Cervical Hernia: Symptoms, Causes, and Treatment

Cervical hernia

Cervical disc herniation is a spinal condition affecting the cervical spine, which consists of the seven vertebrae that support the head and allow neck movements. It occurs when the nucleus pulposus of a cervical intervertebral disc protrudes through a tear in the annulus fibrosus, compressing nerve roots or the spinal cord. The most common consequence is pain radiating from the neck to the arm, known as cervicobrachialgia.

Unlike lumbar disc herniation, which predominantly affects the sciatic nerve with leg pain, cervical disc herniation involves the nerve roots of the brachial plexus, causing symptoms in the upper limb. Although less frequent than lumbar herniation, cervical disc herniation requires particular attention due to its proximity to the spinal cord and its significant impact on quality of life.

The good news is that the vast majority of cervical disc herniations respond positively to conservative treatment, without the need for surgical intervention.

Table of Contents

• Anatomy of the Cervical Spine
• Difference Between Cervical Disc Herniation and Protrusion
• Causes and Risk Factors
• Symptoms of Cervical Disc Herniation
• Diagnosis
• Conservative Treatment
• Exercises for Cervical Disc Herniation
• When is Surgery Necessary?
• Recovery Times
• Prevention
• Frequently Asked Questions (FAQ)
• Frequently Asked Questions
• Sources and Scientific References

Anatomy of the Cervical Spine

The cervical spine is composed of seven vertebrae (C1-C7), separated by six intervertebral discs (there is no disc between C1 and C2). Each disc is formed by:

• Nucleus pulposus: the central, gelatinous part that absorbs shocks
• Annulus fibrosus: the outer structure that contains the nucleus

The cervical vertebrae protect the spinal cord, and from each level, two nerve roots (right and left) emerge, extending towards the arm, forming the brachial plexus. The nerve roots most frequently involved in cervical disc herniation are:

• C5-C6 (the most common): pain in the shoulder and lateral arm, biceps weakness
• C6-C7 (the second most common): pain along the arm to the middle and ring fingers, triceps weakness
• C7-T1: pain along the inner side of the forearm to the little finger

The cervical spine is the most mobile segment of the vertebral column, and this mobility makes it particularly vulnerable to disc degeneration and herniation.

Difference Between Cervical Disc Herniation and Protrusion

The cervical spine consists of seven vertebrae (C1-C7) separated by intervertebral discs, protecting the spinal cord and nerve roots extending to the arms. It is essential to distinguish between herniation and disc protrusion:

• Cervical protrusion: the disc deforms and bulges into the vertebral canal, but the annulus fibrosus remains intact. It is much more common and generally less severe.
• Contained cervical disc herniation: the nucleus pulposus has partially ruptured the annulus fibrosus but is still partially contained.
• Extruded cervical disc herniation: the nucleus pulposus has completely passed through the annulus fibrosus.
• Migrated cervical disc herniation (sequestration): a fragment of the nucleus has detached and migrated into the vertebral canal.

Many cervical protrusions found on MRI are asymptomatic and represent normal signs of disc aging. The correlation between radiological findings and clinical symptoms must be carefully evaluated by your doctor or physical therapist.

Causes and Risk Factors

Disc Degeneration

The main cause of cervical disc herniation is age-related disc degeneration. Over the years, cervical discs lose water and height, the annulus fibrosus weakens, and becomes more susceptible to injury. This process begins as early as 30-40 years of age.

Mechanical and Postural Factors

• Prolonged cervical flexion posture: working at the computer with the neck projected forward (tech neck) increases the load on the cervical discs up to 5 times.
• Repeated microtraumas: repetitive neck movements, vibrations (frequent in truck drivers).
• Acute traumas: road accidents with whiplash mechanism, falls.
• Weight lifting: lifting loads with incorrect technique, excessively loading the cervical spine.

Predisposing Factors

• Sedentary lifestyle: weakness of the cervical and scapular musculature reduces disc protection.
• Smoking: reduces vascular supply to the disc, accelerating degeneration.
• Genetics: a family predisposition to disc degeneration is documented.
• Overweight: increases the overall load on the spine.

The interaction between the kinetic chain and pelvic posture often plays an underestimated role: postural alterations at the level of the pelvis and lumbar spine affect the cervical spine through compensatory mechanisms.

Symptoms of Cervical Disc Herniation

Neck Pain (Cervicalgia)

The initial symptom is often localized neck pain, similar to common cervicalgia, which can be confused with a simple torticollis. The pain worsens with head movements and axial pressure.

