Is diminished disc space in the cervical spine consistent with a herniated intervertebral disc?

From the Guidelines

Diminished disc space in the cervical spine is consistent with a herniated disc, but it can also be caused by other conditions such as degenerative disc disease, disc desiccation, or normal aging processes. When a disc herniates, the inner gel-like nucleus pulposus pushes through the outer annulus fibrosus, which can lead to a reduction in the height of the disc space visible on imaging studies 1. This disc space narrowing occurs because the herniated material reduces the volume within the disc itself.

Key Points to Consider

• Cervical radiculopathy is defined as a syndrome of pain or sensorimotor deficits that are due to dysfunction of a cervical spinal nerve, the roots of the nerve, or both 1.
• The most common clinical presentation is of the combination of neck pain with pain in one arm accompanied by varying degrees of sensory or motor function loss in the affected nerve-root distribution 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.

Diagnostic Approach

• In absence of red flag symptoms, imaging may not be required at time of initial presentation 1 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.
• Accurate diagnosis typically requires correlation of imaging findings (such as MRI or CT scans) with clinical symptoms like neck pain, radiculopathy, or myelopathy.
• A healthcare provider would need to evaluate the complete clinical picture, including physical examination findings and the pattern of symptoms, to determine if the diminished disc space is indeed related to a herniated disc rather than another spinal condition.

From the Research

Diminished Disc Space in Cervical Spine and Herniated Disc

• Diminished disc space in the cervical spine can be associated with a herniated disc, as a herniated disc can cause the disc space to narrow due to the displacement of the disc material 2.
• However, diminished disc space can also be a result of degenerative changes, such as disc degeneration or spinal stenosis, which can occur independently of a herniated disc 3.
• The presence of a herniated disc can be diagnosed through imaging studies, such as MRI or CT scans, which can show the displacement of the disc material and the narrowing of the disc space 2.
• The symptoms of a herniated disc in the cervical spine can include severe local and radicular pain, as well as dermatome-related neurological deficits in the upper extremities 2.
• The treatment of a herniated disc in the cervical spine can include conservative therapy, such as physical therapy and pain management, as well as surgical options, such as discectomy or spinal fusion 2.

Relationship Between Diminished Disc Space and Herniated Disc

• A study published in 2016 found that low signal intensity of intervertebral discs in the cervical spine on fluid-sensitive MR images might be pre-existing and part of the natural course, and not necessarily indicative of a herniated disc 4.
• However, another study published in 2025 found that herniated discs in the cervical spine can cause severe local and radicular pain, and that the prognosis for complete remission is usually favorable with conservative therapy 2.
• The study published in 2002 found that disc lesions can resolve radiologically with time, and that patients' symptoms can improve before their radiographs, suggesting that the relationship between diminished disc space and herniated disc is complex and can vary depending on the individual case 5.

Diagnostic and Treatment Options

• Imaging studies, such as MRI or CT scans, can be used to diagnose a herniated disc in the cervical spine and to evaluate the extent of the disc space narrowing 2.
• Conservative therapy, such as physical therapy and pain management, can be effective in managing the symptoms of a herniated disc in the cervical spine 6, 3.
• Surgical options, such as discectomy or spinal fusion, may be necessary in some cases, particularly if the patient is experiencing severe neurological deficits or if the symptoms are not responding to conservative therapy 2.