eMedicine Specialties > Physical Medicine and Rehabilitation > Cervical Spine Disorders
Cervical Disc Disease: Multimedia
Updated: Apr 6, 2009
Multimedia
 | Media file 1: Disc herniation classification. A: Normal disc anatomy demonstrating nucleus pulposus (NP) and annular margin (AM). B: Disc protrusion, with NP penetrating asymmetrically through annular fibers but confined within the AM. C: Disc extrusion with NP extending beyond the AM. D: Disc sequestration, with nuclear fragment separated from extruded disc. |
 | Media file 2: Axial magnetic resonance imaging (MRI) scan (C3-C4) demonstrating left-sided posterolateral protrusion of the nucleus pulposus with compression of the cerebrospinal fluid. |
 | Media file 3: Sagittal magnetic resonance imaging (MRI) scan demonstrating cervical intervertebral disc protrusions at C3-C4 and C7-T1. |
 | Media file 4: Right C7 cervical transforaminal epidural steroid injection demonstrating epidural and radicular spread of radiologic contrast dye. |
 | Media file 5: Cervical epidural steroid injection at the C7-T1 interlaminar space. |
 | Media file 6: Cervical discography. Anteroposterior fluoroscopic image. |
 | Media file 7: Cervical discography. Lateral fluoroscopic image. |
 | Media file 8: Postdiscography axial computed tomography (CT) scan demonstrating right posterolateral subligamentous protrusion. |
More on Cervical Disc Disease |
| Overview: Cervical Disc Disease |
| Differential Diagnoses & Workup: Cervical Disc Disease |
| Treatment & Medication: Cervical Disc Disease |
| Follow-up: Cervical Disc Disease |
 Multimedia: Cervical Disc Disease |
| References |
| Further Reading |
| « Previous Page |
References
Carette S, Fehlings MG. Clinical practice. Cervical radiculopathy. N Engl J Med. Jul 28 2005;353(4):392-9. [Medline].
Tanaka Y, Kokubun S, Sato T, et al. Cervical roots as origin of pain in the neck or scapular regions. Spine. Aug 1 2006;31(17):E568-73. [Medline].
Baptiste DC, Fehlings MG. Pathophysiology of cervical myelopathy. Spine J. Nov-Dec 2006;6(6 Suppl):190S-197S. [Medline].
Shedid D, Benzel EC. Cervical spondylosis anatomy: pathophysiology and biomechanics. Neurosurgery. Jan 2007;60(1 Supp1 1):S7-13. [Medline].
Miyazaki M, Hong SW, Yoon SH, et al. Reliability of a magnetic resonance imaging-based grading system for cervical intervertebral disc degeneration. J Spinal Disord Tech. Jun 2008;21(4):288-92. [Medline].
Radhakrishnan K, Litchy WJ, O''Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. Apr 1994;117 ( Pt 2):325-35. [Medline].
Salemi G, Savettieri G, Meneghini F, et al. Prevalence of cervical spondylotic radiculopathy: a door-to-door survey in a Sicilian municipality. Acta Neurol Scand. Feb-Mar 1996;93(2-3):184-8. [Medline].
Kelley LA. In neck to neck competition are women more fragile?. Clin Orthop. Mar 2000;(372):123-30. [Medline].
Marchiori DM, Henderson CN. A cross-sectional study correlating cervical radiographic degenerative findings to pain and disability. Spine. Dec 1 1996;21(23):2747-51. [Medline].
Boden SD, McCowin PR, Davis DO, et al. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. Sep 1990;72(8):1178-84. [Medline].
Shim JH, Park CK, Lee JH, Choi JW, Lee DC, Kim DH, et al. A comparison of angled sagittal MRI and conventional MRI in the diagnosis of herniated disc and stenosis in the cervical foramen. Eur Spine J. Mar 18 2009;[Medline].
Bhadra AK, Raman AS, Casey AT, Crawford RJ. Single-level cervical radiculopathy: clinical outcome and cost-effectiveness of four techniques of anterior cervical discectomy and fusion and disc arthroplasty. Eur Spine J. Feb 2009;18(2):232-7. [Medline].
Bapat MR, Chaudhary K, Sharma A, et al. Surgical approach to cervical spondylotic myelopathy on the basis of radiological patterns of compression: prospective analysis of 129 cases. Eur Spine J. Dec 2008;17(12):1651-63. [Medline].
Pechlivanis I, Brenke C, Scholz M, et al. Treatment of degenerative cervical disc disease with uncoforaminotomy--intermediate clinical outcome. Minim Invasive Neurosurg. Aug 2008;51(4):211-7. [Medline].
