Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Cervical Disc Injuries Clinical Presentation

  • Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: Jan 22, 2015
 

History

Athletes with symptomatic cervical disc injuries commonly present with segmental neck pain, muscle spasm, loss of ROM, and referred pain in both radicular and nonradicular distribution. Nerve root involvement leads to radicular upper extremity pain, weakness, and sensory changes. Pain symptoms may be exacerbated with motion, lifting, and Valsalva maneuvers.

Next

Physical

See the list below:

  • Information obtained from the physical examination is often of limited benefit.
  • Examination generally demonstrates reduced segmental motion at involved levels.
  • Pain with mobilization may or may not be present.
  • ROM may or may not be present, depending on the chronicity of the condition and its severity.
  • Neurologic examination is generally within the reference range. (See Cervical Radiculopathy.)
  • Cervical cord neuropraxia (CCN) is a transient neurologic syndrome occurring in athletes with cervical spine injury. CCN is especially common in cervical spine injuries resulting from contact sports. The presentation can range from bilateral paresthesias in the arms to complete quadriplegia. Typical episodes can last from 15 minutes to 48 hours with complete recovery. The mechanism is thought to be due to brief compression of the spinal cord resulting in transient interruption of the spinal pathways. The incidence of cervical spinal stenosis is as high as 86% in athletes who have experienced this condition.[6]
Previous
Next

Causes

Cervical disc injuries are relatively common in athletes involved in both contact and noncontact sports. Information on cervical injuries has primarily been obtained from evaluation of football players; however, this information can be applied to athletes who play other high-risk sports. Sports associated with cervical injuries include football, rugby, ice hockey, wrestling, gymnastics, cheerleading, baseball (headfirst slides), and swimming (diving into shallow water).

  • Injuries are often the result of axial applied forces, with secondary forces of hyperflexion, hyperextension, and rotation adding to the overall injury pattern. Cervical disc disease is most often limited to a single segment and is usually unilateral. In symptomatic athletes, nerve root compression may be the result of an extruded posterolateral disc, combined disc degeneration, osteophytes, and disc fragment extrusion. Preexisting cervical spondylosis or developmental stenosis may lead to central disc herniation resulting in long-tract neurologic findings.
  • Age-related morphologic changes
    • In regards to the continuum of cervical degenerative disc disease, the age-related morphologic changes also must be considered. The intervertebral disc is a hydrostatic load-bearing structure. The nucleus pulposus is a confined and well-localized fluid that exists within the annulus fibrosis. The nucleus pulposus functions in converting axial loads into tensile strain on the annular fibers and the vertebral endplates.
    • During the first 20 years of life, the development of disc protrusion through the cartilaginous endplates is observed. These protrusions are known as Schmorl nodes. Degenerative changes manifest during the third through fifth decades of life, with loss of intervertebral disc height and development of osteophytes, particularly at the origins of the vertebral endplates. The facets, facet joint capsule, and ligamentum flavum hypertrophy potentially compromise the intervertebral foramen and central canal. As the discs become degenerative, the hydrostatic pressure declines.
    • Because of intradiscal compressive forces, disc material has a tendency to follow the radial fissure because it is the path of least resistance. Once the radial fissure becomes complete, the disc is predisposed to herniate. Penetration through the outer annular wall defines herniation (extrusion). An extruded disc penetrating through the posterior longitudinal ligament (PLL) represents an extrusion that is noncontained. One that remains confined by the PLL is termed an extrusion contained by the PLL. Primary annular disruption initially may occur in the periphery. This is called a rim lesion. As the process continues to progress and the margins of the annulus and nucleus coalesce with infiltration of type III collagen, the gelatinous nucleus becomes replaced. The disc becomes increasingly fibrotic.[13, 14, 15, 16]
    • The greatest risk for herniation occurs in the younger age group because the nuclear material in this group can still generate significant turgor, enabling it to produce a focal herniation. A severely degenerative disc lacks nuclear tissue; therefore, it cannot generate the forces needed to create a disruption. Therefore, disc herniation is rare in elderly persons. When disc herniation occurs, it is primarily in the posterolateral aspect of the disc just lateral to the margin of the posterior longitudinal ligament. This is an obvious area of compromised reinforcement.[15]
Previous
 
 
Contributor Information and Disclosures
Author

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ricardo A Nieves, MD, FAAPMR President, Colorado Spine, Pain and Sports Medicine, PC

Ricardo A Nieves, MD, FAAPMR is a member of the following medical societies: North American Spine Society, American Society of Interventional Pain Physicians, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Kevin P Sullivan, MD Consulting Staff, The Boston Spine Group

Kevin P Sullivan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society, International Spine Intervention Society

Disclosure: Nothing to disclose.

