A herniated disc can also be called a bulging disc, ruptured disc, or slipped disc. Regardless of what name it’s called, a herniated disc can lead to intense pain, numbness, and muscle weakness. If left untreated, the long-term effects of a herniated disc can include permanent nerve damage. Read further to learn more about cervical disc herniations.
What Is Cervical Disc Herniation?
Each one of the seven cervical vertebrae (C1 – C7) located within your neck is supported and cushioned by a cervical disc. There are a total of six cervical discs interspersed among the cervical vertebrae. A cervical disc is comprised of two basic components: a strong outer layer called the annulus fibrosus and a soft, gel-like interior called the nucleus pulposus. The annulus fibrosus completely encircles and seals the nucleus pulposus within the center of the disc.
A cervical disc herniation occurs when a cervical disc’s inner core, the nucleus pulposus, protrudes through the outer layer, the annulus fibrosus. In severe cases, a fragment of the nucleus pulposus can completely break free from the disc. Cervical disc herniations most commonly occur between the C5 and C6 vertebrae and C6 and C7 vertebrae.
How a Cervical Disc Herniates and Causes
A cervical disc herniates when the annulus fibrosus is damaged. When part of the annulus fibrosus tears, it creates a weak spot in the disc. As the spine undergoes axial loading, the nucleus pulposus will push out through the weak spot in the annulus fibrosus.
How does the annulus fibrosus become damaged? The annulus fibrosus can weaken and tear for several reasons described below:
- Disc degeneration – As you age, your discs begin to lose water content. The loss of hydration causes the discs to degenerate and weaken, thus increasing the likelihood of cracks and tears in the annulus fibrosus.
- Repetitive movements – Repetitive movements add stress to the structures of the spine. Repeated bending and twisting of the neck can result in long-term wear and tear of the cervical discs.
- Trauma – The annulus fibrosis can be damaged by sudden trauma or injury. Injuries can happen from whiplash, lifting heavy objects, and competitive sports.
Common Signs and Symptoms of a Cervical Disc Herniation
Cervical disc herniations can exist without symptoms. In fact, 35% of adults between 40 and 64 years of age are predicted to have asymptomatic cervical disc herniations. When symptoms of a cervical disc herniation do manifest, they typically arise for two reasons. Firstly, the bulging disc may begin to impinge on one of the cervical nerves. Secondly, the nucleus pulposus may begin to leak inflammatory cytokines. Both the compression and inflammation of a cervical nerve is defined as cervical radiculopathy.
Cervical disc herniation symptoms include the following:
- Pain in the neck, shoulder, arms, and/or hands
- Numbness or tingling in the arms and/or hands
- Muscle spasms
- Muscle weakness
- Decreased mobility
- Diminished reflexes of the elbow and brachioradialis tendon
The nature of your symptoms can help pinpoint exactly which cervical disc has herniated. For example, when the disc between the C5 and C6 vertebrae herniates, it can compress the C6 cervical nerve and create a specific set of symptoms. Symptoms include pain in the neck and shoulder, numbness in the thumb side of the hand, and weakness in the biceps and wrist. When the disc between the C6 and C7 vertebrae herniates, it can compress the C7 cervical nerve and create an altogether different set of symptoms. Symptoms include pain in the neck and shoulder, numbness in the middle finger, and weakness in the triceps. There are eight pairs of cervical nerves located near the cervical vertebrae. Each cervical nerve has its own distinct set of symptoms.
