A herniated disc in the cervical spine rarely makes itself felt in the neck alone. Typically there is a pain that runs over the shoulder into the arm, as far as particular fingers, often worst at night. This page explains what is different about the cervical spine compared with the lower back, when you should act promptly, and which treatments come into question.
In the cervical spine, too, most herniated discs improve without an operation. The difference from the lower back: here the spinal cord runs through the spinal canal, and its warning signs look different from those of a trapped nerve.
What is it?
The cervical spine consists of seven vertebrae with six discs, smaller than those of the lumbar spine but built the same way: a soft core inside a firm fibrous ring. If the ring tears, tissue can escape backwards and press on two structures — the nerve root, which exits to the side towards the arm, or the spinal cord in the middle of the canal. The first case is common and is called radiculopathy. The second is rarer, is called myelopathy, and is the reason why the cervical spine has rules of its own.
The levels C5/6 and C6/7 are most often affected, because they are the most mobile. The terms in your report are explained on our page on understanding your MRI report. Here too: a herniation on the scan only becomes a diagnosis once it matches what you feel and what the examination shows.
What symptoms occur?
Nerve root pain runs from the neck over the shoulder blade into the arm and follows the strip of the affected root: C6 supplies the thumb and index finger and the muscles that bend the elbow, C7 the middle finger and the muscles that straighten the elbow, C8 the ring and little fingers and the small muscles of the hand. Added to this are tingling, numbness, sometimes weakness when lifting or gripping. Many people cannot find a position at night in which the arm settles; resting the arm on top of the head often brings relief.
If the spinal cord is compressed, the signs are different and quieter: the hands become clumsy — doing up buttons, writing, picking up coins becomes difficult — walking becomes unsteady, as if on cotton wool, and both legs feel stiff or heavy without actually hurting. These symptoms need to be assessed promptly, even if they are mild.
Causes
In younger people it is usually the “soft” herniation: core tissue escapes through a tear, often after a sudden movement or seemingly overnight. With age the disc becomes flatter, bony outgrowths form at the edges of the vertebrae, the small joints wear — and in older people this “hard” narrowing constricts the root more often than a fresh herniation does. Accidents are rarely the cause.
How is it diagnosed?
First the consultation: where does the pain radiate to, which fingers tingle, what has become difficult? Then the examination of strength, sensation and reflexes in both arms, plus gait, fine motor control of the hands and the reflexes in the legs — these reveal whether the spinal cord is also affected.
MRI is the investigation of choice where there are neurological deficits, signs of spinal cord involvement, and symptoms that persist for weeks. A CT scan shows bony outgrowths more precisely; electrical testing of the nerves helps when it is unclear whether the cause lies in the spine at all. For pain and tingling in the arm have many sources: the shoulder joint, a trapped nerve at the wrist or elbow, more rarely the heart. Ruling these out is part of the diagnosis.
Warning signs
You should have the following assessed immediately: paralysis of the arm or hand that increases within hours or days, new unsteadiness when walking or clumsiness of both hands, problems passing urine, and symptoms in both arms or both legs at the same time. Neck pain with fever or after a fall also needs prompt medical attention. More on this on the page Warning signs.
Conservative treatment
Without warning signs and without significant paralysis, treatment begins without an operation; in most people the symptoms improve this way. Keep moving. A neck collar can relieve the strain in the first few weeks, but should then be gradually discarded.
- Painkillers — anti-inflammatory medicines for a limited time; for pronounced nerve pain, medicines that act on nerve excitability and can cause tiredness at first.
- Physiotherapy — mobilisation, posture training, later strengthening of the neck and shoulder-blade muscles. Heat, if it helps.
- Targeted injection at the nerve root (periradicular therapy, PRT) — under image guidance, an anti-inflammatory medicine is delivered to the irritated root; this can ease the pain for a few weeks. In the cervical spine, stricter rules of care apply than in the lower back, because important blood vessels run nearby; whether an injection makes sense in your case is something we discuss after the examination. We offer this treatment in our practice.