Cervicobrachialgia

The characteristic symptom of cervical disc herniation is pain radiating to the arm (cervicobrachialgia), which follows the distribution of the compressed nerve root:

• C5 root: pain in the lateral shoulder, weakness in elbow flexion.
• C6 root: pain along the outer side of the arm to the thumb and index finger, deficit of the biceps reflex.
• C7 root: posterior arm pain to the middle finger, weakness in elbow and wrist extension.
• C8 root: pain on the inner side of the forearm to the little finger, grip weakness.

Neurological Symptoms

• Tingling and numbness (paresthesias) along the arm and fingers.
• Muscle weakness of the arm or hand.
• Reduced tendon reflexes (biceps, triceps).

Warning Signs (Myelopathy)

In rare cases, a voluminous cervical disc herniation can compress the spinal cord (cervical myelopathy). Symptoms include:

• Difficulty walking and with balance.
• Leg weakness.
• Fine motor skill disturbances of the hands (difficulty buttoning, writing).
• Sphincter disturbances.

Cervical myelopathy is a medical emergency that requires immediate surgical evaluation. In the presence of these symptoms, it is crucial to promptly consult your doctor or physical therapist.

Diagnosis

Clinical Examination

The physical therapist or doctor will evaluate:

• Cervical mobility: flexion, extension, rotation, and lateral inclination.
• Spurling’s Test: axial compression with the head tilted towards the painful side — reproduction of radiating pain is highly suggestive of radicular compression.
• Distraction Test: head traction that relieves symptoms confirms radicular compression.
• Neurological examination: muscle strength, sensation, deep tendon reflexes.

Imaging Diagnostics

• Magnetic Resonance Imaging (MRI): is the examination of choice, visualizing the disc, nerve roots, and spinal cord.
• CT (Computed Tomography): useful for evaluating bone structures, particularly in cases of bony stenosi (restringimento del canale vertebrale o vascolare)s.
• Electromyography (EMG): may be indicated to assess the degree of nerve root involvement and distinguish cervicobrachialgia from carpal tunnel syndrome.

Conservative Treatment

Most cervical disc herniations (over 75-80%) respond positively to conservative treatment, with symptom resolution in 6-12 weeks.

Acute Phase (0-2 weeks)

• Relative rest: avoid activities that worsen symptoms, but maintain light activity.
• Medications: anti-inflammatories (NSAIDs), muscle relaxants, possibly corticosteroids under medical prescription.
• Soft cervical collar: only for short periods (3-5 days) if pain is very intense. Prolonged use is counterproductive as it weakens the musculature.
• Ice or heat: warm compresses can relieve muscle spasm.

Physiotherapy

The physiotherapy pathway is the cornerstone of conservative treatment and includes:

• Manual therapy: joint mobilizations and cervical decompression techniques.
• Neurodynamics: nerve gliding techniques to reduce tension on the compressed root.
• Cervical traction: manual or mechanical, to increase intervertebral space.
• Therapeutic exercises: muscle strengthening, stabilization, and postural re-education.
• Physical therapies: shockwave therapy, laser therapy, magnetotherapy for pain and inflammation control.

Exercises for Cervical Disc Herniation

Exercises should be performed under the supervision of your physical therapist, who will indicate the appropriate progression based on the recovery phase.

Phase 1 — Gentle Mobilization

Chin tuck (chin retraction)

The chin tuck is the fundamental exercise for cervical disc herniation. It corrects protraction posture and decompresses the posterior structures of the cervical spine.

[IMAGE: Person sitting with a straight back, gaze directed forward. The chin retracts horizontally backward, as if creating a double chin, without flexing or extending the head. The fingers of one hand are placed on the chin as a guide for the movement. Lateral view clearly showing the horizontal direction of the movement.]

Controlled cervical rotations

[IMAGE: Person sitting with a straight back slowly rotating their head to the right, keeping the chin parallel to the floor. Shoulders remain relaxed and still. Frontal view showing the angle of head rotation relative to the shoulders.]

Phase 2 — Stretching and Neurodynamics

Upper trapezius stretch

[IMAGE: Person sitting with a straight back, tilting their head laterally, bringing the right ear towards the right shoulder. The right hand is placed on the left temple and applies gentle pressure. The left arm hangs along the side with the hand reaching towards the floor. Frontal view showing the direction of the tilt and the position of the hands.]

Median nerve neural gliding

[IMAGE: Person standing with the right arm extended laterally at shoulder height, palm facing upward. The wrist extends, bringing the fingers towards the ceiling, while the head tilts towards the opposite side (left). Two positions shown: in the first, the wrist is in a neutral position and the head is centered; in the second, the wrist is extended and the head is tilted. Frontal view.]

