Cervical Disc Herniation

Also known as: Cervical herniated disc, Herniated cervical disc, Herniated disc in the neck, Cervical intervertebral disc herniation, Cervical disc prolapse, Cervical disc protrusion, Cervical disc extrusion, Cervical HNP (herniated nucleus pulposus)

Last updated: December 18, 2024

Cervical disc herniation is when the soft inner part of a neck disc pushes through its outer layer. The displaced material can narrow spaces around the spine and may press on a nerve root or sometimes the spinal cord, often with age-related disc degeneration. Symptoms can include neck pain with stiffness and radiating arm pain, and many cases may improve over weeks to months with non-surgical management.

Key Facts

•Cervical disc herniation refers to protrusion or extrusion of nucleus pulposus material through the annulus fibrosus of an intervertebral disc in the neck
•Neck pain that worsens with certain movements and occurs with muscle spasm or stiffness
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

Cervical disc herniation typically refers to protrusion or extrusion of nucleus pulposus material through the annulus fibrosus of an intervertebral disc in the neck. The displaced disc material may narrow the spinal canal or neural foramina and can compress a cervical nerve root, and in some cases may compress the spinal cord. This process often occurs in the setting of age-related disc degeneration, where disc hydration and height generally decrease and annular fissures can develop. Symptoms may vary based on the level involved and whether nerve root irritation (radiculopathy) or spinal cord involvement (myelopathy) is present.

Affected Anatomy

This condition affects several structures in and around the joint:

•Cervical intervertebral disc (annulus fibrosus and nucleus pulposus)
•Posterior longitudinal ligament along the cervical vertebral bodies
•Cervical nerve roots (e.g., C5, C6, C7, C8) within the neural foramina
•Neural foramina and uncovertebral joints (joints of Luschka) that can contribute to foraminal narrowing
•Cervical spinal cord within the spinal canal
•Dorsal root ganglion and sensory rootlets associated with cervical nerve roots
•Facet (zygapophyseal) joints that can be co-involved with degenerative change
•Paraspinal and scapular stabilizer muscles (e.g., trapezius, levator scapulae) that can develop secondary spasm

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Neck pain that may worsen with certain movements and can occur with muscle spasm or stiffness
•Radiating arm pain (cervical radiculopathy) that may follow a dermatomal pattern and can be described as sharp, burning, or electric
•Numbness or tingling in the shoulder, arm, hand, or fingers that may correlate with the affected nerve root level
•Arm or hand weakness that can involve specific muscle groups (e.g., wrist extension, elbow extension, finger flexion) depending on the level
•Reduced grip strength or fine motor difficulty that may be more noticeable with tasks requiring dexterity
•Symptoms that may worsen with coughing, sneezing, or straining due to transient increases in intraspinal pressure
•Headache, often in the occipital region, that can occur with cervical muscle tension or referred pain
•Signs that can suggest spinal cord involvement (cervical myelopathy), such as gait imbalance, clumsiness, or diffuse hand numbness, which may occur in some cases

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Age-related disc degeneration that can lead to annular fissures and reduced disc height, which may predispose to herniation
•Acute mechanical strain or injury that can increase intradiscal pressure and may contribute to disc material displacement
•Repetitive loading or microtrauma from occupational or athletic activities that can stress the cervical discs over time
•Coexisting cervical spondylosis, including osteophyte formation and uncovertebral or facet joint degeneration, which can contribute to nerve root or cord compression alongside disc herniation
•Congenital or developmental narrowing of the spinal canal (relative stenosis) that can make smaller herniations more clinically significant
•Inflammatory and biochemical irritation of nerve roots from disc material exposure, which can contribute to pain even with limited mechanical compression

Risk Factors

•Increasing age, as disc dehydration and annular weakening generally become more common over time
•Occupations involving repetitive neck motion, overhead work, vibration exposure, or frequent lifting that can increase cervical spine loading
•Smoking or nicotine exposure, which may be associated with accelerated disc degeneration and impaired disc nutrition
•Prior neck injury or whiplash-type trauma, which can contribute to disc and ligamentous strain
•Poor ergonomics or prolonged static postures (e.g., sustained forward head posture) that can increase cervical disc stress
•High body mass index, which can be associated with greater mechanical load and systemic inflammation
•Family history or genetic predisposition to degenerative disc disease, which may influence disc composition and degeneration risk
•Coexisting degenerative cervical spine conditions (spondylosis, foraminal stenosis) that can increase the likelihood of symptomatic nerve compression

