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Cervical Disc DiseaseAka: Cervical Disc Herniation

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  1. Epidemiology
    1. C5-C6 represents 90% of cervical disc lesions
  2. Anatomy
    1. Lateral herniation compresses the nerve root below
      1. Example: C5-6 disc herniation compresses C6 root
  3. Pathophysiology: Nerve Impingement Types
    1. Acute Cervical Disc Herniation (younger patients)
      1. Soft disc protrusion from nuclear herniation
    2. Chronic Cervical Disc Disease (older patients)
      1. Hard disc lesion associated with Cervical Spondylosis
  4. Symptoms
    1. Neck tight or stiff
    2. Provocative
      1. Worse with activity
      2. Worse on awakening in Morning
      3. Worse with neck extension
      4. Worse with coughing, sneezing, or straining
    3. Referred pain
      1. Radiation into shoulder
      2. Radiation along Radial Nerve distribution into arm
        1. Does not often radiate below elbow
        2. Contrast with Paresthesias (distal radiation)
      3. Radiation into medial scapula
        1. Interscapular pain is not of shoulder origin
    4. Associated symptoms
      1. Headaches
      2. Dysphagia
        1. Related to large anterior osteophytes
  5. Signs
    1. Decreased Range of Motion
      1. Neck flexion and extension
      2. Neck lateral bending to right and left
      3. Neck rotation to right and left
    2. Neck hyperextension elicits pain
    3. Pain on palpation
      1. Localized C-Spine tenderness
      2. Trigger Point tenderness over interscapular area
    4. Vertex Compression Test (Spurling Test)
      1. Turn neck to ipsilateral side and axial load
      2. Pressure against top of head reproduces arm pain
    5. Sensory Exam
      1. Often not helpful
  6. Signs: Motor Exam localization
    1. C4-5 Disc (C5 nerve root)
      1. Pain
        1. Base of neck
        2. Shoulder
        3. Anterolateral arm
      2. Numbness
        1. Deltoid
      3. Motor weakness and atrophy
        1. Deltoid muscle
        2. Biceps muscle
      4. Reflexes decreased
        1. Biceps reflex
    2. C5-6 Disc (C6 nerve root)
      1. Pain
        1. Neck
        2. Shoulder
        3. Medial scapula
        4. Dorsolateral arm
      2. Sensory change
        1. Dorsolateral thumb
        2. Index finger
      3. Motor weakness and atrophy
        1. Biceps muscle
        2. Extensor pollicis longus
      4. Reflexes decreased
        1. Biceps reflex
        2. Brachioradialis reflex
    3. C6-7 Disc (C7 nerve root)
      1. Pain same as C5-6 Disc (C6 nerve root)
      2. Sensory change
        1. Index finger
        2. Middle finger
        3. Dorsal hand
      3. Motor weakness and atrophy
        1. Triceps muscle
      4. Reflexes decreased
        1. Triceps reflex
  7. Management
    1. See Cervical Disc Herniation Management
    2. Conservative management indicated in most cases
      1. See Cervical Disc Herniation Rehabilitation
      2. No danger in observation
      3. Encourage patience
      4. Do not rush surgical intervention
    3. Surgery (5% of cases)
      1. Indications
        1. Pain and Disability intolerable
          1. Arm pain responds better than neck pain
        2. Major neurological deficit
      2. Procedure: affected disc replaced
        1. Bone graft
        2. Arthrodesis
      3. Results
        1. Arm pain subsides immediately after surgery
        2. Osteophytes in foramen absorbed in 9-18 months
  8. Prognosis
    1. Most patients improve with conservative management
    2. Recovery may require weeks to months

[X]Cervical disc disorder, unspecified (C0477633)

ConceptsDisease or Syndrome (T047)
EnglishCERVICAL DISC DISEASE, Cervical disc disorder
Parent ConceptsIntervertebral disc disorder (C0158252), Musculoskeletal disorder of the neck (C1290143), Disorder of cervical spine (C1290145)
SourcesCOSTAR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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