Further Outpatient Care

See the list below:

Most cervical spine disorders are treated successfully with conservative measures on an outpatient basis. Refer to the Physical Therapy and Other Treatment sections for discussion.

Deterrence

See the list below:

Maintaining proper cervical posture and cervicothoracic strength and flexibility, avoiding cervical trauma and repetitive cervical stress, and adhering to a healthy lifestyle that advocates proper nutrition, physical activity, and smoking cessation may help to prevent cervical disc disease.

Complications

See the list below:

Complications of cervical spine disorders may include the following:
- Intractable axial or radicular pain
- Myelopathy with associated weakness, hyperreflexia, and neurogenic bowel/bladder dysfunction
Radiculopathy with associated upper extremity weakness and numbness

Patient Education

See the list below:

Educate patients to avoid aggravating factors (eg, vibrational stress from driving, cervical flexion, Valsalva maneuvers) that may exacerbate discogenic pain.
Additionally, instruct patients on correct posture and a home exercise program (eg, cervicothoracic stabilization, aerobic conditioning).
For excellent patient education resources, see eMedicineHealth's patient education articles Shoulder and Neck Pain, Neck Strain, Whiplash, Chronic Pain, and Pain Medications.

Questions

Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976). 2001 Mar 1. 26(5):E93-E113. [QxMD MEDLINE Link].
Carette S, Fehlings MG. Clinical practice. Cervical radiculopathy. N Engl J Med. 2005 Jul 28. 353(4):392-9. [QxMD MEDLINE Link].
Tanaka Y, Kokubun S, Sato T, et al. Cervical roots as origin of pain in the neck or scapular regions. Spine. 2006 Aug 1. 31(17):E568-73. [QxMD MEDLINE Link].
Fakhoury J, Dowling TJ. Cervical Degenerative Disc Disease. StatPearls. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].
Baptiste DC, Fehlings MG. Pathophysiology of cervical myelopathy. Spine J. 2006 Nov-Dec. 6(6 Suppl):190S-197S. [QxMD MEDLINE Link].
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. 2008 Jun. 21(4):288-92. [QxMD MEDLINE Link].
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. 2009 Mar 18. [QxMD MEDLINE Link].
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.
Galbraith JG, Butler JS, Dolan AM, O'Byrne JM. Operative outcomes for cervical myelopathy and radiculopathy. Adv Orthop. 2012. 2012:919153. [QxMD MEDLINE Link]. [Full Text].
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. 2009 Feb. 18(2):232-7. [QxMD MEDLINE Link].
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. 2008 Dec. 17(12):1651-63. [QxMD MEDLINE Link].
Pechlivanis I, Brenke C, Scholz M, et al. Treatment of degenerative cervical disc disease with uncoforaminotomy--intermediate clinical outcome. Minim Invasive Neurosurg. 2008 Aug. 51(4):211-7. [QxMD MEDLINE Link].
Yan D, Li J, Zhu H, et al. Percutaneous cervical nucleoplasty and percutaneous cervical discectomy treatments of the contained cervical disc herniation. Arch Orthop Trauma Surg. 2010 Jan 8. [QxMD MEDLINE Link].
King JT Jr, Abbed KM, Gould GC, et al. Cervical spine reoperation rates and hospital resource utilization after initial surgery for degenerative cervical spine disease in 12,338 patients in Washington State. Neurosurgery. 2009 Dec. 65(6):1011-22; discussion 1022-3. [QxMD MEDLINE Link].
Denda H, Kimura S, Yamazaki A, et al. Clinical significance of cerebrospinal fluid nitric oxide concentrations in degenerative cervical and lumbar diseases. Eur Spine J. 2011 Apr. 20(4):604-11. [QxMD MEDLINE Link]. [Full Text].
Fei Z, Fan C, Ngo S, Xu J, Wang J. Dynamic evaluation of cervical disc herniation using kinetic MRI. J Clin Neurosci. 2011 Feb. 18(2):232-6. [QxMD MEDLINE Link].