Less Common Signs and Symptoms of Cervical Herniated Disc
In less common cases, a cervical herniated disc may cause spinal stenosis and compression of the spinal cord. This is referred to as cervical myelopathy. When this happens, symptoms include the following:
- Pain, tingling, numbness, and/or weakness in both arms (as opposed to just one arm)
- Problems using your hands or arms for fine motor skills
- Pain, tingling, numbness, and/or weakness in both legs
- Problems balancing or walking
- Difficulty with bladder and/or bowel control
Risk Factors for Cervical Disc Herniation
The largest risk factor for cervical disc herniation is your age. As the body ages, the intervertebral discs begin to weaken and deteriorate. Cervical disc herniations most commonly occur in adults who are in their thirties, forties, and fifties. Other risk factors for developing cervical disc herniations are:
- Smoking
- Poor posture
- Repetitive neck movements
When a Cervical Disc Herniation is Serious
You should contact your doctor if you experience any of the symptoms listed above. A doctor will be able to set forth a treatment plan to improve your symptoms. A cervical disc herniation is considered extremely serious when the symptoms of numbness and muscle weakness persist or begin to worsen over a period of at least six weeks. The longer these symptoms last, the higher the chance that the neurological deficits become permanent.
Contained Vs. Uncontained Herniated Disc
A cervical disc herniation can be classified into two general categories:
- Contained – A contained herniated disc is one in which the nucleus pulposus has pushed through a portion of the annulus fibrosus but is still contained within the disc. A contained herniated disc will often bulge outwards towards a cervical nerve root.
- Uncontained – An uncontained herniated disc is one in which the nucleus pulposus has fully exited the boundaries of the annulus fibrosus. In an uncontained herniated disc, the nucleus pulposus and its inflammatory cytokines leak into the surrounding tissues. In severe cases, a portion of the nucleus pulposus can detach itself from the rest of the disc.
Conservative (Non-Surgical) Treatment for a Cervical Disc Herniation
A cervical disc herniation does not always necessitate surgery. In fact, there are several conservative (non-surgical) treatment options that are available. Cervical disc herniation treatment includes collar immobilization, muscle relaxants, anti-inflammatory medication, ice/heat therapy, physical therapy, chiropractic therapy, cervical traction, and steroid injections. Conservative treatment options are generally explored for a minimum of six weeks before surgical treatment is even considered. 75% to 90% of patients improve with non-surgical treatment options.
Spine Surgery for a Cervical Disc Herniation
If your pain persists or worsens despite conservative treatment, surgery may be the best solution. The goal of cervical disc herniation surgery is to remove the damaged disc and ensure the cervical nerve and/or spinal cord are decompressed. There are three options for cervical disc herniation surgery:
Anterior Cervical Discectomy and Fusion (ACDF)
In Anterior Cervical Discectomy and fusions, surgeons make a small incision near the front, or anterior, of the neck. Soft tissues (the skin, fat, muscle, and trachea) are pulled to the side to expose the cervical vertebrae. The herniated disc is then removed and replaced with a bone graft. A metal plate is installed onto the vertebrae above and below the affected disc. The bone graft, metal plate, and screws serve to fuse the two vertebrae together to create one solid piece of bone.
Cervical Artificial Disc Replacement (CADR)
In this surgical procedure, surgeons approach the cervical vertebrae anteriorly (from the front of the neck). Once the cervical vertebrae are exposed, the herniated disc is completely removed and replaced with an artificial disc. CADR is considered a newer and more innovative procedure with several advantages over ACDF including, but not limited to, a significantly reduced recovery time.
Posterior Cervical Discectomy
This surgery is not as common as ACDF or CADR surgeries, but it may be chosen in certain situations. In posterior cervical discectomy, surgeons make a small incision in the back, or posterior, of the neck. Spinal muscles and soft tissues are moved to the side to expose the vertebrae underneath. A small section of the vertebrae is removed to access the affected cervical nerve and disc space. Surgeons will then work to remove the ruptured part of the disc that is compressing the cervical nerve and/or spinal cord.
Whether you treat your cervical disc herniation through non-surgical or surgical means, it is best to work with a doctor that you trust and respect. The doctors at The Spine Center are dedicated to answering all the questions you may have. Our experts have over 50 years of experience with treating spinal conditions and are leaders in their field. Contact The Spine Center today for your own personal consultation.