cervical spine

Cervical disc herniation (cervico-brachialgia)

What is it ?

Cervical disc herniation is defined as a part of the intervertebral disc pushing into the cervical spinal canal: protrusion, fragment, etc. The natural aging of the disc causes its dehydration. The disc therefore becomes less effective mechanically, but it can also fragment and push back into the cervical spinal canal. The picture below represents a cervical disc herniation: the fibrous annulus can be seen (in blue), with a part of the disc nucleus protruding into the spinal canal.

Clinical presentation

The cervical disc herniation that is medically relevant, is the one that causes neurological symptoms. An MRI scan will be needed to confirm the diagnosis if the pain persists for more than 6 weeks or if there is significant loss of strength. The herniated disc usually protrudes on the sides of the spinal canal, and thus irritates a nerve root, rather than the spinal cord. This will clinically manifest as a pain radiating along the arm, called “cervico-brachialgia”, which follows a path corresponding to a nerve root territory. Very rarely, if it is big enough, it can compress the spinal cord, but it will cause different and more serious neurological symptoms.

When to consult a specialist?

The vast majority of cervical disc herniations present as pain WITHOUT serious neurologic disorder, that is to say without serious strength loss. Your GP will examine you and determine if there is a loss of strength that would require an MRI and a specialized surgical opinion. In addition, if the pain is very strong despite the non surgical treatment or if it lasts and prevents a return to normal life within 6 to 8 weeks, a surgical opinion may also be seeked.

Non surgical treatment

The vast majority of cervical disc herniations are treated non-surgically: medication, physiotherapy, possibly infiltration. Typically, most people return to a near-normal life after 6-8 weeks of nonsurgical treatment. A small proportion will need surgery.

Surgical treatment

It will be emergent in case of significant strength loss (50% or more) corresponding to the neurological territory of the herniated disc or in case of injury to the spinal cord. Surgery can also be offered if the pain persists ands prevents a return to normal life beyond 6-8 weeks. Most often, the procedure involves completely removing the disc with the herniation, by an anterior approach. The disc is replaced by a cage or a disc prosthesis. Below, the picture represents the surgical removal of a cervical disc herniation: the fragment is removed by a small instrument, then the disc is replaced by a graft or a cage. Sometimes a plate is added.

Postoperative follow-up

Follow-up of cervical discectomy is quite simple. Patient do not experience a lot of pain. Most often patients walk the same day after surgery and return home after one or two nights. We recommend they resume everyday life activities as soon as possible, avoiding strenous activities, until the first post-operative follow-up at 6 weeks.

Risks and complications

The vast majority of surgical risks are less than 5%. Serious neurological complication are very rare (close to 0%). Most often, patients complain of dysphagia (difficulty swallowing solids) for a few days. You will have the opportunity to discuss in more detail the other risks and complications with your surgeon.