Nam TW, Lee HS, Goh TS, Lee JS. Predictors of Motor Weakness and Delayed Recovery in Cervical Disk Herniation. J Spinal Disord Tech. 2015 Aug. 28 (7):E405-9. [QxMD MEDLINE Link].
Shedid D, Benzel EC. Cervical spondylosis anatomy: pathophysiology and biomechanics. Neurosurgery. 2007 Jan. 60(1 Supp1 1):S7-13. [QxMD MEDLINE Link].
Radhakrishnan K, Litchy WJ, O''Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994 Apr. 117 ( Pt 2):325-35. [QxMD MEDLINE Link].
Schoenfeld AJ, George AA, Bader JO, Caram PM Jr. Incidence and epidemiology of cervical radiculopathy in the United States military: 2000 to 2009. J Spinal Disord Tech. 2012 Feb. 25(1):17-22. [QxMD MEDLINE Link].
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. 1996 Feb-Mar. 93(2-3):184-8. [QxMD MEDLINE Link].
Kelley LA. In neck to neck competition are women more fragile?. Clin Orthop. 2000 Mar. (372):123-30. [QxMD MEDLINE Link].
Marchiori DM, Henderson CN. A cross-sectional study correlating cervical radiographic degenerative findings to pain and disability. Spine. 1996 Dec 1. 21(23):2747-51. [QxMD MEDLINE Link].
Slipman CW, Plastaras C, Patel R, et al. Provocative cervical discography symptom mapping. Spine J. 2005 Jul-Aug. 5(4):381-8. [QxMD MEDLINE Link].
Yates JP, McGill SM. The effect of vibration and posture on the progression of intervertebral disc herniation. Spine (Phila Pa 1976). 2011 Mar 1. 36(5):386-92. [QxMD MEDLINE Link].
Malanga GA, Landes P, Nadler SF. Provocative tests in cervical spine examination: historical basis and scientific analyses. Pain Physician. 2003 Apr. 6(2):199-205. [QxMD MEDLINE Link].
Abdalkader M, Guermazi A, Engebretsen L, et al. MRI-detected spinal disc degenerative changes in athletes participating in the Rio de Janeiro 2016 Summer Olympics games. BMC Musculoskelet Disord. 2020 Jan 20. 21 (1):45. [QxMD MEDLINE Link]. [Full Text].
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. 1990 Sep. 72(8):1178-84. [QxMD MEDLINE Link].
Kuijper B, Tans JT, van der Kallen BF, Nollet F, Lycklama A Nijeholt GJ, de Visser M. Root compression on MRI compared with clinical findings in patients with recent onset cervical radiculopathy. J Neurol Neurosurg Psychiatry. 2011 May. 82(5):561-3. [QxMD MEDLINE Link].
van Eerd M, Patijn J, Loeffen D, van Kleef M, Wildberger J. The Diagnostic Value of an X-ray-based Scoring System for Degeneration of the Cervical Spine: A Reproducibility and Validation Study. Pain Pract. 2021 Sep. 21 (7):766-77. [QxMD MEDLINE Link]. [Full Text].
Michelini G, Corridore A, Torlone S, et al. Dynamic MRI in the evaluation of the spine: state of the art. Acta Biomed. 2018 Jan 19. 89 (1-S):89-101. [QxMD MEDLINE Link].
Manchikanti L, Dunbar EE, Wargo BW, Shah RV, Derby R, Cohen SP. Systematic review of cervical discography as a diagnostic test for chronic spinal pain. Pain Physician. 2009 Mar-Apr. 12(2):305-21. [QxMD MEDLINE Link].
Dillingham TR, Lauder TD, Andary M, et al. Identification of cervical radiculopathies: optimizing the electromyographic screen. Am J Phys Med Rehabil. 2001 Feb. 80(2):84-91. [QxMD MEDLINE Link].
Sugawara T. Anterior Cervical Spine Surgery for Degenerative Disease: A Review. Neurol Med Chir (Tokyo). 2015. 55 (7):540-6. [QxMD MEDLINE Link]. [Full Text].
Fay LY, Huang WC, Wu JC, et al. Arthroplasty for cervical spondylotic myelopathy: similar results to patients with only radiculopathy at 3 years' follow-up. J Neurosurg Spine. 2014 Sep. 21(3):400-10. [QxMD MEDLINE Link].
Radcliff K, Coric D, Albert T. Five-year clinical results of cervical total disc replacement compared with anterior discectomy and fusion for treatment of 2-level symptomatic degenerative disc disease: a prospective, randomized, controlled, multicenter investigational device exemption clinical trial. J Neurosurg Spine. 2016 Aug. 25 (2):213-24. [QxMD MEDLINE Link].
