Landspitali - University Hospital
Diagnosis of a herniated disc
Herniated disc in the cervical spine
Prognosis and Surgical Considerations for Cervical Disc Herniation
In most cases, the prognosis is very good without intervention, which is why a wait-and-see approach is taken to determine whether the condition improves without surgical procedures.
Cervical disc herniation with radicular pain:
affects the upper limbs
significantly disrupts daily activities over an extended period
is a severely quality-of-life impairing condition
Because the natural course of nerve root compression due to disc herniation is usually benign, re-evaluation is necessary before a referral is made. If radicular pain is already decreasing in intensity or distribution at the time of re-evaluation, further improvement can usually be expected without surgical intervention.
Indications for Surgery to Relieve or Cure Radicular Pain in the Upper Limb
Surgical intervention is considered for patients who:
have daily, quality-of-life–disturbing radicular pain lasting more than 8 weeks
show no improvement despite rest and pharmacological treatment
have proven nerve root compression on MRI not older than two months
The timeframes for the duration of radicular pain and surgical indication are relative, individualized, and dependent on symptom progression.
Patients who undergo surgery within the recommended timeframes are typically those who are:
on full pharmacological treatment
so restricted in mobility due to pain that they cannot perform daily activities such as going to the toilet, maintaining hygiene, or eating
Additionally, patients with progressive neurological deficits, such as severe muscle weakness in the upper limb, 3/5 or less, require earlier surgical intervention.
In very rare cases, a cervical disc herniation is large enough to cause spinal cord compression, leading to symptoms like weakness in the lower limbs. It is critical to diagnose this condition immediately, confirm it with MRI, and obtain a neurosurgical evaluation.
Why Surgery is Delayed for Cervical Disc Herniation
Surgery for cervical disc herniation is postponed longer than for lumbar disc herniation because it is a more extensive and higher-risk procedure, with greater potential complications. Additionally, surgery results in a permanent alteration of the cervical spine, as the entire intervertebral disc is removed and an implant is inserted, leading to spinal fusion at the affected level.
Background and Symptoms
Cervical disc herniation presents similarly to lumbar disc herniation, often starting with centralized pain that radiates to the surrounding areas, such as the shoulder blades, shoulders, and neck. This nociceptive pain originates from supporting tissues, and surgery is ineffective for treating this type of pain.
In fewer cases, cervical disc herniation presents with radicular pain, a neuropathic pain that occurs when the herniated disc compresses a nerve root. Unlike radicular pain in the lower limbs, cervical radicular pain does not always follow a clear dermatomal distribution.
Patients often describe the pain as a deep, unbearable discomfort extending down the arm, sometimes localized only to the upper arm.
Numbness in the corresponding dermatome is common, but muscle weakness in the affected myotome is less frequent.
Initially, radicular pain can be severe, as the nerve is inflamed, a condition that can persist for over two weeks.
Treatment Approach
During this acute phase, patients are given full pain management and advised to rest in the positions that provide the most relief.
Patient education and regular follow-ups are crucial to ensure proper management and recovery.
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