- Multimodal pain therapy — for symptoms lasting months, a combined programme of treatment may be considered.
When an operation is considered
A prompt operation is performed for significant or increasing paralysis and for myelopathy with progressive symptoms. The aim is to prevent further damage; deficits that have already occurred do not always recover.
A planned operation is considered if the arm pain persists for weeks despite consistent treatment, the MRI findings match the examination, and you want the procedure. Neck pain alone, without radiation and without deficits, is not a reason for disc surgery. Every decision includes the question of what happens if you do not have the operation.
Surgical options
The most common procedure is removal of the disc from the front with insertion of a spacer — anterior cervical discectomy with a cage. We offer this procedure, as well as procedures from the back, in which the nerve exit is widened and the segment is stabilised with small implants if necessary. Which approach is suitable depends on where the narrowing lies and whether the spinal cord is involved.
- ProcedureUnder general anaesthetic, the spine is reached through a short skin incision at the front of the neck. The disc is removed, and the nerve root and spinal cord are decompressed under the microscope. A spacer made of plastic or titanium is placed in the space, secured with a small plate if necessary; it maintains the height and allows the vertebrae to fuse together over months. The hospital stay is usually a few days.
- RisksIn general: infection, bleeding, thrombosis, risks of anaesthesia. Specific to this procedure: difficulty swallowing and hoarseness, which usually pass, rarely a permanent weakness of the vocal cord; bleeding in the neck, which must be treated promptly; an injury to the membrane around the nerves; damage to the nerve root or spinal cord, very rare but serious; failure of the bone to fuse; displacement of the implant; over the years, increased wear of the adjacent levels. Which of these carry weight in your case is something we discuss before the procedure.
- AftercareGetting up on the day after the operation. A rigid neck collar is usually not necessary. No heavy loads and no jerky head movements for a few weeks, then physiotherapy for the neck and shoulder girdle. A follow-up X-ray shows whether the vertebrae are fusing. A follow-up check with us is part of the process.
A motion-preserving disc prosthesis instead of the rigid spacer may be considered where the findings are suitable; it is not suitable where there is advanced wear of the neighbouring structures.
Alternatives
For pure nerve root pain without deficits, supervised waiting is the most important alternative: monitoring of strength and sensation, pain treatment, exercise, and an injection if appropriate. In myelopathy, waiting is justifiable only under close monitoring, because a deterioration costs time that cannot be recovered. If you have been advised to have an operation and are unsure, you can obtain a second opinion from us.
What to expect
Nerve root pain in the cervical spine improves in most people within weeks to a few months, with or without an operation. Tingling and numbness take longer, and some may remain; a mild weakness often recovers, but not always completely. In myelopathy, the aim of any treatment is to prevent deterioration — all the more important that the quiet signs are taken seriously early on. What you can do yourself: take breaks from screen work, move your head regularly, strengthen the muscles between the shoulder blades. And check both hands once a day: make a fist, spread your fingers, do up a button. If that gets worse, get in touch.
Frequently asked questions
Is a herniated disc in the neck more dangerous than in the back?
Not as a rule. Most herniations affect only one nerve root and heal without an operation. It is different if the spinal cord is compressed; then a prompt assessment is needed.
Should I wear a neck collar?
In the first few weeks it can bring relief, especially at night; in one study it was about as effective as physiotherapy in the early phase. Long-term it is not advisable, because the muscles waste — so discard it gradually afterwards and get moving.
Is my dizziness coming from the cervical spine?
Dizziness has many causes, and the cervical spine is a rare and disputed one. As a rule, a herniated disc does not explain dizziness; it should first be seen by your GP practice, an ear, nose and throat specialist or a neurologist.
When can I drive again after an operation?
As soon as you can turn your head in all directions without pain, no longer need strong painkillers and feel confident about an emergency stop. When that is, we discuss at the follow-up check.