Cervical Disc Herniation
Updated: Nov 26, 2020
Cervical disc herniation causes cervical radiculopathy which is typically accompanied by some form of radicular pain, but not always. In cases where cervical radiculopathy involves pain, it can range anywhere from a dull, general discomfort or achiness to a sharp, shock-like or burning pain. Cervical radicular pain may be felt anywhere from neck all the way down the arm into the fingers.
The two most common causes of cervical radiculopathy include:
Cervical foraminal stenosis. When a nerve gets entrapped in a narrowed bony opening while exiting from the spinal cord, the nerve root has less space and may become impinged. Degenerative changes related to cervical osteoarthritis and/or cervical degenerative disc disease may result in nearby bone spurs (osteophytes), thickening ligaments, or a bulging disc that pushes against the nerve root in the foramen. Cervical foraminal stenosis is the most common cause of cervical radiculopathy.
Cervical herniated disc. If the inner material of the cervical disc leaks out and inflames or impinges the adjacent nerve, it can cause cervical radiculopathy. A herniated disc is more likely to occur from an injury or strenuous activity, which may explain why it is the most common cause of cervical radiculopathy in younger people (20s or 30s).
While much less common, other potential causes of cervical radiculopathy include:
Fracture. If part of a vertebra becomes fractured, the resulting instability or foraminal narrowing in the cervical spine may impinge a nerve root. Such a fracture could be caused by an injury or cervical spondylolisthesis (where one vertebra slips in front of another).
Tumor. A tumor, whether malignant or benign, may grow nearby and push against a nerve root.
Infection. Various spinal infections as Tuberculosis (T.B.) and—less commonly—systemic infections can lead to inflammation and/or damage to a nerve root.
Sarcoidosis. A rare disease that can cause granulomas (lumps) to grow on any organ in the body.
Other conditions may also compress or cause damage to the cervical nerve root. It is also possible for a congenital anomaly to result in a narrowed foramen or other changes that increase the likelihood for cervical radiculopathy to develop.
Risk Factors for Cervical Radiculopathy
Some factors that may increase the risk for developing cervical radiculopathy include:
Age. The risk for cervical radiculopathy tends to increase with age. Some estimates state that this risk peaks in a person’s 40s or 50s.
Strenuous activities that are capable of putting high levels of stress on the cervical spine, such as wrestling or weight-lifting.
Repetitive neck motions or vibrations, such as driving a truck (vibrating equipment) or repeatedly diving head first from a diving board into a pool
· Several other risk factors increase the risk for having cervical radiculopathy, such as smoking or previously having lumbar radiculopathy
Symptoms in Cervical Radiculopathy
Cervical radiculopathy signs and symptoms typically include pins-and-needles tingling, numbness, and/or weakness in the areas served by the affected nerve root. In addition to these neurological deficits, pain is also present in most cases. These signs and symptoms may be felt in one area only, such as the shoulder, or progress along the entire arm and into the hand and fingers.
Cervical radiculopathy signs and symptoms are most commonly on just one side of the body, but they can be on both sides. If neurological deficits become severe or go into the hand, they can reduce the ability to perform many routine tasks, such as gripping or lifting objects, writing, typing, or getting dressed.
Symptoms Progression in Cervical Radiculopathy
Cervical radiculopathy involves one or more of the following neurological deficits that may be experienced in the neck, shoulder, arm, hand, and/or fingers:
Sensory. Feelings of numbness or reduced sensation in the skin. There may also be tingling, electrical sensations.
Motor. Weakness or reduced coordination in one or more muscles.
Reflex. Changes in the body’s involuntary (automatic) reflex responses. Some examples may include diminished ability to respond when the skin touches hot or cold.
Cervical Radiculopathy Signs and Symptoms by Location
Cervical radiculopathy signs and symptoms differ depending on which nerve root is affected. For example, C6 radiculopathy occurs when the nerve root that runs above the C6 vertebra is affected.
While any patient's specific signs and symptoms can vary widely and do not always follow a predictable pattern, the following are common descriptions for how cervical radiculopathy may differ by location:
C5 radiculopathy. Tingling, numbness, and/or pain may go from the neck into the shoulder and/or down the arm and into the thumb. Weakness may be experienced in the shoulder or upper arm.
C6 radiculopathy. Tingling, numbness, and/or pain may radiate through the arm and into the second digit (index finger). Weakness may occur in the front of the upper arm (biceps) or wrist.
C7 radiculopathy. Tingling, numbness, and/or pain may be felt down the arm and into the middle finger. Weakness may be experienced in the back of the upper arm (triceps).
C8 radiculopathy. Tingling, numbness, and/or pain may radiate down the arm and into the little finger. Handgrip strength may be reduced.
Less commonly, cervical radiculopathy can occur higher in the cervical spine, such as C4 radiculopathy or higher. While rare, it is also possible to have nerve compression or inflammation at multiple levels of the cervical spine at the same time, resulting in multiple radiculopathies.
Pain with Position or Movement of the neck
Sometimes cervical radiculopathy signs and symptoms flare up with certain activities, such as bending the neck forward to peer at a mobile phone or laptop screen for long periods, and will resolve when the neck is supported and at rest. For others, signs and symptoms may become persistent and do not resolve when the neck is in a supported, resting position.