Anderson PA, Subach BR, Riew KD. Predictors of outcome after anterior cervical discectomy and fusion: a multivariate analysis. Spine. Jan 15 2009;34(2):161-6. [Medline].
Derby R, Baker R, Dreyfuss P. Cervical radicular pain: transforaminal vs. interlaminar steroid injections. ISIS Scientific Newsletter: Current Concepts-SpineLine. 2005;5(1):16-17.
Hodges SD, Castleberg RL, Miller T, et al. Cervical epidural steroid injection with intrinsic spinal cord damage. Two case reports. Spine. Oct 1 1998;23(19):2137-42; discussion 2141-2. [Medline].
Furman MB, Giovanniello MT, O''Brien EM. Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine. Jan 1 2003;28(1):21-5. [Medline].
Brouwers PJ, Kottink EJ, Simon MA, et al. A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root. Pain. Apr 2001;91(3):397-9. [Medline].
Baker R, Dreyfuss P, Mercer S, et al. Cervical transforaminal injection of corticosteroids into a radicular artery: a possible mechanism for spinal cord injury. Pain. May 2003;103(1-2):211-5. [Medline].
Adams F. In: Paulus Aeginata. Vol 2. London:. Sydenham Society;1816:55-6, 193, 197.
Alejos JT, Wilder RP, Cole AJ, et al. Return to work and functional optimization programs. In: Cole AJ, Herring SA, eds. The Low Back Pain Handbook: A Practical Guide for the Primary Care Clinician. St Louis, Mo:. Mosby;1997:149-52.
Antich PA, Sanjuan AC, Girvent FM, Simo JD. High cervical disc herniation and Brown-Sequard syndrome. A case report and review of the literature. J Bone Joint Surg Br. May 1999;81(3):462-3. [Medline].
Aprill C, Bogduk N. The prevalence of cervical zygapophyseal joint pain. A first approximation. Spine. Jul 1992;17(7):744-7. [Medline].
Aprill C, Dwyer A, Bogduk N. Cervical zygapophyseal joint pain patterns. II: A clinical evaluation. Spine. Jun 1990;15(6):458-61. [Medline].
Bannister G, Gargan M. Prognosis of whiplash injuries. A review of the spine. In: State of the Art Reviews. Philadelphia, Pa:. Hanley & Belfus;1993:557-70.
Barnsley L, Lord S, Bogduk N. Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain. Pain. Oct 1993;55(1):99-106. [Medline].
Barnsley L, Lord S, Wallis B, Bogduk N. False-positive rates of cervical zygapophysial joint blocks. Clin J Pain. Jun 1993;9(2):124-30. [Medline].
Bogduk N. The clinical anatomy of the cervical dorsal rami. Spine. Jul-Aug 1982;7(4):319-30. [Medline].
Bogduk N, Aprill C. On the nature of neck pain, discography and cervical zygapophysial joint blocks. Pain. Aug 1993;54(2):213-7. [Medline].
Bogduk N, Windsor M, Inglis A. The innervation of the cervical intervertebral discs. Spine. Jan 1988;13(1):2-8. [Medline].
Braddom RL, Buschbacher RM, Dumitru D. Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: WB Saunders; 2000:. 426-9.
Bush K, Chaudhuri R, Hillier S, Penny J. The pathomorphologic changes that accompany the resolution of cervical radiculopathy. A prospective study with repeat magnetic resonance imaging. Spine. Jan 15 1997;22(2):183-6; discussion 187. [Medline].
Butler D. Mobilization of the Nervous System. New York, NY: Churchill Livingstone; 1991.
Butler D. The Sensitive Nervous System. Adelaide, Australia: Noigroup Publications; 2000:. 98, 378, 383-4, 394.
Chen TY. The clinical presentation of uppermost cervical disc protrusion. Spine. Feb 15 2000;25(4):439-42. [Medline].
Cicala RS, Thoni K, Angel JJ. Long-term results of cervical epidural steroid injections. Clin J Pain. Jun 1989;5(2):143-5. [Medline].
Cloward RB. Cervical diskography. A contribution to the etiology and mechanism of neck, shoulder and arm pain. Ann Surg. Dec 1959;150:1052-64. [Medline].
Connor PM, Darden BV 2d. Cervical discography complications and clinical efficacy. Spine. Oct 15 1993;18(14):2035-8. [Medline].
