Herniated Disc in the Cervical Spine – Symptoms and Treatment

The seven cervical vertebrae are located in the upper part of the spine and support the skull; the top two cervical vertebrae form the atlanto-occipital joint.

In a herniated disc of the cervical spine, disc tissue from the gelatinous nucleus (nucleus pulposus) protrudes backward through the fibrous ring of the disc (annulus) and out of the disc. The condition is listed under ICD code M50.

This type of disc damage can occur in any of the 24 intervertebral discs of the spine. The lumbar spine (LWS) is under the greatest strain. A herniated disc is also a common condition in the cervical spine (HWS), particularly among middle-aged individuals. 

This illustration shows the mechanism of a herniated disc in the cervical spine © Henrie / Fotolia

A distinction must be made between:

• a herniated disc (prolapse), in which the annulus fibrosus ruptures and allows the inner nucleus pulposus to protrude,
• disc protrusion, in which the disc is deformed while the annulus fibrosus remains intact.

If a large portion of the prolapsed material shifts into the spinal canal, this is referred to as a free sequester. In either case, pressure is exerted on the spinal nerves, leading to pain and neurological deficits.

The different stages of a herniated disc © bilderzwerg / Fotolia

The primary cause is a congenital weakness of the intervertebral disc tissue. This tissue is less elastic and stable.

Intervertebral discs themselves have no blood supply and receive their nutrients solely through interstitial fluid, which is regularly pressed in and out during movement. During sleep, the discs regenerate by reabsorbing water—after all, they consist of 90% water.

Over the course of a lifetime, the intervertebral discs and the bony vertebrae age. The discs’ ability to regenerate decreases. The vertebrae now respond to improper loading with wear and tear and ossification of the small vertebral joints (facet syndrome or spondylarthrosis). The video illustrates these symptoms: 

These degenerative diseases of the spine are also called spondylosis. They can narrow the spinal canal, which is formed by the circular opening in the center of the vertebrae. In a condition known as spinal canal stenosis, there is a lack of space. This, in turn, has a negative effect on the spinal cord and the spinal nerves branching off from it. Nerve compression and pressure on the spinal cord trigger severe pain.

A recent herniated disc can lead to acute compression of a nerve root. The pain then radiates along the nerve root toward individual fingers. This radiculopathy can result in functional deficits, i.e., motor problems.

Shoulder and neck pain is common. In addition, nearly all patients experience restricted movement of the cervical spine.

 

Over the course of a lifetime, the intervertebral discs and vertebral bones age. The discs’ ability to regenerate decreases. The vertebrae now respond to improper loading with wear and ossification of the small vertebral joints (facet syndrome or spondylarthrosis). The video illustrates these symptoms:

 

 

These degenerative diseases of the spine are also called spondylosis. They can narrow the spinal canal, which is formed by the circular opening in the center of the vertebrae. In a condition known as spinal canal stenosis, a lack of space develops. This, in turn, has a negative effect on the spinal cord and the spinal nerves branching off from it.

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

A recent herniated disc can lead to acute compression of a nerve root. The pain then radiates along the nerve root toward individual fingers. This radiculopathy can result in functional deficits, i.e., motor problems.

Shoulder and neck pain is common. In addition, nearly all patients experience restricted movement of the cervical spine.

 Shoulder and neck pain are among the typical symptoms of a herniated disc in the cervical spine © detailblick-foto / Fotolia

Spinal canal stenosis in the cervical spine can cause neurological symptoms that are difficult to diagnose. For example, pressure-related changes in the spinal cord can also lead to gait disturbances.

A distinction is made between conservative and surgical treatment. Success rates for conservative treatment are particularly good in the cervical spine.

Conservative (non-surgical) treatment 

A herniated disc is an acute inflammatory process involving swollen tissue and nerve compression. In principle, a herniated disc can resolve on its own, and the protruding disc tissue is broken down by the body. This process requires time and medication.

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

Highly effective and well-supported by studies are

• injections into the area of the affected nerve root, as well as
• the technically challenging administration of medication into the spinal canal of the cervical spine.

Watch the video to see how this type of interventional pain therapy is performed for a cervical disc herniation:

 

Surgery for a herniated disc and spinal canal stenosis in the cervical spine

Surgical removal of the intervertebral disc (nucleotomy) and the herniated disc is the treatment of choice for

• chronic symptoms despite conservative treatment or
• acute herniated disc accompanied by paralysis.

Herniated discs in the cervical spine are primarily treated through an anterior approach, during which the affected disc is removed.

