despite appropriate treatment, surgery is assessed together with a neurosurgeon. When the spinal cord is compressed, this assessment should not be delayed.

When should you see a doctor?

See a doctor if arm pain is not easing after a few weeks, if you have numbness or weakness in your hand, or if pain is stopping you from sleeping. An algology (pain medicine) specialist will review your examination together with your MRI and explain the treatment options that may suit you; you can request an appointment through our contact page.