Dai L. Disc degeneration and cervical instability. Correlation of magnetic resonance imaging with radiography. Spine. Aug 15 1998;23(16):1734-8. [Medline].
Dai L, Jia L. Central cord injury complicating acute cervical disc herniation in trauma. Spine. Feb 1 2000;25(3):331-5; discussion 336. [Medline].
Dan NG. A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary. Neurosurgery. Apr 1999;44(4):919. [Medline].
Derby R, Bogduk N, Schwarzer A. Precision percutaneous blocking procedures for localizing spinal pain. Part 1: The posterior lumbar compartment. Pain Digest. 1993;3:89-100.
Dreyfuss P. The Texas two-step injection technique. (Personal communication).
Dumitru D, Dreyfuss P. Dermatomal/segmental somatosensory evoked potential evaluation of L5/S1 unilateral/unilevel radiculopathies. Muscle Nerve. Apr 1996;19(4):442-9. [Medline].
Dwyer A, Aprill C, Bogduk N. Cervical zygapophyseal joint pain patterns. I: A study in normal volunteers. Spine. Jun 1990;15(6):453-7. [Medline].
Ferrante FM, Wilson SP, Iacobo C, et al. Clinical classification as a predictor of therapeutic outcome after cervical epidural steroid injection. Spine. May 1993;18(6):730-6. [Medline].
Gore DR, Sepic SB. Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients. Spine. Oct 1984;9(7):667-71. [Medline].
Grant RN, McKenzie RA. Mechanical diagnosis and therapy for the cervical and thoracic spine. In: Grant R, ed. Physical Therapy of the Cervical and Thoracic Spine. New York, NY: Churchill Livingstone; 1998:. 359-77.
Grubb SA, Kelly CK. Cervical discography: clinical implications from 12 years of experience. Spine. Jun 1 2000;25(11):1382-9. [Medline].
Guyer RD, Collier R, Stith WJ, et al. Discitis after discography. Spine. Dec 1988;13(12):1352-4. [Medline].
Hamada G, Rida A. Orthopaedics and orthopaedic diseases in ancient and modern Egypt. Clin Orthop. 1972;89:253-68. [Medline].
Heckmann JG, Lang CJ, Zobelein I, et al. Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients. J Spinal Disord. Oct 1999;12(5):396-401. [Medline].
Herzog J. Use of cervical spine manipulation under anesthesia for management of cervical disk herniation, cervical radiculopathy, and associated cervicogenic headache syndrome. J Manipulative Physiol Ther. Mar-Apr 1999;22(3):166-70. [Medline].
Humphreys SC, Hodges SD, Patwardhan A, et al. The natural history of the cervical foramen in symptomatic and asymptomatic individuals aged 20-60 years as measured by magnetic resonance imaging. A descriptive approach. Spine. Oct 15 1998;23(20):2180-4. [Medline].
Jackson R. The Cervical Syndrome. Springfield, Ill: Charles C. Thomas; 1958.
Jensen MV, Tuchsen F, Orhede E. Prolapsed cervical intervertebral disc in male professional drivers in Denmark, 1981-1990. A longitudinal study of hospitalizations. Spine. Oct 15 1996;21(20):2352-5. [Medline].
Judovich BD. Herniated cervical disc; a new form of traction therapy. Am J Surg. Dec 1952;84(6):646-56. [Medline].
Jull G, Bogduk N, Marsland A. The accuracy of manual diagnosis for cervical zygapophysial joint pain syndromes. Med J Aust. Mar 7 1988;148(5):233-6. [Medline].
Kang JD, Bohlman HH. Cervical disc herniation in a patient with congenital insensitivity to pain: a case report. Spine. Jul 1 2000;25(13):1726-8. [Medline].
Klein GR, Vaccaro AR, Albert TJ. Health outcome assessment before and after anterior cervical discectomy and fusion for radiculopathy: a prospective analysis. Spine. Apr 1 2000;25(7):801-3. [Medline].
Laun A, Lorenz R, Agnoli AL. Complications of cervical discography. J Neurosurg Sci. Jan-Mar 1981;25(1):17-20. [Medline].
Lind B, Sihlbom H, Nordwall A, Malchau H. Normal range of motion of the cervical spine. Arch Phys Med Rehabil. Sep 1989;70(9):692-5. [Medline].
Lu J, Ebraheim NA, Huntoon M, Haman SP. Cervical intervertebral disc space narrowing and size of intervertebral foramina. Clin Orthop. Jan 2000;(370):259-64. [Medline].
