Non-Surgical Treatment for Cervical Disc Herniation

What is it?

Non-surgical treatment for a cervical disc herniation is a stepwise plan that aims to ease neck and arm pain, protect nerve function and help you return to daily life without open surgery. It covers options ranging from medication, exercise and physiotherapy to image-guided interventional procedures.

In a cervical disc herniation, the inner part of a disc between the neck vertebrae pushes outwards and can press on the nerve roots leaving the spinal cord. Alongside neck pain, this can cause pain spreading around the shoulder blade, into the shoulder and down the arm. Numbness, tingling and sometimes weakness in the arm may also occur. This pattern is called cervical radiculopathy, meaning radiating pain from an irritated nerve root in the neck. For other causes of shoulder and arm symptoms, see shoulder and arm pain.

For many people, arm pain from a cervical disc herniation eases over weeks to months. Treatment therefore usually starts with the least invasive option.

When is it considered?

If there are no signs of spinal cord compression and no progressive weakness, non-surgical options are usually considered first. The decision is based on your symptoms, the neurological examination and your MRI findings taken together. Not every disc change seen on an MRI scan is the source of pain.

How does it work?

The stepwise approach aims to match the least invasive suitable treatment to the source of the pain and to bring the pain down to a level that lets you keep up with an exercise programme.

Step one: medication, posture and physiotherapy

• Pain medication adjusted to the severity of your symptoms
• Controlled movement and exercise rather than keeping the neck completely still
• Exercises with a physiotherapist to strengthen the neck and shoulder girdle
• Advice on computer and phone use, sleeping position and your workspace

Step two: image-guided injections

For severe pain radiating down the arm, an epidural steroid injection may be considered to calm inflammation around the nerve root. Because the spinal cord and major blood vessels are close by in the neck, the technique is chosen with particular care. If the pain seems to come mainly from the small joints of the neck, a facet joint injection followed by radiofrequency treatment may be options. For muscle pain that often accompanies a herniation, a trigger point injection can be a helpful addition.

Step three: disc procedures

In selected cases where the herniation is still contained within the outer ring of the disc, procedures that aim to reduce pressure inside the disc, such as nucleoplasty, may be discussed. These are not suitable when a fragment has broken away from the disc, when the spinal canal is severely narrowed or when the spinal cord is compressed.

Before the procedure

At your first visit you will be asked when the pain began, how it has changed, which treatments you have tried and which medicines you take. A neurological examination of the arms and legs checks muscle strength, reflexes, sensation and walking. A nerve conduction study (EMG) or other tests may be requested if needed.

If a procedure is planned, you will be advised how to manage blood thinners, diabetes medicines and blood pressure tablets, so please do not stop any of them on your own. The aim of the procedure, its expected benefits, possible risks and the alternatives will be explained before you give your consent.

After the procedure

After most procedures you can go home the same day following a short period of observation. Rest on the day and do not drive. The injection site may feel tender for a few days.

As pain eases, keeping up with physiotherapy and home exercises may help strengthen the neck and shoulder muscles and lower the chance of symptoms returning. At your follow-up visit, the change in your pain and the strength in your arm are reassessed.

When might you notice results?

This depends on the method. Improvement with medication and physiotherapy usually becomes noticeable over weeks. After an epidural injection, the effect often begins within a few days.

Results vary from person to person. Some people notice a clear reduction in pain, while for others the benefit is limited or treatment needs to be repeated. At the end of each step, your pain, arm strength and daily function are reviewed together.

When is surgery considered?

Non-surgical treatment is not right for everyone. In the following situations, surgery is discussed together with a spinal surgeon:

• Signs of spinal cord compression, such as unsteady walking, clumsy hands or a change in bladder control
• Rapidly worsening or severe arm weakness
• Arm pain that persists for weeks despite appropriate non-surgical care and clearly limits daily life
• Large herniations that press significantly on the spinal cord on MRI, or fragments that have broken away from the disc

The decision about surgery is also made individually, weighing the expected benefits against the risks for each person.

To find out which step suits you, you can request a consultation.