Frank J King, MD Clinical Instructor, Department of Physical Medicine and Rehabilitation, Georgia Pain Physicians/Emory School of Medicine

Frank J King, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Samuel Punnamoottil Thampi, MD Attending Pain Management, Anesthesiology, North Shore Pain Service

Samuel Punnamoottil Thampi, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society

Disclosure: Nothing to disclose.

Erik D Hiester, DO Fellow in Interventional Pain Management, Georgia Pain Physicians, Emory University School of Medicine

Erik D Hiester, DO is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, American Osteopathic Association, American Pain Society

Disclosure: Nothing to disclose.

R Blake Windsor, MD Resident Physician, Department of Pediatrics, Boston Children's Hospital and Boston Medical Center

R Blake Windsor, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor Dr Dennis P White to the development and writing of this article.

References
  1. Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990 Sep. 72(8):1178-84. [Medline].

  2. Ernst CW, Stadnik TW, Peeters E, Breucq C, Osteaux MJ. Prevalence of annular tears and disc herniations on MR images of the cervicalspine in symptom free volunteers. Eur J Radiol. 2005 Sep. 55(3):409-14. [Medline].

  3. Bogduk N, Tynan W, Wilson AS. The nerve supply to the human lumbar intervertebral discs. J Anat. 1981 Jan. 132(Pt 1):39-56. [Medline].

  4. Mercer S, Bogduk N. The ligaments and annulus fibrosus of human adult cervical intervertebral discs. Spine. 1999 Apr 1. 24(7):619-26; discussion 627-8. [Medline].

  5. Torg J. Epidemiology, pathomechanics, and prevention of athletic injuries to the cervical spine. The Cervical Spine. 1989. 442-463.

  6. Torg JS, Corcoran TA, Thibault LE, Pavlov H, Sennett BJ, Naranja RJ Jr, et al. Cervical cord neurapraxia: classification, pathomechanics, morbidity, and management guidelines. J Neurosurg. 1997 Dec. 87(6):843-50. [Medline].

  7. Mall NA, Buchowski J, Zebala L, Wright RW, Matava MJ. Spine and axial skeleton injuries in the national football league. Am J Sports Med. 2012 Aug. 40(8):1755-61. [Medline].

  8. National Collegiate Athletic Association. Article 2-1,2-N 1976; Rule 2, Section 24; Rule 9, Section 1. Football rule changes and modifications. 1976.

  9. American Academy of Pediatrics. Trampoline. Pediatrics. 1981. 67:438.

  10. Tator CH, Edmonds VE. National survey of spinal injuries in hockey players. Can Med Assoc J. 1984 Apr 1. 130(7):875-80. [Medline].

  11. Mochida K, Komori H, Okawa A, Muneta T, Haro H, Shinomiya K. Regression of cervical disc herniation observed on magnetic resonance images. Spine. 1998 May 1. 23(9):990-5; discussion 996-7. [Medline].

  12. Nachemson, Alf L. The lumbar spine: An orthopedic challenge. Spine. 1976. 1(1):

  13. Coventry MB, Ghormley RK, Kernahan JW. The intervertebral disc: Its microscopic anatomy and pathology. Part III: Pathologic changes in the intervertebral disc. J Bone and Joint Surg. 1945. 27:460-474.

  14. Gower WE, Pedrini V. Age-related variations in proteinpolysaccharides from human nucleus pulposus, annulus fibrosus, and costal cartilage. J Bone Joint Surg Am. 1969 Sep. 51(6):1154-62. [Medline].

  15. Lipson SJ, Muir H. Experimental intervertebral disc degeneration: morphologic and proteoglycan changes over time. Arthritis Rheum. 1981 Jan. 24(1):12-21. [Medline].

  16. Pearce RH, Grimmer BJ, Adams ME. Degeneration and the chemical composition of the human lumbar intervertebral disc. J Orthop Res. 1987. 5(2):198-205. [Medline].

  17. Torg JS, Sennett B, Pavlov H, Leventhal MR, Glasgow SG. Spear tackler's spine. An entity precluding participation in tackle football and collision activities that expose the cervical spine to axial energy inputs. Am J Sports Med. 1993 Sep-Oct. 21(5):640-9. [Medline].

  18. Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal Findings on Magnetic Resonance Images of the Cervical Spines in 1,211 Asymptomatic Subjects. Spine (Phila Pa 1976). 2015 Jan 12. [Medline].

  19. Tomasino A, Gebhard H, Parikh K, Wess C, Härtl R. Bioabsorbable instrumentation for single-level cervical degenerative disc disease: a radiological and clinical outcome study. J Neurosurg Spine. 2009 Nov. 11(5):529-37. [Medline].