Maiman DJ, Kumaresan S, Yoganandan N, Pintar FA. Biomechanical effect of anterior cervical spine fusion on adjacent segments. Biomed Mater Eng. 1999;9(1):27-38. [Medline].
Maimaris C, Barnes MR, Allen MJ. ''Whiplash injuries'' of the neck: a retrospective study. Injury. Nov 1988;19(6):393-6. [Medline].
McKinney LA. Early mobilisation and outcome in acute sprains of the neck. BMJ. Oct 21 1989;299(6706):1006-8. [Medline].
Mochida K, Komori H, Okawa A, et al. Regression of cervical disc herniation observed on magnetic resonance images. Spine. May 1 1998;23(9):990-5; discussion 996-7. [Medline].
Modic MT, Masaryk TJ, Ross JS. MRI of the Spine. Chicago, Ill: Year Book Medical Publishers, 1992.
Nishizawa S, Yokoyama T, Yokota N, Kaneko M. High cervical disc lesions in elderly patients--presentation and surgical approach. Acta Neurochir (Wien). 1999;141(2):119-26. [Medline].
Norris SH, Watt I. The prognosis of neck injuries resulting from rear-end vehicle collisions. J Bone Joint Surg Br. Nov 1983;65(5):608-11. [Medline].
Okada Y, Ikata T, Yamada H, et al. Magnetic resonance imaging study on the results of surgery for cervical compression myelopathy. Spine. Oct 15 1993;18(14):2024-9. [Medline].
Parke WW. Correlative anatomy of cervical spondylotic myelopathy. Spine. Jul 1988;13(7):831-7. [Medline].
Pospiech J, Stolke D, Wilke HJ, Claes LE. Intradiscal pressure recordings in the cervical spine. Neurosurgery. Feb 1999;44(2):379-84; discussion 384-5. [Medline].
Roeske R. The new vertebral subluxation. J Chiro. 1993;30:19-24.
Rogers EJ, Rogers R. Pain clinic #14. Fibromyalgia and myofascial pain: either, neither, or both?. Orthop Rev. Nov 1989;18(11):1217-24. [Medline].
Russell EJ. Cervical disk disease. Radiology. Nov 1990;177(2):313-25. [Medline].
Saal JS, Saal JA, Yurth EF. Nonoperative management of herniated cervical intervertebral disc with radiculopathy. Spine. Aug 15 1996;21(16):1877-83. [Medline].
Sambrook PN, MacGregor AJ, Spector TD. Genetic influences on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis Rheum. Feb 1999;42(2):366-72. [Medline].
Sampath P, Bendebba M, Davis JD, Ducker TB. Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review. Spine. Mar 15 2000;25(6):670-6. [Medline].
Schwarzer AC, Aprill CN, Derby R, et al. The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain. Aug 1994;58(2):195-200. [Medline].
Sengupta DK, Kirollos R, Findlay GF, et al. The value of MR imaging in differentiating between hard and soft cervical disc disease: a comparison with intraoperative findings. Eur Spine J. 1999;8(3):199-204. [Medline].
Shulman M. Treatment of neck pain with cervical epidural steroid injection. Regional Anesth. 1986;11:92-4.
Skidmore-Roth L. In: Mosby's 2000 Nursing Drug Reference. St Louis, Mo:. Mosby;2000.
Slipman CW, Plastaras CT, Palmitier RA, et al. Symptom provocation of fluoroscopically guided cervical nerve root stimulation. Are dynatomal maps identical to dermatomal maps?. Spine. Oct 15 1998;23(20):2235-42. [Medline].
Smith GW, Nichols P. The technique of cervical discography. Radiology. 1963;68:163-5.
Smith MD, Kim SS. A herniated cervical disc resulting from discography: an unusual complication. J Spinal Disord. Dec 1990;3(4):392-4; discussion 395.
Sweeney T, Prentice C, Saal JA. Cervicothoracic muscular stabilizing technique. In: Physical Medicine and Rehabilitation. State of the Art Reviews. Philadelphia, Pa:. Hanley & Belfus;1990:345.
Takae R, Matsunaga S, Origuchi N, et al. Immunolocalization of bone morphogenetic protein and its receptors in degeneration of intervertebral disc. Spine. Jul 15 1999;24(14):1397-401. [Medline].
Tanaka N, Fujimoto Y, An HS, et al. The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine. Feb 1 2000;25(3):286-91.
Taylor JR, Twomey LT. Acute injuries to cervical joints. An autopsy study of neck sprain. Spine. Jul 1993;18(9):1115-22.
