When is cervical intervertebral disc protrusion concerning?

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DS

Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: February 19, 2025 • View editorial policy

From the Guidelines

Cervical intervertebral disc protrusion is concerning when it causes significant symptoms or neurological deficits, such as numbness, tingling, or weakness in the arms, which is often seen in cervical radiculopathy 1.

Key Concerns

  • Neurological deficits: numbness, tingling, or weakness in the arms, which can be due to compression of a cervical spinal nerve or its roots 1
  • Severe pain: difficulty with balance or coordination, or bladder and bowel dysfunction, which may indicate compression of the spinal cord
  • Red flag symptoms: trauma, malignancy, prior neck surgery, spinal cord injury, systemic diseases, or suspected infection, which require urgent evaluation 1 ### Evaluation and Management
  • If the patient's symptoms worsen or do not improve with conservative management, such as physical therapy and pain management, further evaluation and possible surgical intervention may be necessary
  • Imaging studies such as an MRI or CT scan should be performed to assess the extent of the disc protrusion and potential compression of the spinal cord or nerve roots, especially in the absence of red flag symptoms, as spondylotic changes are commonly identified on radiographs and MRI in patients >30 years of age and correlate poorly with the presence of neck pain 1 ### Important Considerations
  • Most cases of acute cervical neck pain with radicular symptoms resolve spontaneously or with conservative treatment measures 1
  • A recent meta-analysis assessing the positive predictive value of physical examination tests in the setting of a clinical history of cervical radiculopathy concluded there was limited evidence for a correlation between physical examination findings and MRI evidence of cervical nerve root compression 1

From the Research

Cervical Intervertebral Disc Protrusion Concerns

Cervical intervertebral disc protrusion can be concerning in several situations, including:

  • Significant neurological deficits and larger disc herniations, which may require surgery 2
  • Moderate or marked spinal cord and/or nerve root compression, which may warrant surgery 2
  • Extruded or sequestrated discs, resulting in significant compression of the spinal cord and/or nerve root 2
  • Patients with cervical radiculopathy (root compression) and/or myelopathy (cord compression) with disc herniations on MR/CT studies, who may or may not require surgery 2

Neurological Deficits

Neurological deficits can be a concern in cervical intervertebral disc protrusion, including:

  • Radiculopathy, which can cause pain radiating down one or both arms 2
  • Myelopathy, which can result in more diffuse numbness, tingling, or weakness in the upper and/or lower extremities 2
  • Focal or diffuse loss of motor strength, changes in reflexes, loss of sensation, and cerebellar dysfunction 2

Diagnostic Tools

Diagnostic tools such as MRI and CT scans can help identify cervical intervertebral disc protrusion and determine the severity of the condition, including:

  • MR examinations, which can best document soft disc herniations 2
  • CT scans, which can most readily demonstrate calcification/ossification of cervical discs and accompanying arthritic changes 2
  • Dynamic cervical radiographs, which can be useful in predicting the severity of degenerative disc and disc protrusion in cervical MRI, especially at the C3/4, C4/5, C5/6, and C6/7 levels 3

Surgical Interventions

Surgical interventions may be necessary in some cases of cervical intervertebral disc protrusion, including:

  • Anterior cervical discectomy/fusion (ACDF), which is a common surgical procedure for cervical disc disease 2, 4
  • Posterior decompression and stabilisation, which may be necessary in cases where the neurological deficit continues to deteriorate post-ACDF 4

References

1
Guideline

acr appropriateness criteria<sup>®</sup> cervical neck pain or cervical radiculopathy.

Journal of the American College of Radiology, 2019

4
Research

Major neurological deficit following anterior cervical decompression and fusion: what is the next step?

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2015

Related Questions

Is inpatient level of care medically necessary for a patient with cervical radiculopathy (nerve root pain in the cervical spine) in the C3-C4, C4-C5, C5-C6 regions undergoing anterior cervical discectomy and fusion (ACDF) with hardware?
Is the request for anterior cervical discectomy and fusion (ACDF) at C6-7, exploration of previous fusion, and removal of instrumentation medically necessary for a 60-year-old female with persistent and progressive arm pain, paresthesia, and weakness, given her history of previous ACDF at C4-5 and C5-6, and significant neural compression on imaging studies?
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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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