Phase 3 — Strengthening and Stabilization

Multiplanar isometric cervical strengthening

[IMAGE: Person sitting with a straight back, pressing their forehead against the palm of their hand, without moving the head. The neck muscles contract against the resistance of the hand. Four positions shown: forward pressure (forehead-hand), backward (nape-hand), right lateral, and left lateral. Frontal view.]

Scapular retraction with resistance band

[IMAGE: Person sitting or standing with a therapeutic resistance band stretched between both hands, arms extended forward at shoulder height. The shoulder blades move closer to the spine by pulling the band towards the chest, elbows bending at the sides of the body. Posterior view showing the movement of the shoulder blades and the position of the resistance band.]

Chin tuck with resistance

[IMAGE: Person sitting with their back against a wall. A small folded towel is placed between the nape of the neck and the wall. The person presses the nape against the towel while keeping the chin retracted. Lateral view showing the head alignment and pressure against the wall.]

Cervical stabilization in quadruped position

[IMAGE: Person in a quadruped position on a mat (on all fours), with hands under shoulders and knees under hips. The neck is in a neutral position, gaze directed towards the floor. The right arm is raised forward parallel to the floor, maintaining neck and trunk stability. Lateral view.]

When is Surgery Necessary?

Surgical intervention is indicated in a minority of cases:

• Cervical myelopathy: spinal cord compression with progressive neurological deficits.
• Significant motor deficit: marked and progressive weakness of the arm or hand.
• Intractable pain: failure of at least 6-12 weeks of adequate conservative treatment.
• Cervical cauda equina syndrome: sphincter disturbances (rare).

The most common surgical techniques are:

• Anterior Cervical Discectomy and Fusion (ACDF): the standard approach, involving removal of the disc and fusion of adjacent vertebrae.
• Cervical disc arthroplasty: replacement of the disc with an artificial implant that preserves movement.

The choice of technique depends on the specific situation and should be discussed with your doctor or physical therapist.

Recovery Times

Spontaneous resorption of cervical disc herniation is documented, similar to what occurs with lumbar disc herniation. Extruded herniations tend to resorb more quickly than contained herniations.

Prevention

• Ergonomics: ensure a proper workstation setup with the monitor at eye level and the keyboard in the correct position.
• Active breaks: every 30-45 minutes, stand up, move your neck and shoulders.
• Muscle strengthening: keep cervical and scapular muscles toned with regular exercises.
• Sleeping posture: avoid pillows that are too high or too low; prefer an anatomical cervical pillow.
• Regular physical activity: movement keeps discs hydrated and muscles toned.

For a complete overview of spinal conditions, consult the Complete Guide to Back Pain and the Spine.

Frequently Asked Questions (FAQ)

Frequently Asked Questions

What is the primary approach to treating cervical disc herniation?

Most cervical disc herniations respond very well to conservative treatment, which focuses on managing symptoms and restoring function without surgical intervention. This approach typically includes rest, medication, and a structured physical therapy program.

What is the role of a physical therapist in managing cervical disc herniation?

A physical therapist plays a crucial role in conservative treatment by guiding patients through exercises for gentle mobilization, stretching, and strengthening. This structured program aims to reduce pain, improve range of motion, and stabilize the cervical spine.

What are the common symptoms of cervical disc herniation?

A common symptom of cervical disc herniation is neck pain that radiates into the arm, known as cervicobrachialgia. Other potential symptoms include neurological manifestations such as numbness, tingling, or weakness in the affected limb.

When is surgical intervention considered for cervical disc herniation?

Surgery for cervical disc herniation is generally considered when conservative treatments have not provided adequate relief or when there are signs of progressive neurological deficits. The decision for surgical intervention is made after a comprehensive medical evaluation.

For a broader overview of related conditions, see our complete guide to back pain.

Sources and Scientific References

1. Kuligowski T et al. (2021). Manual Therapy in Cervical and Lumbar Radiculopathy: A Systematic Review of the Literature. Int J Environ Res Public Health. 18. DOI | PubMed
2. Chrcanovic B et al. (2022). Exercise therapy for whiplash-associated disorders: a systematic review and meta-analysis. Scand J Pain. 22:232-261. DOI | PubMed
3. Gross A et al. (2015). Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 1:CD004250. DOI | PubMed
4. Binder AI (2008). Neck pain. BMJ Clin Evid. 2008. PubMed
5. Wu SK et al. (2022). Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation. BMC Musculoskelet Disord. 23:728. DOI | PubMed