Conditions: Cervical Herniated Disc

Keywords
Cervical Herniated Disc
Cervical Pinched Nerve
Cervical Radiculopathy

Definition
A lumbar herniated disc involves displacement of the nucleus (inner part of the disc) through the annulus (outer boundary of the disc) into the spinal canal. The herniation may produce pressure on the cervical nerve root or the spinal cord or both.

Indications
The operations for herniated disc are indicated for the relief of arm pain, arm numbness, and/or arm weakness from pressure on a single cervical nerve root or multiple cervical nerve roots. Cervical disc herniations can place pressure on the spinal cord and produce symptoms of cervical myelopathy (spinal cord symptoms).

The table below illustrates the findings associated with a single nerve root in the lumbar spine.

Root	Sensory	Motor	Reflex
C4	back of neck, shoulder top	none	none
C5	outer upper arm	deltoid, biceps	Occasionally biceps
C6	thumb and index fingers	biceps	biceps
C7	index and middle fingers	triceps	triceps
C8	ring and little fingers	intrinsic muscles	none

Technical Considerations
The goal of disc surgery is the removal of the mechanical pressure on the cervical spinal nerve. Different surgical options are available to the patient.

Microscopic Anterior Cervical Discectomy	Microscopic Anterior Cervical Foraminotomy	Anterior Cervical Discectomy and Fusion with Cadaver Bone Graft
Anterior Cervcial Discectomy and Fusion with Autogenous Bone Graft	Anterior Cervcial Discectomy and Fusion with Autogenous Bone Graft with Instrumentation	Anterior Cervcial Discectomy and Fusion with Cadaver Bone Graft with Instrumentation
Microscopic Posterolateral Cervical Foramintomy	Microendoscopic Cervical Foraminotomy

Literature Review
Featured Review:
Cervical radiculopathy is defined as arm pain due to irritation of a cervical spinal nerve. Commonly, cervical disc herniations produce cervical radiculopathy by compressing a cervcial spinal nerve. The natural history of cervical radiculopathy was reviewed in a study from 1963 with long term follow-up. (ref #9).

1 episode, no recurrent symptoms		mild symptoms		persistent or worsening symptoms
45%		30%		25%

A more recent study reviewed 561 patients from 1976 to 1990. (ref #6) Cervical radiculopathy was due to a herniated disc in 21.9% and due to bone spurs or foraminal narrowing in 68.4%.

Recurrence of symptoms		Surgery incidence
31.7%		26%

At the final follow-up, 90% of patients had no symptoms or only mild symptoms. (ref#6)

The natural history of cervical radiculopathy appears to resolve without surgery in the majority of cases. (ref #2, ref #3, ref #4, ref #5, ref #8)

Surgery for cervical radiculopathy is very successful. (ref #1, ref #7, ref#8)

Complications
The potential complications of surgery for cervical radiculopathy depend on the surgical approach and the nature of the operation. In general, the common risks are death, paralysis, failure to improve, nerve root injury, spinal fluid leak, and wound problems. Specific operations may produce risks related to approach (hoarseness, difficulty swallowing) or problems related to bone grafts (non-union, bone graft malposition) or due to instrumentation (hardware failure)

Author’s Comment
Most patients with cervcial pinched nerves resolve without surgery. Patients who undergo surgery have many options for approach: anterior vs. posterior, fusion or no fusion, traditional vs. microscopic vs. microendoscopic. The individual structural issue needs analysis to determine the surgical options for a particular patient.

References
1. Wirth, F.P., et al., Cervical discectomy. A prospective analysis of three operative techniques. Surg Neurol, 2000. 53(4): p. 340-6; discussion 346-8.
2. Heckmann, J.G., et al., Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients. J Spinal Disord, 1999. 12(5): p. 396-401.
3. Bush, K., et al., The pathomorphologic changes that accompany the resolution of cervical radiculopathy. A prospective study with repeat magnetic resonance imaging. Spine, 1997. 22(2): p. 183-6; discussion 187.
4. Saal, J.S., J.A. Saal, and E.F. Yurth, Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine, 1996. 21(16): p. 1877-83.
5. Smith, M.D., Cervical radiculopathy: causes and surgical treatment. Minn Med, 1995. 78(4): p. 28-30, 42-5.
6. Radhakrishnan, K., Epidemiology of cervical radiculopathy. Brain, 1994. 117: p. 325-335.
7. Dubuisson, A., J. Lenelle, and A. Stevenaert, Soft cervical disc herniation: a retrospective study of 100 cases. Acta Neurochir (Wien), 1993. 125(1-4): p. 115-9.
8. Dillin, W., Cervical Radiculopathy. A review. Spine, 1986. 11: p. 988-91.
9. Lees, F.T., JWA, Natural history and prognosis of cervcial spondylosis. Brit Med J, 1963: p. 1607-10.

Spine References 1990 to 2000

Spine References 2001

Spine Education

Spine Conditions