Understanding Cervical Disc Herniations

Article written by Jeffrey C Wang, MD

Cervical disc herniations (ruptures) are a common problem that can lead to neck pain and symptoms that radiate down the arms to the fingers. The discs are the soft material that lies between the bones of the neck. This material acts as a cushion or shock absorber that decreases the stress between the bones and allows for neck movement. Unfortunately, these discs can wear out or become arthritic and then weaken. When they weaken to a certain point, they can tear or rupture which allows for the disc material to herniate or bulge outward. They can bulge to the point where they push on the nerves and the spinal cord, which can lead to nerve problems.

Most patients with disc herniations will experience symptoms of some neck pain, but the most severe problem is the pinched nerve. The nerves in the neck control strength, sensation, reflexes, and pain fibers that typically run down the arm in certain areas depending on which nerve is pinched. The pain, weakness and numbness can range from mild to severe, but it can lead to nerve damage when the pressure is severe and prolonged.

There is a spectrum of different treatment options that can be used to treat these symptoms. They range from very conservative therapies to surgical treatment. The best treatment for any individual patient will vary depending on the severity of the symptoms and the length of time that they have been present.

Your physician will perform an extensive neurological exam to detect any neurological signs and symptoms of nerve damage. In severe cases, the disc can not only pinch the nerves which exit the spine, but also the spinal cord itself which is a serious and potentially catastrophic situation. However, most patients do not need urgent surgery and can try numerous non-operative treatments to attempt to resolve the pain.

Once your physician has determined that surgery is not needed emergently, there are many conservative treatments that can be instituted. These conservative therapies include: rest, anti-inflammatory medications, cervical collar, pain medications, muscle relaxants, and physical therapy exercises. If these options fail, an epidural or steroid injection can be attempted and may provide significant relief.

If all of the conservative options fail, there are several surgical options that can be considered that have high success rates and can reliably alleviate the symptoms. These can include removal of the disc herniation and decompression of the nerve roots and spinal cord. Often, a cervical fusion can also be performed to stabilize the spine, provide a strong structural environment, and prevent recurrence of the symptoms.

Most patients with this condition resolve their symptoms with a carefully implemented treatment program without the need for surgery. The important points are to make sure that you see your physician to determine whether the situation is amenable to conservative care.