  20. Phillips FM, Tzermiadianos MN, Voronov LI, Havey RM, Carandang G, Dooris A, et al. Effect of two-level total disc replacement on cervical spine kinematics. Spine (Phila Pa 1976). 2009 Oct 15. 34(22):E794-9. [Medline].

  21. Peng CW, Quirnoa M, Bendo JA, Spivak JM, Goldstein JA. Effect of intervertebral disc height on postoperative motion and clinical outcomes after Prodisc-C cervical disc replacement. Spine J. 2009 Jul. 9(7):551-5. [Medline].

  22. Gore DR, Sepic SB. Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients. Spine. 1984 Oct. 9(7):667-71. [Medline].

  23. Flynn TB. Neurologic complications of anterior cervical interbody fusion. Spine. 1982 Nov-Dec. 7(6):536-9. [Medline].

  24. Johnson JP, Filler AG, McBride DQ, Batzdorf U. Anterior cervical foraminotomy for unilateral radicular disease. Spine. 2000 Apr 15. 25(8):905-9. [Medline].

  25. Tu TH, Wu JC, Fay LY, Ko CC, Huang WC, Cheng H. Vertebral body split fracture after a single-level cervical total disc replacement. J Neurosurg Spine. 2012 Mar. 16(3):231-5. [Medline].

  26. Miyazaski K, Hirohuji E, Ono S, et al. Extensive simultaneous multisegment laminectomy and posterior decompression with posterolateral fusion. Jpn Spine Res Soc. 5:167.

  27. Pointillart V. Cervical disc prosthesis in humans: first failure. Spine. 2001 Mar 1. 26(5):E90-2. [Medline].

  28. Goffin J, Casey A, Kehr P, Liebig K, Lind B, Logroscino C. Preliminary clinical experience with the Bryan Cervical Disc Prosthesis. Neurosurgery. 2002 Sep. 51(3):840-5; discussion 845-7. [Medline].

  29. Aydin Y, Kaya RA, Can SM, Türkmenoglu O, Cavusoglu H, Ziyal IM. Minimally invasive anterior contralateral approach for the treatment of cervicaldisc herniation. Surg Neurol. 2005 Mar. 63(3):210-8; discussion 218-9. [Medline].

  30. Whang PG, Simpson AK, Rechtine G, Grauer JN. Current trends in spinal arthroplasty: an assessment of surgeon practices and attitudes regarding cervical and lumbar disk replacement. J Spinal Disord Tech. 2009 Feb. 22(1):26-33. [Medline].

  31. Buchowski JM, Anderson PA, Sekhon L, Riew KD. Cervical disc arthroplasty compared with arthrodesis for the treatment of myelopathy. Surgical technique. J Bone Joint Surg Am. 2009 Oct 1. 91 Suppl 2:223-32. [Medline].

  32. Lin CY, Kang H, Rouleau JP, Hollister SJ, Marca FL. Stress analysis of the interface between cervical vertebrae end plates and the Bryan, Prestige LP, and ProDisc-C cervical disc prostheses: an in vivo image-based finite element study. Spine (Phila Pa 1976). 2009 Jul 1. 34(15):1554-60. [Medline].

  33. Torg JS, Ramsey-Emrhein JA. Suggested management guidelines for participation in collision activities with congenital, developmental, or post-injury lesions involving the cervical spine. Med Sci Sports Exerc. 1997. 29:256-272.

  34. Cantu RC. Functional cervical spinal stenosis: a contraindication to participation in contact sports. Med Sci Sports Exerc. 1993 Mar. 25(3):316-7. [Medline].

  35. Morganti C. Recommendations for return to sports following cervical spine injuries. Sports Med. 2003. 33(8):563-73. [Medline].

  36. Cantu RC, Bailes JE, Wilberger JE Jr. Guidelines for return to contact or collision sport after a cervical spine injury. Clin Sports Med. 1998 Jan. 17(1):137-46. [Medline].

  37. Duggal N, Pickett GE, Mitsis DK, Keller JL. Early clinical and biomechanical results following cervical arthroplasty. Neurosurg Focus. 2004 Sep 15. 17(3):E9. [Medline].

  38. North American Spine Society. Orthopaedic Knowledge Update: Spine. American Academy of Orthopaedic Surgeons; 1997. 75, 97-101.

  39. Sasai K, Saito T, Ohnari H, Yamamoto T, Kasuya T, Wakabayashi E, et al. Microsurgical posterior herniotomy with en bloc laminoplasty: alternative methodfor treating cervical disc herniation. J Spinal Disord Tech. 2005 Apr. 18(2):171-7. [Medline].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.