Cervical Disc Herniation

A condition guide by Mr Mohammed Madi, Consultant Orthopaedic & Spinal Surgeon.

A cervical disc herniation — sometimes called a slipped or prolapsed disc in the neck — happens when the soft cushion between two neck vertebrae bulges or ruptures and presses on a nearby nerve. The most common result is pain travelling down the arm. The reassuring news is that, for the great majority of people, the symptoms settle over weeks to months without an operation. This page explains what a cervical disc herniation is, how it is diagnosed, and when surgery is and is not needed.

Between each pair of neck vertebrae sits an intervertebral disc, which acts as a cushion and allows movement. Each disc has a tough outer ring and a softer gel-like centre. A herniation occurs when some of the softer material pushes through the outer ring. If it presses on a nerve root as it leaves the spine, it causes a pattern of arm symptoms called cervical radiculopathy. Less commonly, a large central herniation can press on the spinal cord itself, causing cervical myelopathy — a more significant problem covered in its own guide.

In plain terms: the disc is like a jam doughnut; if the jam squeezes out to one side, it can press on a nearby nerve and send pain down the arm.

Nerve roots branch off the spinal cord at each level of the neck and travel into the arms, each supplying a particular area of skin and particular muscles. This is why a herniation at a specific level produces a recognisable pattern — pain, numbness or weakness in a defined part of the arm or hand — which helps pinpoint where the problem is. Behind the discs lies the spinal cord, which is why a large herniation can occasionally affect the cord as well as a nerve root.

Most cervical disc herniations relate to the normal age-related changes of the disc, which gradually make the outer ring more prone to tearing. A herniation may appear after a particular movement or strain, or with no identifiable trigger at all. Risk factors include increasing age (up to a point — herniations are actually most common in the middle decades of life), smoking, and physically demanding activities, though many occur in otherwise healthy people without any clear cause.

The hallmark of a cervical disc herniation pressing on a nerve root is arm pain, often more troublesome than the neck pain itself. Typical features include:

Sharp, burning or electric pain travelling from the neck into the shoulder, arm, forearm or hand, in a pattern that follows the affected nerve.

Numbness or tingling in part of the arm or hand.

Weakness of specific muscles in the arm or hand.

Neck pain and stiffness, which may be present but is often overshadowed by the arm symptoms.

Relief in certain positions — many people find that resting the hand on top of the head eases the arm pain (a recognised pattern).

If a herniation affects the spinal cord, the picture changes to one of clumsy hands, unsteadiness when walking and balance problems — features of myelopathy that need prompt specialist assessment.

Seek prompt assessment for significant or progressive weakness in the arm or hand, symptoms affecting both arms or the legs, clumsy hands or unsteadiness when walking, or any disturbance of bladder or bowel control. These suggest more than a simple trapped nerve.

Diagnosis starts with the history and a focused examination, mapping the pattern of pain, sensation, reflexes and strength to work out which nerve is involved. MRI is the key investigation, showing the disc, the nerve root and the spinal cord, and confirming the level and severity of any compression. As with the rest of the spine, scans must be interpreted alongside the symptoms: disc bulges are common in people without pain, so the scan finding has to match the clinical pattern to be meaningful. Nerve conduction studies are occasionally used to help distinguish a trapped nerve in the neck from nerve problems elsewhere, such as carpal tunnel syndrome.

This is the most important and most reassuring part. The natural course of cervical radiculopathy from a disc herniation is favourable: the great majority of people improve substantially over a period of weeks to a few months, often without any operation. Herniated disc material frequently shrinks and is reabsorbed by the body over time, and the inflammation around the nerve settles. This is why an initial period of non-surgical treatment is usually appropriate, provided there is no significant or progressive weakness and no sign of cord involvement.

For most people, the first approach is non-surgical, aimed at controlling symptoms while nature takes its course:

Pain relief, which may include anti-inflammatory medicines and, for nerve pain, specific medicines used for neuropathic pain.

Staying active and continuing daily activities as the pain allows, avoiding prolonged rest.

Physiotherapy to maintain movement, posture and strength as the symptoms settle.

A nerve root (epidural) injection of steroid in selected cases, which can reduce inflammation around the nerve and ease severe arm pain while recovery occurs.

Surgery is considered when arm pain remains severe and disabling despite a reasonable period of non-surgical treatment, when there is significant or progressive muscle weakness, or when the spinal cord is involved (myelopathy). The aim is to take the pressure off the nerve (or cord). The main operations are:

Anterior cervical discectomy and fusion (ACDF) — removing the herniated disc through the front of the neck and stabilising the level with a fusion. This is a well-established and highly effective operation, particularly for relieving arm pain.

Cervical disc replacement (arthroplasty) — removing the disc and replacing it with an artificial one, preserving movement at that level, which is suitable for selected patients.

Surgery for a disc herniation is generally very effective at relieving arm pain and stabilising or improving nerve-related weakness; it is less reliable for neck pain alone. The choice of operation depends on the individual, the level involved and other factors, and is discussed in detail before any decision.

Most people treated without surgery recover well over weeks to months. For those who do need surgery, relief of arm pain is usually good and often rapid, and many people return to normal activities within a few weeks, with restrictions during healing after a fusion. Where weakness has been present, recovery is best when the nerve is decompressed before the weakness becomes long-standing. As with any operation, surgery carries risks, which are weighed against the severity and persistence of symptoms and discussed individually.

"A herniated disc means I need surgery." Most settle without surgery over weeks to months.

"The herniation will never go away." Herniated disc material often shrinks and is reabsorbed by the body over time.

"Surgery is mainly for my neck pain." Surgery is most reliable for arm pain from a trapped nerve, less so for neck pain alone.

"A disc bulge on my scan must be the cause." Disc bulges are common in pain-free people; the finding must match the symptoms.

"I should rest completely until it heals." Staying gently active is better than prolonged rest.

A cervical disc herniation usually causes pain travelling down the arm, from pressure on a nerve root. The natural course is favourable — most people improve over weeks to months without surgery, and herniated material often shrinks on its own. Non-surgical care manages symptoms while this happens. Surgery is reserved for arm pain that remains severe and disabling despite a reasonable trial of non-surgical treatment, for significant or progressive weakness, or for spinal cord involvement — and it is very effective at relieving arm pain. The warning signs that need prompt review are significant weakness, symptoms in both arms or the legs, clumsy hands or unsteadiness, and any bladder or bowel disturbance.

This page is for general education and does not replace advice from your own clinical team. Seek prompt review if you develop significant or progressive arm or hand weakness, symptoms in both arms or the legs, clumsy hands or unsteadiness when walking, or any disturbance of bladder or bowel control.

• —Iyer S, Kim HJ. Cervical radiculopathy. Current Reviews in Musculoskeletal Medicine. 2016;9(3):272–280.
• —Wong JJ, Cote P, Quesnele JJ, et al. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review. The Spine Journal. 2014;14(8):1781–1789.
• —Engquist M, Lofgren H, Oberg B, et al. Surgery versus nonsurgical treatment of cervical radiculopathy: a prospective, randomized study. Spine. 2013;38(20):1715–1722.
• —North American Spine Society. Clinical Guidelines for Diagnosis and Treatment of Cervical Radiculopathy from Degenerative Disorders. 2010.

This information is for general patient education and is not a substitute for an individual consultation. Always seek personalised advice from a qualified spinal specialist.