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Clinical history and symptom mapping, including characterization of neck and arm pain distribution, sensory changes, and functional limitations that may suggest a specific nerve root level
•Physical examination that can include cervical range of motion assessment, neurologic examination (strength, reflexes, sensation), and evaluation for myelopathic features such as gait changes or coordination difficulty
•Provocative maneuvers such as the Spurling test and shoulder abduction relief sign, which can help support suspected cervical radiculopathy when interpreted in clinical context
•Magnetic resonance imaging (MRI) of the cervical spine, which can visualize disc herniation, nerve root or spinal cord compression, and associated soft-tissue changes
•Computed tomography (CT) or CT myelography, which may be used when MRI is limited or contraindicated and can better define bony contributors and canal/foraminal narrowing
•Electrodiagnostic testing (EMG and nerve conduction studies), which can help differentiate cervical radiculopathy from peripheral neuropathies and can assess chronicity or denervation patterns
•Plain radiographs (X-rays) of the cervical spine, which can evaluate alignment, degenerative changes, and instability, although disc herniation itself typically is not directly visualized

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Activity modification and relative rest, which may reduce symptom provocation while maintaining general mobility as tolerated
•Manual therapy techniques and supervised mobilization, which may help some individuals when performed within appropriate clinical parameters
•Cervical traction (mechanical or manual), which can reduce foraminal compression in selected cases and may provide short-term symptom relief
•Neuropathic pain-modulating medications, which may be considered when radicular pain features predominate and can be used in some clinical settings
•Short-term cervical collar use in selected cases, which may reduce motion-related pain but generally is limited due to deconditioning concerns

Physical Therapy and Exercise

•Physical therapy approaches that can include cervical stabilization exercises, posture and ergonomic training, and graded strengthening to support function

Medications

•Non-opioid analgesics and anti-inflammatory medications, which can be used for symptom control in many care pathways and may be selected based on individual risk profiles

Surgery

•Epidural steroid injections or selective nerve root blocks, which may reduce inflammation and pain in some individuals and can be used as part of a non-surgical strategy
•Surgical decompression for persistent or progressive neurologic deficits or significant cord compression, which can include anterior cervical discectomy and fusion (ACDF) or posterior approaches depending on anatomy and level
•Cervical disc arthroplasty (artificial disc replacement) in selected patients, which may preserve motion at the treated level when appropriate anatomical and clinical criteria are met

Prognosis and Recovery

The course of this condition varies between individuals:

•Many cases of cervical radiculopathy from disc herniation may improve over weeks to months with non-surgical management, although symptom duration can vary.
•Pain often improves earlier than sensory changes, and numbness or tingling may persist longer even as function generally improves.
•Persistent weakness or progressive neurologic deficits can occur in some cases and may be associated with a more guarded functional recovery, particularly when spinal cord involvement is present.
•Cervical myelopathy related to cord compression can be associated with ongoing functional impairment, and outcomes may depend on severity, duration of symptoms, and imaging findings.
•Recurrence of symptoms can occur, and adjacent-level degenerative changes may develop over time, particularly after fusion procedures, although individual risk can vary.

Anterior Cervical Discectomy and Fusion (ACDF)(Procedure)
Cervical Spinal Fusion(Procedure)
Cervical Radiculopathy(Condition)
Lumbar Disc Herniation(Condition)

Frequently Asked Questions

Common symptoms include: Neck pain that may worsen with certain movements and can occur with muscle spasm or stiffness; Radiating arm pain (cervical radiculopathy) that may follow a dermatomal pattern and can be described as sharp, burning, or electric; Numbness or tingling in the shoulder, arm, hand, or fingers that may correlate with the affected nerve root level; Arm or hand weakness that can involve specific muscle groups (e.g., wrist extension, elbow extension, finger flexion) depending on the level; Reduced grip strength or fine motor difficulty that may be more noticeable with tasks requiring dexterity.

Diagnosis typically involves: Clinical history and symptom mapping, including characterization of neck and arm pain distribution, sensory changes, and functional limitations that may suggest a specific nerve root level; Physical examination that can include cervical range of motion assessment, neurologic examination (strength, reflexes, sensation), and evaluation for myelopathic features such as gait changes or coordination difficulty; Provocative maneuvers such as the Spurling test and shoulder abduction relief sign, which can help support suspected cervical radiculopathy when interpreted in clinical context; Magnetic resonance imaging (MRI) of the cervical spine, which can visualize disc herniation, nerve root or spinal cord compression, and associated soft-tissue changes.

Treatment options range from conservative measures to surgical interventions, including: Activity modification and relative rest, which may reduce symptom provocation while maintaining general mobility as tolerated; Physical therapy approaches that can include cervical stabilization exercises, posture and ergonomic training, and graded strengthening to support function; Manual therapy techniques and supervised mobilization, which may help some individuals when performed within appropriate clinical parameters; Cervical traction (mechanical or manual), which can reduce foraminal compression in selected cases and may provide short-term symptom relief; Non-opioid analgesics and anti-inflammatory medications, which can be used for symptom control in many care pathways and may be selected based on individual risk profiles.