Cervical Disc Herniation Management

1. General
   1. Algorithm for nontraumatic cervical disc Syndrome
2. Management: Neurologic deficit (rare)
   1. Immediate referral to Spinal Surgery or Neurosurgery
3. Management: Initial with No Neurologic Deficit
   1. Rest (Cornerstone of Management)
      1. Acute disc injury(soft Cervical Disc Herniation)
         1. Allows healing of disc
      2. Chronic disc disease (hard Cervical Disc Herniation)
         1. Allows inflammation around disc to subside
      3. Absolute bed rest is most beneficial
   2. Local moist heat and massage
      1. Relieves tenderness and muscle pain
   3. Medications
      1. NSAIDs
      2. Narcotic Analgesics may be necessary
      3. Muscle relaxants not effective
4. Management: Second line if not improved in 2 weeks
   1. Cervical Spine XRay
   2. Continue general rest
   3. Consider Soft collar
      1. Keeps head slightly flexed or in neutral position
   4. Cervical Disc Herniation Rehabilitation
      1. Physical therapy 3-5 times per week for 2-4 weeks
      2. Provides short term relief
      3. Does not change the course of the disc disease
   5. Provide reassurance
5. Management: Third line if not improved in 2 weeks
   1. Consult Spine Surgery or Neurosurgery
   2. Continue conservative therapy
   3. Consider further imaging evaluation for surgical cause
      1. Myelography followed by CT C-Spine (invasive)
      2. MRI C-Spine (noninvasive, but costly)
      3. CT C-Spine (less efficacious)