In young patients without facet joint osteoarthritis,

• intervertebral disc prostheses or
• stabilizing rings made of titanium or plastic—known as a cage—

be used to replace the defective disc. In middle-aged and older patients, the adjacent vertebral bodies are fused using a bone graft or a spacer in place of the disc.

 

 

 

 

In cases of spinal stenosis in the cervical spine, the cause of the narrowing may also originate from structures at the back of the spine. In these cases, a procedure known as dorsal decompression is performed using various techniques. During this procedure, bony vertebral arches are removed or opened up to create more space for the spinal cord.

Possible Complications and Risks of Surgical Treatment 

The indication for intervertebral disc surgery must be determined with great care. When this is done, complication rates are low and primarily involve possible injury to the dura mater or misplacement of the spacer.

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

Bleeding or nerve injuries in the access area of the neck occur very rarely.

Conservative therapy or injection therapy should be followed by physical therapy exercises. It is important for the patient to learn exercises that they should perform regularly on their own. If there is pre-existing damage to structures in the cervical spine, it is important to avoid strain—especially tensile strain—on the cervical spine.

Stretching shortened muscles is helpful for achieving a physiological—that is, healthy—posture. The chest and arm muscles tend to shorten, particularly due to prolonged desk work in a single position. Stretching exercises that promote flexibility can help and should initially be performed under professional guidance.

Physical therapy is necessary to fully restore mobility © pololia / Fotolia

Surgery on the cervical spine is generally very well tolerated and places only a minimal burden on the patient. The postoperative hospital stay is usually limited to a few days. After the procedure, a recovery and healing period of about 6 weeks can be expected. The surgery is often followed by a rehabilitation or follow-up treatment (AHB) program, usually lasting three weeks.

In most cases, herniated discs in the cervical spine can be effectively treated conservatively. Injections are the most effective treatment option. Surgery for herniated discs in the cervical spine—which is rarely necessary—provides rapid pain relief and has a high success rate.

Spinal canal stenosis of the cervical spine has symptoms that are difficult to diagnose but serious in nature. It is therefore often detected late. At that point, surgery can often only limit the damage but no longer provide a cure.

For conditions affecting a single intervertebral disc in a specific segment, the prognosis is good for both conservative and surgical treatments. In cases of acute herniated discs, the pain can be treated very effectively with injections and, when appropriate, with surgery. If nerve damage is not yet severe, the nerves will recover over the course of several months following surgery.

If multiple segments—most commonly in the lower cervical spine—are affected by disc degeneration, only symptom relief can be achieved. In cases of severe spinal canal stenosis in the cervical spine with signs of spinal cord damage, permanent damage to the spinal cord may occur. Even if surgery is performed, such damage is only partially reversible.

A herniated disc in the cervical spine is usually the result of anatomical characteristics, as the cervical spine consists of seven mobile segments from C1 to C7, and its structure allows for a high degree of mobility while withstanding stress. A cervical disc herniation can cause symptoms such as radiating pain, neurological symptoms, or even neurological deficits, particularly during the acute phase of a herniated disc.

The causes of a herniated disc often lie in degenerative changes, which is why herniated discs in the cervical spine become more common with increasing age. Conservative treatment, supplemented by manual therapy, is successful in many cases of cervical disc herniation and is a central component of treatment for this condition.

If symptoms persist or worsen, surgical intervention—including the implantation of an artificial disc—may be necessary for herniated discs in the cervical spine. Overall, it is evident that herniated discs in the cervical spine, depending on their location, cause symptoms that require individually tailored treatment.

What is a herniated disc in the cervical spine?

A herniated disc in the cervical spine occurs when the gel-like nucleus of the disc protrudes through the fibrous ring and presses on nerve roots or the spinal cord in the cervical spine. This can lead to pain, sensory disturbances, or motor deficits.

What symptoms does a herniated disc in the cervical spine cause?

Typical symptoms of a herniated disc include neck pain, radiating pain in the shoulder, arm, or hand, tingling, numbness, and, in severe cases, paralysis.

How is a herniated disc in the cervical spine diagnosed?

The most important diagnostic method is an MRI of the cervical spine. This is supplemented by a clinical neurological examination and, if necessary, additional imaging procedures.

When is surgery necessary for a herniated disc in the cervical spine?

Surgery is considered if conservative treatment does not lead to improvement, if severe pain persists, or if neurological deficits occur due to pressure on the spinal cord or a nerve root.

What conservative treatment options are available?

Conservative treatment includes physical therapy, pain management, targeted injections, rest for the cervical spine, and the gradual strengthening of the neck muscles to improve mobility and relieve symptoms.