Understanding Cervical Disc Herniations: Updated Clinical Guidelines for Effective Management

Written By Cuan Wayne Coetzee .

Cervical disc herniation, often presenting with neck pain, arm pain, and neurological symptoms, is a common yet challenging condition. It can significantly impact daily life, from limiting simple movements to causing chronic discomfort. As healthcare providers, staying abreast of the latest guidelines is crucial in delivering the most effective care. In this blog, I’ll outline the current clinical recommendations for diagnosing and managing cervical disc herniations, blending the latest research with practical insights from our experience at MoveMed.

What is Cervical Disc Herniation?

Cervical disc herniation occurs when the inner core of an intervertebral disc in the neck protrudes through the outer ring, often compressing nearby nerves or the spinal cord. This can result in neck pain, radiating arm pain, numbness, tingling, or even weakness. The prevalence of cervical disc herniations increases with age, but with appropriate management, many patients can achieve significant relief and improved function.

Diagnosing Cervical Disc Herniation

Accurate diagnosis begins with a comprehensive clinical assessment, including a detailed patient history and physical examination. Identifying symptoms like neck stiffness, radicular arm pain, or neurological deficits is essential.

Imaging Guidelines

  • MRI: Magnetic Resonance Imaging (MRI) is the preferred imaging modality for cervical disc herniation, providing excellent visualisation of the disc, nerves, and spinal cord. It helps confirm the diagnosis and guide treatment decisions .

  • CT Scan with Myelography: This combination can be useful for patients who cannot undergo MRI, especially when there’s a need to evaluate the spinal cord in detail.

Guidelines recommend reserving imaging for patients with persistent or severe symptoms, as imaging in asymptomatic cases may lead to overdiagnosis and unnecessary interventions .

Management: Focusing on Conservative Care First

Most cases of cervical disc herniation can be managed successfully with conservative treatment. Here are the key evidence-based recommendations:

  1. Pain Management:

    • NSAIDs and acetaminophen remain the first-line options for managing pain. They help reduce inflammation and discomfort, allowing patients to engage in physical therapy and daily activities .

    • Corticosteroids may be prescribed short-term for significant nerve-related pain, although their long-term use is discouraged due to potential side effects.

  2. Physical Therapy:

    • A tailored programme focusing on neck strengthening, posture correction, and gentle mobilisation can significantly improve outcomes. Recent studies support the role of targeted exercise in reducing pain and enhancing quality of life for cervical disc herniation patients .

  3. Spinal Manipulation and Mobilisation:

    • Chiropractic care, including gentle spinal manipulation and mobilisation, can help alleviate pain and improve neck function. A 2023 systematic review found that spinal manipulation, when performed appropriately, is effective in reducing pain and disability associated with cervical disc herniation .

  4. Cervical Traction:

    • Mechanical or manual cervical traction can relieve nerve compression by gently stretching the neck, which may create a slight decompression effect on the affected disc. This technique can be particularly useful for reducing radicular symptoms .

  5. Epidural Steroid Injections (ESIs):

    • For patients with severe, persistent radicular pain not responding to other conservative measures, ESIs can provide temporary relief. However, the guidelines suggest that their use should be limited due to potential side effects and variable efficacy .

Surgical Intervention: When is it Necessary?

Surgery is typically considered only when conservative treatments fail, or when patients exhibit progressive neurological deficits, significant spinal cord compression, or debilitating pain. The most common surgical options include:

  1. Anterior Cervical Discectomy and Fusion (ACDF):

    • ACDF is the standard surgical treatment, involving the removal of the herniated disc and fusion of the adjacent vertebrae to stabilise the spine. It is highly effective in relieving symptoms and has a good long-term success rate .

  2. Cervical Disc Replacement:

    • For selected patients, artificial disc replacement can be an alternative to fusion, allowing for better preservation of neck mobility. Current evidence suggests it offers comparable or even superior outcomes to ACDF in certain cases .

Conclusion: A Balanced, Evidence-Based Approach to Cervical Disc Herniation

Cervical disc herniation management continues to evolve, with a strong emphasis on conservative care as the first line of treatment. Understanding the latest clinical guidelines ensures we can provide personalised and effective care to our patients. At MoveMed, we are dedicated to guiding you through every step of your recovery journey, with a focus on restoring movement, reducing pain, and improving quality of life.

Ready to regain control over your neck pain? Book your appointment today and let’s start your path to better health and movement.

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References

  1. Sharrak S, Al Khalili Y. Cervical Disc Herniation. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546618/

  2. Thoomes E, Thoomes-de Graaf M, Cleland J, et al Timing of evidence-based non-surgical interventions as part of multimodal treatment guidelines for the management of cervical radiculopathy: a Delphi study protocol BMJ Open 2021;11:e043021. doi: 10.1136/bmjopen-2020-043021 https://bmjopen.bmj.com/content/bmjopen/11/3/e043021.full.pdf

  3. Kjaer P, Kongsted A, Hartvigsen J, Isenberg-Jørgensen A, Schiøttz-Christensen B, Søborg B, Krog C, Møller CM, Halling CMB, Lauridsen HH, Hansen IR, Nørregaard J, Jørgensen KJ, Hansen LV, Jakobsen M, Jensen MB, Melbye M, Duel P, Christensen SW, Povlsen TM. National clinical guidelines for non-surgical treatment of patients with recent onset neck pain or cervical radiculopathy. Eur Spine J. 2017 Sep;26(9):2242-2257. doi: 10.1007/s00586-017-5121-8. Epub 2017 May 18. PMID: 28523381. https://pubmed.ncbi.nlm.nih.gov/28523381/

  4. Rodine RJ, Vernon H. Cervical radiculopathy: a systematic review on treatment by spinal manipulation and measurement with the Neck Disability Index. J Can Chiropr Assoc. 2012 Mar;56(1):18-28. PMID: 22457538; PMCID: PMC3280115. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280115/

  5. Chaibi A, Stavem K, Russell MB. Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. J Clin Med. 2021 Oct 28;10(21):5011. doi: 10.3390/jcm10215011. PMID: 34768531; PMCID: PMC8584283. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584283/

  6. Romeo A, Vanti C, Boldrini V, Ruggeri M, Guccione AA, Pillastrini P, Bertozzi L. Cervical Radiculopathy: Effectiveness of Adding Traction to Physical Therapy-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Phys Ther. 2018 Apr 1;98(4):231-242. doi: 10.1093/physth/pzy001. Erratum in: Phys Ther. 2018 Aug 1;98(8):727. doi: 10.1093/ptj/pzy064. PMID: 29315428. https://pubmed.ncbi.nlm.nih.gov/29315428/

  7. Chang, C., Liu, Y., Hsiao, Y., Huang, Y., Liu, K., Lin, R., & Lin, C. (2022). Comparison of anterior cervical discectomy and fusion versus artificial disc replacement for cervical spondylotic myelopathy: a meta-analysis. Journal of Neurosurgery: Spine, 37(4), 569-578. https://doi.org/10.3171/2022.2.SPINE211500

Cuan Wayne Coetzee .
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