Cervical Spine Herniated Disc

Cervical Spine Herniated Disc Overview

A herniated disc (cervical spine) is a common condition that can lead to a considerable amount of neck, shoulder, arm and hand pain. The most common symptom, is neck pain in the back of the neck.

What is a Disc Injury?

To understand the cervical spine is to understand the anatomy of the cervical spine. Discs, which are sandwiched between the vertebrae, act as the spine’s protective shock absorbers. In essence, they are like a jelly-filled donut that contains the annulus (the outside of the donut) that surrounds the nucleus pulposus (the gel-like substance within the donut). The annulus is made up of about 30 layers that act just like the plies of a tire. If some of these plies break or tear, just like taking a cap off a toothpaste tube and squeezing the tube, the gel-like substance inside can squeeze out. This extrusion of jelly is the actual herniated disc which leads to neck pain. Causes of a herniated disc (which people sometimes call a pinched nerve in the neck) are often the wear and tear and degeneration of the discs that reside in the spine.

This herniated disc material can ultimately put pressure on nerve roots which live right next to the disc and occasionally on the spinal cord itself. In addition, the substance that makes up this gel (the nucleus) also contains substances that are toxic to nerves. Why God or Mother Nature designed the disc this way is anybody’s guess. This toxic substance can cause inflammation within the nerve, which can lead to arm pain and numbness even without direct compression of the nerve itself.

If the herniated disc (cervical spine) compresses a nerve root, pain from nerve compression will normally develop down the arm into the shoulder or to the hand (depending upon the nerve root involved). This is caused by an inflammation of the cervical spinal cord (called radiculopathy). If the herniation compresses the spinal cord it is called myelopathy and information on this condition is found in another section on this web site.

Cervical Spine Herniated Disc Symptoms

Depending upon the position of the disc herniation, cervical spine herniated disc symptoms may cause neck pain in the back of the neck, sides, in the shoulder, arm or hand. Common symptoms are pain and numbness or occasionally just weakness of the muscles of the nerve that is compressed. Depending on the nerve, pain may radiate only into the shoulder or may radiate down the arm into the fingers. Almost all cervical spine herniations radiate pain into the shoulder blade on the side of the herniation.

There are many patients that have pain that radiates only to the area between the shoulders and these symptoms are commonly misdiagnosed as thoracic or scapular (shoulder blade) pain when the pain is really referral pain from the compressed nerve in the neck. Likewise, patients may assume they have a simple pinched nerve in the neck when really it is the compression that is leading to the neck pain. Causes of these various symptoms can be revealed by an x-ray of the cervical spine region.

If present muscle weakness may not be revealed unless the individual lifts weights and is familiar with which muscles are used with different positions. Sometimes, the weakness is significant and disabling. Other times, just feeling clumsy and dropping objects can be a symptom of weakness.

(Click to Enlarge Image) This illustration is a side view of the cervical spine (neck). Here you can see the vertebral bodies with the discs in the front of the spine and the facets in the rear. The nerve roots exit through the sides of the spine.

(Click to Enlarge Image) This is a side view (sagittal) MRI of a large disc herniation in the cervical spine (neck). The arrow points to the herniation.

(Click to Enlarge Image) This is an MRI of a cervical herniated disc. The arrow points to the extruded fragment that is pushing the spinal cord to the opposite side of the canal and the nerve root that exits here is under significant compression.

(Click to Enlarge Image) This is a side view picture of a patient who had significant compression of his C5 nerve for a period of time. You can see the “hollowing out” of the back of his shoulder where the deltoid muscle has undergone significant atrophy.

Are you suffering from symptoms of a cervical spine herniated disc?

Would you like to consult with Dr. Corenman about your condition?
You can set up a long distance consultation to discuss your
current X-rays and/or MRIs for a clinical case review.

REQUEST A SECOND OPINION

(Please keep reading below for more information on this condition.)

Biomechanics

While most patients may assume that they have a pinched nerve in the neck, the reality for most is that they have a cervical spine herniated disc. The biomechanics of a herniated disc are easy to understand. The nerve hole itself becomes larger with bending the head forward and away from the side that it is on. Bending the head backwards or to the side that the nerve hole or foramen is on will narrow the hole. Therefore, with a herniated disc, arm and shoulder pain will normally become worse with bending backwards or to the side of the arm pain as this maneuver causes further compression to the nerve. Obviously avoid any head motions that increase the pain into the arm, as it is not a good idea to crush this nerve any further.

Most of the varying herniations will cause moderate discomfort to intense pain in the shoulder, neck and upper back area depending on the location of the herniation. The most common symptoms are a dull, nagging pain in the neck or between the shoulder blades. This pain will become more intense if the patient bends the neck backwards (this narrows the hole the nerve lives in) or with lifting or exercising. Some activities can be more painful (bike riding with a low stem and swimming can extend the neck causing increased pain).

Cervical Spine Herniated Disc Treatment

Non-Surgical

Medications, injection therapies, physical therapy and rest can relieve the symptoms of a herniated disc cervical spine. If the symptoms persist or the weakness is significant, then surgery may be recommended.

Surgical

The best surgery to treat a herniated disc in the cervical spine is an anterior cervical decompression and fusion (ACDF). This surgery for a herniated disc is explained in one of Dr. Corenman’s educational videos. With this surgery, the offending torn disc is removed, the nerve root pressure can be relieved and the segment stabilized with a fusion. This procedure can be performed microscopically which will use a smaller incision and leads to a faster recovery. There are times that the fragment can be removed posteriorly in a procedure called a posterior cervical foramenotomy. (See surgical section for information on both procedures.)

An artificial disc can be implanted to allow motion to continue after surgery. There are risks and benefits of this procedure. (See the section on cervical artificial disc surgery). Neck pain causes patients to miss work and stop the activities they love most. It’s important to get an accurate diagnosis so that the symptoms associated with this pain can be resolved.

For additional resources on a cervical spine herniated disc, or to discuss treatment options, please contact the office of Dr. Donald Corenman, neck doctor and spine specialist offering diagnostic and surgical second opinions to patients in the USA and around the world.

Related Content

Donald Corenman, MD, DC

Average rating:

81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

Herniated Disc Cervical Spine