Spinal disc herniation in the cervical spine: Information and clinics

Leading Medicine Guide Editors
Leading Medicine Guide Editors
The cervical spine consists of seven vertebrae, named C1 to C7 (C stands for cervix, Latin for neck or nape of the neck). Intervertebral discs lie between these vertebrae acting as aqueous buffer discs with a firm fibrous ring known as the annulus fibrosus. A disc herniation in the cervical spine refers to damage to one or more intervertebral discs in this section of the spine. It is also called a herniated cervical disc and may be associated with a narrowing of the spinal canal in the cervical spine area, known as spinal stenosis. Often there is shoulder and neck pain that can radiate to the arms and hands. Neurological symptoms such as gait abnormalities are also possible. Here you can find additional information and selected clinics for the treatment of herniated discs in the cervical spine.
ICD codes for this diseases: M50

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Brief overview:

  • What is a disc herniation in the cervical spine? A herniated disc, i.e., the protrusion of intervertebral disc material from the spaces specifically between the vertebrae of the cervical spine.
  • Cause: A congenital weakness of the connective tissue causes the disc tissue to be less elastic and stable, which can cause it to shift.
  • Symptoms: Shoulder and neck pain is common. Motor disorders, such as gait abnormalities, may also become apparent.
  • Treatment: A herniated disc in the cervical spine can be properly treated with a conservative approach. For this purpose, the patient receives pain-relieving medication and undergoes physiotherapy.
  • Surgery: Surgery is necessary if conservative measures are unsuccessful. The damaged disc is removed and replaced with either a prosthesis or the adjacent vertebrae are fixed to each other.
  • Risks associated with surgery: If surgery is not performed carefully, disc remnants in the spinal canal may be missed; nerve injury or bleeding is also possible.
  • Follow-up care: Conservative therapy is followed by physiotherapy. A three-week rehabilitation is often necessary after surgery.
  • Prognosis: In most cases, conservative treatment is sufficient to cure the condition in the long term. In severe cases, however, healing may be significantly prolonged, and permanent damage is then also possible.

Article overview

What is a disc herniation in the cervical spine?

Seven cervical vertebrae are located at the upper part of the spinal column and support the skull. The head joint is formed by the skull together with the top two cervical vertebrae.

In the case of a herniated disc of the cervical spine, intervertebral disc tissue protrudes from the gelatinous core (nucleus pulposus) through the disc’s fibrous ring (annulus fibrosus) to the back of the disc. The condition is listed under the ICD code M50.

Such damage can occur in any one of the 24 intervertebral discs of the spine. The lumbar spine (LS) is under the greatest strain. A herniated disc is a common disease of the cervical spine, especially in middle age.

Zervikaler Bandscheibenvorfall
This image shows the disease mechanism in a herniated disc in the cervical spine © Henrie / Fotolia

A distinction must be made between:

  • Disc herniation (extrusion), in which the fibrous ring breaks open and allows the internal nucleus to escape,
  • Disc protrusion (prolapse), in which, on the other hand, the disc is deformed with the fibrous ring still intact.

If a larger portion of the nucleus is displaced into the spinal canal, it is referred to as a free sequestration. In either case, pressure is exerted on spinal nerves, resulting in pain and neurological symptoms.

The different stages of a herniated disc © bilderzwerg / Fotolia

Causes of a herniated disc in the cervical spine

The primary cause is a congenital weakness of the disc tissue. The tissue is less elastic and stable in this situation.

Intervertebral discs themselves are not supplied with blood and receive their nutrients only from tissue fluid that is regularly forced in and out during movement. During sleep, the intervertebral discs regenerate by absorbing water again. After all, they are made up of 90% water.

In the course of life, the intervertebral discs and bony vertebrae age. The regenerative capacity of the intervertebral discs decreases. The vertebrae now react to unequal load distribution with wear and ossification of the small vertebral joints (facet joint syndrome or spondylarthrosis). The video shows this pathology:

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These degenerative diseases of the spine are also called spondylosis. They can constrict the spinal canal formed by the round recess in the center of the vertebrae. Thus a lack of space occurs in so-called spinal stenosis. In turn, this negatively affects the spinal cord and the spinal nerves branching off from it.

Nerve compression and pressure on the spinal cord cause severe pain.

Symptoms and diagnosis of cervical disc herniation

A recently herniated disc can lead to acute compression of a nerve root, i.e., a pinched nerve. Pain then radiates along the nerve root toward individual fingers. Functional deficits, i.e., motor problems, may occur corresponding to this radiculopathy.

