What it is
Each cervical disc has a tough outer ring and a softer center. When the outer ring tears, the inner material can push out and press on a nerve root as it exits, or — less often but more seriously — on the spinal cord itself.
Which of those two it is changes everything about how urgent the problem is. A disc pressing on a nerve root causes arm symptoms and is rarely dangerous. A disc pressing on the cord can cause myelopathy, which is assessed and treated differently.
Symptoms
- Neck pain, often with a sudden onset
- Pain, numbness or weakness following a nerve's path into the arm and hand
- Relief when the arm is raised above the head
- Where the cord is involved: clumsiness, balance change, or symptoms in both hands or the legs
How it is diagnosed
MRI is the test of choice and shows the fragment, the level and what it is touching. Dr. Long reads it alongside the examination rather than in isolation: herniations are common findings in people with no symptoms at all, so the picture only means something when it matches the pattern of complaints.
Non-surgical treatment
Most nerve-root herniations settle. Physical therapy, anti-inflammatories, activity modification and selective injections are the mainstay, and the natural history is genuinely favorable — extruded fragments often shrink over six to twelve months.
When surgery is considered
Arm pain that persists despite good non-operative treatment, weakness that is getting worse, or any sign of spinal cord compression. When the compression is in front of the nerve, the operation is usually done from the front — either replacing the disc to keep the level moving, or removing it and fusing. Where motion can be preserved safely, it usually should be.