Cervical disc herniation

Cervical herniated discs less common than lumbar herniated discs
Cervical disc herniations are far less common than lumbar disc herniations for two reasons:

There is far less disc material in the cervical spine
There is substantially less force across the cervical spine

When they do occur, most cervical disc herniations will extrude out to the side of the spinal canal and impinge on the exiting nerve root at the lower level (e.g. C6 at C5-C6) (Figure 1 and Figure 2).

If the space for the nerve root (foramen) is already compromised because of associated disc space collapse or bone spurs (osteophytes), the added impingement of the disc may irritate the nerve root and cause a radiculopathy (arm pain). If the foramen is not compromised, the radiculopathy may be temporary and relieved with conservative treatment.

Treatment options for a cervical herniated disc
In general, most cervical disc herniations will heal with time and conservative treatment and will not require surgery. The following includes an overview of:

Conservative treatments for a cervical herniated dics
Surgical treatments for a cervical herniated disc

Conservative treatments for a cervical herniated disc
As in the lumbar spine, the first line or treatment is generally a couple days of rest and non-steroidal anti-inflammatory drugs (NSAID’s).

If the pain is severe and/or continues for more than a couple of weeks, oral steroids can be useful to decrease inflammation. Oral narcotic agents can be added for severe pain, but should only be taken for a short time (less than two weeks).

If the pain lasts for more than two to four weeks, conservative treatments may include:

Physical therapy for exercises to help relieve the pressure on the nerve root
Chiropractic treatments for manual manipulation to help relieve the pressure on the nerve root
Manual traction to help open up the cervical foramen where the nerve root exits the spinal canal. If this therapy helps relieve the pain, a home traction unit can be prescribed. Traction should be initiated under a physical therapist's supervision.

For pain that does not get better with medical and physical treatments, epidural injections may be considered. Epidural injections effectively relieve pain approximately 50% of the time, and if they do work they may be repeated every two weeks up to a total of three times within one year.

Surgical treatments for a cervical herniated disc
If 6 to 12 weeks of conservative treatment fails to relieve the arm pain, then surgical removal of the disc may be reasonable.

An MRI scan or CT with myelogram can confirm the presence of a disc herniation and the level that is affected. If the patient’s symptoms and neurological deficit match the results of the scan, surgery is reliable in terms of relieving arm pain and has a low completion rate.

The disc may be removed from the back of the neck (posterior approach) or from the front (anterior approach). Generally, surgeons favor the anterior approach for most cervical disc herniations.

Anterior surgical approach for a cervical disc herniation – may be favored if there is any disc space collapse, as the approach allows the surgeon to "jack open" the disc space and place a bone graft to keep it open. This procedure opens up the foramen, which gives the exiting nerve root more room
Posterior surgical approach for a cervical disc herniation– may be favored for a large soft disc that is lateral (to the side of) the canal

Both spine surgeries can usually be done with an overnight stay in the hospital.