There is often shoulder and neck pain. Almost all patients also suffer from restricted movement of the cervical spine.

Frau mit schmerzhafter Verspannung
Shoulder and neck pain is one of the typical symptoms of a herniated disc in the cervical spine © detailblick-foto / Fotolia

Spinal stenosis in the cervical spine can cause neurological symptoms that are difficult to diagnose. Pressure-induced changes in the spinal cord can also cause gait abnormalities, for example.

Treating herniated discs and spinal stenosis in the cervical spine

There is a distinction made between conservative and surgical treatment. Especially in the area of the cervical spine, the success rates of conservative treatment are good.

Conservative (non-surgical) treatment 

A herniated disc is an acute inflammatory event with swollen tissue and nerve compression. In principle, it can regress well on its own and the sequestered disc tissue is broken down by the body. This requires time and medicinal support.

Therapy begins with the administration of anti-inflammatory and pain-relieving drugs (NSAIDs such as diclofenac and ibuprofen). Muscle relaxants (prescription-only, for example, methocarbamol) and physiotherapeutic treatments help with severe muscle tension. Manual therapy and local heat application are usually well tolerated. A period of about 8 weeks should be planned for conservative therapy.

The following therapies are highly effective and supported by studies

  • Injections into the area of the affected nerve root, and
  • The technically demanding administration of drugs into the spinal canal of the cervical spine.

See the procedure of such a pain management intervention for a herniated cervical disc in the video:

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Surgery for herniated discs and spinal stenosis in the cervical spine

Surgical excision of the intervertebral disc (discectomy) and herniated disc is the treatment of choice in the case of

  • Chronic complaints despite conservative therapy, or
  • An acute herniated disc with paralysis.

Herniated discs in the cervical spine are predominantly operated on from the front, thus excising the diseased disc.

In young patients without facet arthrosis,

can be used to replace the defective intervertebral disc. In middle-aged and older patients, the adjacent vertebrae are fused with a bone block or spacer in lieu of the disc.

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Please accept additional external content to watch this video.

In cases of spinal stenosis in the cervical spine, the narrowing may also be caused by posterior structures. In these cases, a so-called dorsal decompression surgery is performed using various techniques. In this procedure, bony vertebral arches are removed or opened up to create more space for the spinal cord.

Possible complications and risks associated with surgical therapy 

The indication for intervertebral disc surgery must be determined very carefully because complication rates are low and primarily involve possible injury to the spinal cord meninx or misplacement of the spacer.

If surgery is not performed carefully with the aid of a microscope, disc remnants in the spinal canal may be overlooked.

Very rarely, bleeding or nerve injury occurs at the entry point on the neck.

Follow-up care for a herniated disc in the cervical spine

Conservative treatment or injection therapy should be followed by physical therapy exercises. In this regard, it is important that the patient learns to do their exercises on a regular basis. In the case of pre-damaged structures in the cervical spine, it is important to avoid loads, especially tensile loads, on the cervical spine.

Stretching the shortened muscles is helpful for a physiological, i.e., healthy posture. One-sided desk work in particular causes the chest and arm muscles to shorten. Opening stretching exercises can help and should initially be performed under professional guidance.

Physiotherapie Halswirbelsäule und Schultern
Physiotherapy is necessary to fully restore mobility © pololia / Fotolia

Cervical spine surgeries are usually very well tolerated and represent only a minor burden for the patient. The postoperative hospital stay is usually limited to a few days.

After the procedure, a recovery and healing period of about six weeks can be expected. The operation is often followed by rehabilitation or follow-up treatment, usually lasting three weeks.

Healing prospects for a herniated disc in the cervical spine

In most cases, herniated discs in the cervical spine can be treated well with a conservative approach. Injections are the most effective treatment in this regard. The relatively rare operations required for herniated discs of the cervical spine act quickly against the pain and have a high success rate.

Spinal stenosis of the cervical spine is a difficult to diagnose but has a severe pathology. It is therefore often detected late. Surgery can then often only limit the damage, but no longer provide a cure.

In the case of a diseased intervertebral disc in one segment, the chances of success are good with both conservative and surgical procedures. In acute herniated discs, the pain is very easy to treat, both by injections and, in appropriate cases, by surgery. If nerve damage is not yet so severe, it recovers postoperatively over the course of a few months.

If several segments, mostly in the area of the lower cervical spine, are affected by disc degeneration, only alleviation can be achieved.

In cases of severe spinal stenosis in the cervical spine with signs of spinal cord damage, permanent damage to the spinal cord may occur. This is then only partially reversible even if surgery is performed.

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