The Spine and Cervical Disc Herniation

The spine consists of a series of interconnected bones called vertebrae. Discs act as cushions or shock absorbersbetween the vertebrae. They facilitate movement, allowing the neck and back to bend and rotate.

Each disc has a tough outer layer called the "anulus fibrosus" and a gel-like center called the "nucleus pulposus". Aging or microtraumas can lead to damage and tears in the outer layer. This may cause the central structure of the disc to protrude into the spinal canal, where nerves and the spinal cord pass through. This condition is called disc herniation (a herniated disc).

When a herniated disc occurs in the neck, it is referred to as cervical disc herniation. It can put pressure on nerves, resulting in pain, numbness, or weakness radiating to the arms. In rare cases, cervical disc herniation can compress the spinal cord, leading to issues in the legs.

Diagnosis of Cervical Disc Herniation

Your doctor will first ask about the onset, nature, and spread of your pain. By assessing muscle strength, sensory function, and reflex changes in the arms, they can evaluate the severity and location of the herniated disc.

Diagnosis is confirmed through imaging techniques such as X-rays, computed tomography (CT), or magnetic resonance imaging (MRI).

Treatment Options

Most cervical disc herniations heal without surgery. Therefore, non-surgical treatments are prioritized to relieve pain.

Your doctor may recommend:

• Short periods of rest,

• Restricted neck movements,

• Anti-inflammatory medications,

• Pain relievers,

• Physical therapy and exercises,

• Epidural steroid injections.

Non-surgical treatments aim to reduce nerve irritation, alleviate pain, and improve physical function. Many patients benefit from a structured care program that combines multiple therapies. Neck exercises can be performed at home, but seeking guidance from a physical therapist may be helpful for a controlled exercise plan.

Surgical Treatment

Surgery may be required if the patient:

• Does not respond to medical treatments,

• Has severe weakness,

• Experiences significant spinal cord compression.

Surgery aims to remove the portion of the disc that is pressing on the spinal cord or nerves. This is performed via discectomy.

Depending on the location of the herniation, the surgeon may operate from the front (anterior approach) or back (posterior approach) of the neck. The choice of approach depends on:

• The exact location of the herniated disc,

• The surgeon’s expertise,

• Other relevant factors.

In both approaches, the compressed disc material is removed, relieving pressure on the nerves. The outcomes are generally favorable.

With the anterior approach, the removed disc material is replaced with a bone graft or a motion-preserving implant, facilitating spinal fusion. Your doctor will explain the reasons for this procedure and its expected outcomes.

Patients can usually return home the day after surgery. Your doctor will provide guidance on when to resume daily activities. Even after a successful surgery, rehabilitation programs such as post-surgical exercises or physical therapy can accelerate recovery.

Risks and Possible Complications

Most patients respond well to discectomy, but as with any surgery, certain risks exist, including:

• Bleeding,

• Infection,

• Nerve or spinal cord damage.

In anterior (front) surgeries, rare complications such as hoarseness or difficulty swallowing may occur, but these are usually temporary and uncommon.

Additionally, pain may persist post-surgery, and symptoms may recur. In 3–5% of patients, disc herniation may return, requiring future treatment.