Teresi LM, Lufkin RB, Reicher MA, et al. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology. Jul 1987;164(1):83-8. [Medline].
Travell JG, Simons DG. In: Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, Md: Lippincott Williams & Wilkins; 1983.
Tucci SM, Hicks JE, Gross EG, et al. Cervical motion assessment: a new, simple and accurate method. Arch Phys Med Rehabil. Apr 1986;67(4):225-30.
Walker EA. A History of Neurological Surgery. New York, NY: Hafner Publishing; 1967.
Warfield CA, Biber MP, Crews DA, et al. Epidural steroid injection as a treatment for cervical radiculitis. Clin J Pain. 1988;4:201-4.
White AA 3d, Southwick WO, Deponte RJ, et al. Relief of pain by anterior cervical-spine fusion for spondylosis. A report of sixty-five patients. J Bone Joint Surg [Am]. Apr 1973;55(3):525-34. [Medline].
White AA, Panjabi MM. In: Biomechanics of the Spine. 2nd ed. Philadelphia, Pa:. JB Lippincott;1990.
Whitecloud TS 3d, Seago RA. Cervical discogenic syndrome. Results of operative intervention in patients with positive discography. Spine. May 1987;12(4):313-6. [Medline].
Wilbourn AJ, Aminoff MJ. AAEM minimonograph 32: the electrodiagnostic examination in patients with radiculopathies. American Association of Electrodiagnostic Medicine. Muscle Nerve. Dec 1998;21(12):1612-31. [Medline].
Williams JL, Allen MB Jr, Harkess JW. Late results of cervical discectomy and interbody fusion: some factors influencing the results. J Bone Joint Surg [Am]. Mar 1968;50(2):277-86. [Medline].
Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. Feb 1990;33(2):160-72. [Medline].
Wu MP, Chen HH, Yen EY, et al. A potential complication of laparoscopy--the surgeon''s herniated cervical disk. J Am Assoc Gynecol Laparosc. Nov 1999;6(4):509-11.
Yiannikas C, Shahani BT, Young RR. Short-latency somatosensory-evoked potentials from radial, median, ulnar, and peroneal nerve stimulation in the assessment of cervical spondylosis. Comparison with conventional electromyography. Arch Neurol. Dec 1986;43(12):1264-71. [Medline].
Yunus MB, Kalyan-Raman UP, Kalyan-Raman K. Primary fibromyalgia syndrome and myofascial pain syndrome: clinical features and muscle pathology. Arch Phys Med Rehabil. Jun 1988;69(6):451-4.
Zhang HY, Kim YS, Cho YE. Thermatomal changes in cervical disc herniations. Yonsei Med J. Oct 1999;40(5):401-12. [Medline].
Further Reading
Related eMedicine topics:
Cervical Discogenic Pain Syndrome
Cervical Disc Injuries
Lumbar Disc Disease
Discography
Intradiscal Electrothermal Therapy
Guidelines:
Neck and Upper Back Complaints
ACR Appropriateness Criteria Chronic Neck Pain
Clinical studies:
Advent Cervical Disc Versus Anterior Cervical Discectomy and Fusion(ACDF) for Treatment of One level Degenerative Disc Disease (IDE Study)
Comparison of DISCOVER Artificial Cervical Disc and ACDF for Treatment of Cervical DDD (IDE Study)
Keywords
cervical disc disease, spine, cervical spine, herniated disc, spinal stenosis, back surgery, degenerative disc disease, disc disease, radiculopathy, cervical spondylosis, disc herniation, back disc, cervical disc, disc surgery, spinal disc, disc pain, disk disease, degenerative spine, cervical disk, herniated discs, spine disc, nucleus pulposus, degenerative disk disease, cervical spinal stenosis, cervical spine surgery, annular tear, DDD, disc degeneration, disc extrusion, disc herniation, disc protrusion, disc sequestration, discogenic pain, herniated nucleus pulposus, HNP, inflammatory radiculopathy, internal disc disruption, IDD, intervertebral disc herniation, radicular pain, radiculitis, degenerative annular tears, cervical radiculopathy, nerve root injury, disc stenosis, myofascial pain, cervical disc disorder, central cord syndrome, CCS, spondylosis, neck pain, shoulder pain, Brown-Séquard syndrome, chemical radiculitis, vertebral sclerosis, osteophytic formation, whiplash, dynatome, Spurling maneuver, abduction sign, repetitive cervical stress, cervical flexion injury, cervical rotation injury
