Cervical Disc Herniation

See: - Cervical Spondylosis: - SCIWORA Syndrome

Discussion: - are most frequent at C 6-7 level but also occur at C 5-6 & to a lesser extent at C4-5 & other levels; - in relatively younger persons soft disk protrussion is more common than hard disk protrussion; - differential diagnosis:

Types of herniation: - intraforaminal herniation: - most common type: - cause predominately sensory changes; - posterolateral type: - occurs near near entrance zone of foramen; - causes predominately motor changes; - central type: - if disc herniation occurs more to the midline (ie posterior herniation), then it compresses spinal cord in addition to, or instead of the nerve root; - results in cervical myelopathy:

Symptoms: - neck pain from nerve root compression; - pain radiating into ipsilateral upper extremity w/ paresthesias, numbness, or weakness; - pain & paresthesias may be intensified by neck movement, especially by extension or by lateral flexion to side of herniation, & by coughing or straining;

Exam: - see: cervical radiculopathy and myelopathy - limitation of neck extension - downward head compression increases pt's radicular pain & paresthesias, especially if neck is flexed to side of involvment;

Shoulder abduction relief test: - significant relief of arm pain with shoulder abduction; - this sign is more likely to be present w/ soft disc herniation, whereas, the test is likely to be negative with radiculopathy caused by spondylosis (osteophyte compression);

Spurling's Sign: - mechanical stress, such as excessive vertebral motion, may exacerbate symptoms; - the provocation of the patient's arm pain with induced narrowing of the neuroforamen - gentle neck hyperextension with the head tilted toward the affected side will narrow the size of the neuroforamin and may exacerbate the symptoms or produce radiculopathy; - ipsilateral rotation of the neck will also increase radiculopathy; - downward head compression increases the patient's radicular pain and paresthesias, especially if the neck is flexed to the side of involvment; - provocation of pt's arm pain w/ induced narrowing of neuroforamen - oblique cervical extension augments root compression & increases symptoms; - lower motor neuron dysf(x) (muscle weakness & hypotonia, reduction of deep tendon reflexes) at level of cord compression; - upper motor neuron dysfunction (spasticity, clonus, increased deep tendon reflexes, Babinski's sign, reduction of sensation) below level; - loss of erection, bladder, & bowel f(x) may occur;

Treatment: - surgery is usually performed by a posterior approach thru a hemi-laminectomy or by an anterior approach to approach the intervebral disc; - anterior approach: - anterior approach tends to be more popular with orthopaedic surgeons and is especially indicated for central or peri-central disc herniation; - decompression is usually followed by arthrodesis; - posterior approach: - posterior decompression is a smaller operation that takes less time and does not require a bone graft; - posterior decompression is most indicated for far-lateral disc herniation;