Neck (Cervical)
Cervical Disc Herniation
경추 추간판 탈출증
A condition where a herniated disc compresses the nerve
- How common
- Very common
- Typical age
- 30s–50s
What is it?
The nucleus pulposus of the intervertebral disc herniates through the annulus fibrosus and compresses the nerve root or spinal cord.
Commonly affected: C5-6 and C6-7 levels are most commonly affected
How it develops
- Normal discThe nucleus pulposus is normally contained within the annulus fibrosus, serving as a shock absorber.
- Annular tearRepeated compression and degenerative changes cause fissures in the annulus fibrosus.
- Nucleus herniationThe nucleus pulposus herniates posteriorly through the tear and compresses the neural foramen.
- Nerve compressionThe herniated disc irritates and compresses the nerve root, causing radicular pain and paresthesia.
Symptoms
- Radicular pain (arm)Electric-shock-like pain following the nerve root distribution from shoulder to arm to fingers
- Neck painLocalized pain around the cervical spine, worsening with movement
- Finger numbnessC6: thumb, C7: middle finger, C8: little finger numbness
- Muscle weaknessWeakness in the arm or hand
- HeadacheOccipital headache may accompany
How it is examined
- Spurling test (+)Tilting the head to the painful side with downward pressure reproduces radicular pain → positive
- Upper limb weaknessC6: wrist extension weakness / C7: elbow extension weakness
- Sensory deficitDecreased sensation in the corresponding dermatome
- Decreased deep tendon reflexBiceps reflex (C5-6), triceps reflex (C7) diminished
Imaging
X-ray may show loss of cervical lordosis and disc space narrowing.
- Disc space narrowing
- Loss of cervical lordosis (straightening)
- Possible osteophyte formation
T2-weighted MRI is most accurate. Directly visualizes posterior disc herniation and nerve root compression.
- Posterior disc protrusion or herniation
- Neural foraminal narrowing
- Nerve root compression
- Decreased T2 signal (disc dehydration)
Non-surgical care
- Rest and posture correction2–3 days of rest in the acute phase, education on proper computer ergonomics
- Anti-inflammatory analgesics (NSAIDs)Ibuprofen, naproxen, etc. for inflammation and pain control
- Physical therapyTraction therapy, hot packs, and ultrasound for 4–6 weeks
- Nerve blockEpidural steroid injection reduces inflammation with rapid effect
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Failure of 6 weeks of conservative treatment, progressive neurological deficit, severe pain
Procedures that may be discussed
- ACDF (Anterior Cervical Discectomy and Fusion)
- Cervical artificial disc replacement
- Posterior foraminotomy
Outlook
Over 90% of patients improve with conservative treatment within 6–12 weeks.