Any condition that somehow compresses or irritates a cervical nerve root can cause cervical radiculopathy. It most commonly results from degenerative changes to the cervical spine over a longer period of time, but it can also occur due to an acute injury or illness.
Patient History and Physical Exam
The process of diagnosing cervical radiculopathy typically involves a physical examination and review of the patient history and for the confirmation of the exact etiology of the symptoms, imaging studies and other advanced diagnostics may be needed.
When a person presents with suspected cervical radiculopathy, such as pins-and-needles tingling, weakness, or numbness in the shoulder, arm, and/or hand, the doctor will likely start with the following:
Patient history. Information is gathered regarding current signs and symptoms, any prior or current illnesses or conditions, accidents or injuries, family history, and lifestyle. This medical background can help give a better picture of what might need further investigation.
Physical exam. The neck is palpated (felt) for any abnormalities or tenderness. The arm and hand are tested for any reductions in strength, sensation, or reflexes. Head and neck range of motion are also checked.
Spurling’s test. As part of the physical exam, Spurling’s test enables the doctor to see if compressing the cervical spine can reproduce or (temporarily) worsen the patient’s radicular symptoms. This test is typically done by having the patient bend the head to the side where symptoms have occurred, and then the doctor gently applies pressure to the top of the head. This process will cause the cervical foramen—bony openings in the spine where nerve roots exit—to compress and narrow, which might have the effect of compressing a nerve root and reproducing the radicular symptoms that the patient has been experiencing.
In some cases, especially if signs and symptoms have not been subsiding with conservative treatment, advanced diagnostic techniques might be requested, such as:
Imaging studies. Imaging of the body may show how a cervical herniated disc or a bone spur is impeding a nerve root in the neck. Magnetic resonance imaging (MRI) is the most common imaging study used when checking for cervical radiculopathy because it shows nerves and other soft tissues, such as herniated discs, so clearly. For people who cannot have an MRI for medical reasons, or if a better image of the bones is needed, an x-ray or CT scan may be advised.
Electrodiagnostic testing. These types of tests check how nerves are functioning. Two components of electrodiagnostic tests include:
Electromyography (EMG), which can check nerve and muscle function as well as nerve communication with muscle fibers by monitoring electrical activity in the muscle
Nerve conduction studies (NCS), which check whether nerves are sending signals at an appropriate speed.
Several other conditions have signs and symptoms similar to cervical radiculopathy, so getting an accurate diagnosis is important. For example, cervical radiculopathy involves nerve inflammation in the neck whereas carpal tunnel syndrome involves nerve entrapment in the wrist, yet both can have similar hand tingling and numbness symptoms. Distinguishing between the two is important in selecting a treatment plan that targets the actual source of the problem.
Cervical Disc Herniation Treatment
There is a wide range of treatment options available for cervical radiculopathy. The treatment will depend mainly on the underlying cause of the patient's symptoms as well as the severity of signs and symptoms. Nonsurgical treatments might be tried first but if a patient shows advanced neurological symptoms like numbness, tingling or weakness in any of the limbs or if there is no improvement in cervical radiculopathy symptoms then surgery might be considered.
Nonsurgical treatments for cervical radiculopathy typically include one or more of the following:
Rest or activity modification. Limiting strenuous activities, like sports or lifting heavy objects, or using better posture while sitting or driving might provide some relief.
Physical therapy. A physical therapist or other certified health professional might prescribe an exercise and stretching routine that is specific for the patient’s needs. Improving the neck and back’s strength and flexibility may help them to hold better posture and become more resistant to pain.
Ice and/or heat therapy. Applying an ice pack or a heated gel pack to the neck might offer pain relief for some people. For example, applying cold therapy after an activity-related flare-up of pain may help reduce inflammation and pain. When applying ice or heat therapy, it is important to have a layer that prevents direct contact with the skin, and limit applications to 15 or 20 minutes at a time with about a 2-hour break in between.
Medications. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first medications tried to relieve inflammation related to cervical radiculopathy. Examples could include aspirin, ibuprofen, or naproxen.
There is limited evidence to suggest that any one treatment for cervical radiculopathy is better than another. Many people find optimal relief with a combination of treatments rather than a single approach.
Role of Surgery
If nonsurgical treatments are not providing pain relief from cervical radiculopathy, or if neurological symptoms of arm or hand numbness and weakness are present, surgery is to be considered to prevent permanent neurological damage.
Common surgical options for cervical radiculopathy include:
Anterior cervical discectomy and fusion. This surgery goes through a small incision in the front of the neck to remove the disc (which may be herniated or damaged) and then fuses that level of the cervical spine to restore normal height to give spinal nerves enough room and ensure the neck stays stable. This surgery is the most common used to relieve symptoms of cervical radiculopathy.
Artificial disc replacement. Instead of doing a fusion, this surgery replaces the problematic disc with an artificial disc. A potential benefit to this procedure is that it aims to maintain mobility at that level of the cervical spine instead of fusing two vertebrae together.