What is a cervical disc herniation?

A cervical disc herniation occurs when part of the disc's nucleus pushes against its ring and creates a crack. The nucleus can then protrude outside the ring. This is one of the possible causes of neck pain.

What is the intervertebral disc?

The intervertebral disc acts as a cushion between the vertebrae in your neck. Its main function is to absorb shock and allow the vertebrae to move properly. To better understand where these discs are located, see our guide tocervical anatomy.

The disc is composed of two parts:

• The core (in the center) is the soft, gelatinous part.
• The ring (surrounding the core) is the solid, fibrous part.

The stages of disc herniation

Bulging (or "bulging disc") is the beginning of a herniated disc. The nucleus pushes on the disc ring and slightly deforms it. It's like a balloon that inflates on one side.

Protrusion is when the nucleus protrudes from the ring outside the disc. The protrusion of the nucleus is the hernia itself.

Extrusion is when there is a tear in the disc ring and the hernia protrudes further outward. This is a more significant hernia.

Sequestration is when a piece of the hernia breaks off and moves independently. This is the most advanced stage, but also the rarest.

What causes a cervical disc herniation?

You can develop a cervical disc herniation gradually over several years or suddenly following trauma.

A herniated disc that develops gradually is caused by the process of disc wear and tear that occurs over the years. The disc ring becomes less solid over time. Small cracks can form in this ring. The disc nucleus can put pressure on this crack and eventually cause a hernia.

A herniated disc, known as traumatic, is caused by a specific event such as trauma or a sudden movement involving a load. At that precise moment, the disc ring may tear. The nucleus will protrude from the disc through this tear.

What are the symptoms of a cervical disc herniation?

Symptoms vary from person to person. Some people experience significant pain. Others have no symptoms, even with a hernia visible on medical imaging. That's why it's important to consult a doctor to properly assess your condition.

It is important to know that you can have a herniated disc without any symptoms. In fact, when healthy adults undergo an MRI, 98% of them are found to have degenerative changes in their discs and no pain.

However, when symptoms are present, the following will be observed:

• Gradual or sudden neck pain
• Neck muscle spasms (involuntary contractions)
• Decreased neck mobility due to pain
• Often, your head remains bent forward and you are unable to straighten it because the pain is too severe.

If you also experience pain, numbness, or tingling that radiates into your arms, it is possible that the herniated disc is irritating one or more nerves. This is called cervical radiculopathy or cervicobrachialgia. In this case, the herniated disc is compressing or irritating a nerve that runs down to your arm.

People sometimes present themselves with their hand on their head, as this is the only position they have found to relieve the pain that radiates down their arm.

What are the serious symptoms of a cervical disc herniation to watch out for?

Severe symptoms are rare (less than 1% of cases). In most cases, although the pain can be very unpleasant, the condition responds well to appropriate treatment.

However, certain signs and symptoms should prompt you to seek immediate medical attention at the emergency room or from a doctor. These include:

• Severe weakness or paralysis of one or both arms
• Significant or even complete loss of sensation in one or both arms
• Recent loss of balance when walking
• New incoordination of the arms or hands
• New difficulties with bladder or bowel control
• Loss of sensation in the genital areas or when wiping after a bowel movement

If you have any of these symptoms, don't delay. Seek medical attention immediately.

How to diagnose a cervical disc herniation?

The diagnosis is made based on your symptom history and a clinical examination. Your physical therapist or doctor will ask you questions about how the pain started. He or she will then assess your mobility, strength, and sensitivity in your neck and arms.

In some cases, more rarely, it is necessary to undergo radiological examinations (X-ray, MRI, EMG) to determine the severity of the herniated disc or to find out if it is compressing a nerve in the neck.

It is important to know that what we see on X-rays or other types of imaging is not always relevant. Did you know that up to 78% of young adults in their twenties with no neck pain show signs of early disc herniation on MRI (magnetic resonance imaging)? Yet they have absolutely no pain!

Rest assured, just because a hernia appears on an image does not necessarily mean that it is the cause of your pain.

Please note that it is not possible to see a herniated disc on an X-ray. An MRI is the most accurate test for viewing discs and nerves.