Cervical Disc Herniation
Cervical disc herniation is displacement of the inner disc material (nucleus pulposus) through the outer annulus, compressing a nerve root or the spinal cord in the neck. It most often occurs at C5-C6 and C6-C7, causing arm pain, numbness and weakness (radiculopathy), and in severe cases spinal cord compression (myelopathy).
Останнє оновлення: 2026-06-06
Definition
Cervical disc herniation is protrusion of the gel-like disc nucleus through the fibrous outer ring (annulus fibrosus) into the spinal canal or neural foramen. The displaced material may compress a nerve root (radiculopathy), the spinal cord (myelopathy) or both. Herniations are described as bulging, protrusion, extrusion or sequestration, and by location as central, paracentral (most common) and foraminal.
Causes and Risk Factors
The most common cause is age-related disc degeneration, in which the dehydrated disc develops annular tears and loses height. Acute trauma (motor-vehicle accidents, whiplash, sudden neck movement) can cause herniation in younger patients. Risk factors include older age, male sex, genetic predisposition, smoking, prolonged forward-flexed posture (extended computer use), exposure to vibration and repetitive neck trauma. Most herniations occur at C5-C6 and C6-C7.
Symptoms
Neck pain is the most frequent complaint. Nerve-root compression (radiculopathy) produces sharp, burning pain radiating into the arm in a dermatomal pattern, with numbness and weakness; coughing or sneezing (Valsalva) worsens it. The affected level determines the picture: the C6 root involves the thumb and index finger, the C7 root the middle finger. Cord compression (myelopathy) causes hand clumsiness, gait imbalance, spasticity, hyperreflexia and, in advanced cases, bladder symptoms; a shock-like sensation down the back on neck flexion (Lhermitte's sign) is typical.
Diagnosis
Diagnosis begins with a detailed history and neurological examination. The Spurling test (neck extension, rotation and axial load) provokes radicular pain; Hoffmann's and Babinski's signs suggest myelopathy. Magnetic resonance imaging (MRI) is the gold standard and best shows the herniation and compression of the cord and nerve roots; increased T2 cord signal indicates chronic compression and a poorer prognosis. Computed tomography (CT) is complementary for bony detail and osteophytes. Electromyography (EMG) confirms radiculopathy and distinguishes it from peripheral nerve disorders.
Treatment Options
For radiculopathy without neurological deficit, conservative care is first-line and brings marked improvement in most patients within 6-12 weeks: activity and ergonomic modification, analgesics/NSAIDs and neuropathic-pain medication, physical therapy and exercise, and in selected cases cervical epidural steroid injection. Surgery is considered for progressive weakness, radiculopathy unresponsive to conservative care, and myelopathy. Anterior cervical discectomy and fusion (ACDF) is the most commonly performed procedure; motion-preserving cervical disc arthroplasty (in suitable patients), posterior foraminotomy (for lateral herniations) and laminoplasty/laminectomy (for multilevel compression with myelopathy) are alternatives.
Postoperative Course
After ACDF the hospital stay is usually 1-2 days and the patient is mobilized the same or next day. A collar may be worn for 4-6 weeks depending on surgeon preference; heavy lifting and extremes of neck motion are restricted early on. Return to office work is typically 6-8 weeks and to physical work longer. Radiographic fusion takes 3-6 months. Recovery after arthroplasty and foraminotomy is generally faster.
Prognosis
Most patients with radiculopathy improve with conservative treatment, and many acute herniations resorb over time. Appropriately selected surgical patients can expect significant relief of arm pain. In myelopathy, the outcome depends on the duration of compression and the degree of cord injury; early treatment is important to prevent progression. Outcomes vary individually.
Джерела
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1280-1294.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011.
- North American Spine Society (NASS) — Clinical Guidelines: Diagnosis and Treatment of Cervical Radiculopathy from Degenerative Disorders.
Ця стаття має загальний інформаційний характер і не замінює огляду лікаря. Рішення щодо діагностики та лікування є індивідуальними.