Herniated Disc — Cervical
A herniated disc in the neck compresses the nerves that travel into your arms. The symptoms are often felt far from the source.
Also Called: Slipped disc, ruptured disc, bulging disc, disc protrusion, disc extrusion. The same terms used for a lumbar herniation, applied to the neck.
What It Is
Discs in the neck sit between the bones, cushioning them and letting your head turn and bend. A cervical disc herniates the same way a lumbar one does: the outer ring tears and the soft center pushes through. The nerves in the neck run into the shoulder, arm, and hand, so a herniated disc there often causes pain, numbness, or weakness in the arm. Some patients feel little or no neck pain at all.
Causes & Risk Factors
Age-related disc degeneration is the most common factor. A movement or minor strain is usually the trigger people notice, though the degeneration came first. Repetitive neck strain, a prior injury, and a genetic tendency toward earlier degeneration all raise the risk. Smoking speeds disc breakdown throughout the spine, including the neck.
Symptoms
- Pain, numbness, tingling, or weakness that travels from the neck into the shoulder, arm, or hand
- Some patients have significant neck pain
- Others have almost none — only arm symptoms
Diagnosis
Because the nerves in the neck run into the shoulder, arm, and hand, the location of the arm symptoms is what identifies the nerve involved, and Dr. Hirsch will ask specifically whether the symptoms are in the front, the side, or the back of the arm, and how far down they travel. An MRI confirms which disc is responsible. A CT scan is sometimes added when it matters whether the structure pressing on the nerve is disc material or bone, since the two are approached differently in surgery.
Treatment
Most cervical disc herniations are treated without surgery. Non-surgical care uses the same three categories: anti-inflammatory and other pain medications, physical therapy, and targeted injections. These are short-term measures rather than permanent treatment, and most patients with new neck or arm pain improve over roughly six to eight weeks.
Surgery is considered when a complete course of non-surgical treatment has not relieved the symptoms, or when weakness or spinal cord involvement makes waiting inappropriate.
Cervical Disc Replacement
The disc is removed through a small incision at the front of the neck and replaced with an implant made of metal endplates and a plastic or ceramic bearing surface, which maintains motion at that segment. Preserving motion also means the discs above and below are not asked to absorb the movement that a fused level gives up, which is the reason disc replacement is generally preferred for younger patients when their anatomy allows it.
ACDF — Anterior Cervical Fusion
The same anterior approach, with a spacer, bone graft, and fixation placed so the two bones heal together. There are situations where fusion is the better choice, and the most common one is severe arthritis in the joints at the back of the neck. There is no implant to replace those joints, so replacing the disc while leaving arthritic joints in motion would leave the source of the neck pain untreated. Stopping motion at the segment stops it in those joints as well.
Endoscopic and Minimally Invasive Decompression
For a herniation compressing a nerve as it exits the side of the neck, the nerve can sometimes be decompressed from the back through a muscle-sparing approach, leaving the disc in place.
Dr. Hirsch is board-certified and Yale-trained. Read his full background.