Cervical Disc Herniation

Cervical disc herniation (CDH) is defined as the displacement of the nucleus pulposus beyond the limits of the intervertebral disc (annulus fibrosus), being able to generate an impingement of the nerve that exits the neural foramen, or making a direct compression on the spinal cord. Clinical manifestations of herniated discs are unpredictable and can range from mild/moderate symptoms to rapid motor deficits. Symptom severity is usually correlated with the acuity and degree of neural and vascular elements involved. Patients with radiculopathy are habitually present with unilateral neck pain and radiation into the arm in a dermatomal distribution. The most common symptom of cervical radiculopathy is radicular pain, followed by paresthesia. The majority of CDH symptomatic patients are initially treated conservatively. Even though the final success rate might vary depending on different factors, some studies have shown up to 92% success with nonsurgical treatment. Operative treatment is generally reserved for a subgroup of patients who manifest signs of spinal cord dysfunction, significant muscle weakness, or moderate to severe symptoms with considerable disc herniation. Patients who failed nonoperative treatment or whose symptoms increase in severity are also candidates for surgical treatment.