Pandey PK, Pawar I, Gupta J, Verma RR. Comparison of Outcomes of Single-Level Anterior Cervical Discectomy With Fusion and Single-Level Artificial Cervical Disc Replacement for Single-Level Cervical Degenerative Disc Disease. Spine (Phila Pa 1976). 2017 Jan 1. 42 (1):E41-9. [QxMD MEDLINE Link].
Luo J, Gong M, Huang S, et al. Incidence of adjacent segment degeneration in cervical disc arthroplasty versus anterior cervical decompression and fusion meta-analysis of prospective studies. Arch Orthop Trauma Surg. 2015 Feb. 135(2):155-60. [QxMD MEDLINE Link].
Delamarter RB, Zigler J. Five-year Reoperation Rates, Cervical Total Disc Replacement versus Fusion, Results of a Prospective Randomized Clinical Trial. Spine (Phila Pa 1976). 2012 Nov 2. [QxMD MEDLINE Link].
Jackson R, Johnson DE. 159 Neurological Outcomes of Two-Level Total Disk Replacement Versus Anterior Discectomy and Fusion: 7-Year Results From a Prospective, Randomized, Multicenter Trial. Neurosurgery. 2016 Aug. 63 Suppl 1:164. [QxMD MEDLINE Link].
Salari B, McAfee PC. Cervical total disk replacement: complications and avoidance. Orthop Clin North Am. 2012 Jan. 43(1):97-107, ix. [QxMD MEDLINE Link].
Denaro V, Di Martino A. Cervical spine surgery: an historical perspective. Clin Orthop Relat Res. 2011 Mar. 469(3):639-48. [QxMD MEDLINE Link]. [Full Text].
Gebremariam L, Koes BW, Peul WC, Huisstede BM. Evaluation of treatment effectiveness for the herniated cervical disc: a systematic review. Spine (Phila Pa 1976). 2012 Jan 15. 37(2):E109-18. [QxMD MEDLINE Link].
Anderson PA, Subach BR, Riew KD. Predictors of outcome after anterior cervical discectomy and fusion: a multivariate analysis. Spine. 2009 Jan 15. 34(2):161-6. [QxMD MEDLINE Link].
Joaquim AF, Riew KD. Multilevel cervical arthroplasty: current evidence. A systematic review. Neurosurg Focus. 2017 Feb. 42 (2):E4. [QxMD MEDLINE Link]. [Full Text].
Laratta JL, Shillingford JN, Saifi C, Riew KD. Cervical Disc Arthroplasty: A Comprehensive Review of Single-Level, Multilevel, and Hybrid Procedures. Global Spine J. 2018 Feb. 8 (1):78-83. [QxMD MEDLINE Link]. [Full Text].
Hu Y, Lv G, Ren S, Johansen D. Mid- to Long-Term Outcomes of Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion for Treatment of Symptomatic Cervical Disc Disease: A Systematic Review and Meta-Analysis of Eight Prospective Randomized Controlled Trials. PLoS One. 2016. 11 (2):e0149312. [QxMD MEDLINE Link]. [Full Text].
Wullems JA, Halim W, van der Weegen W. Current evidence of percutaneous nucleoplasty for the cervical herniated disk: a systematic review. Pain Pract. 2014 Jul. 14(6):559-69. [QxMD MEDLINE Link].
Hodges SD, Castleberg RL, Miller T, et al. Cervical epidural steroid injection with intrinsic spinal cord damage. Two case reports. Spine. 1998 Oct 1. 23(19):2137-42; discussion 2141-2. [QxMD MEDLINE Link].
Furman MB, Giovanniello MT, O''Brien EM. Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Spine. 2003 Jan 1. 28(1):21-5. [QxMD MEDLINE Link].
Brouwers PJ, Kottink EJ, Simon MA, et al. A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root. Pain. 2001 Apr. 91(3):397-9. [QxMD MEDLINE Link].
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. 2003 May. 103(1-2):211-5. [QxMD MEDLINE Link].
Zhang Y, Chee A, Thonar EJ, An HS. Intervertebral disk repair by protein, gene, or cell injection: a framework for rehabilitation-focused biologics in the spine. PM R. 2011 Jun. 3(6 Suppl 1):S88-94. [QxMD MEDLINE Link].
Drazin D, Rosner J, Avalos P, Acosta F. Stem cell therapy for degenerative disc disease. Adv Orthop. 2012. 2012:961052. [QxMD MEDLINE Link]. [Full Text].
DePalma M. Biologic Treatments for Discogenic Low Back Pain. SpineLine. 2012 Mar-Apr. 3:19-26.
Green C, Butler J, Eustace S, Poynton A, O'Byrne JM. Imaging modalities for cervical spondylotic stenosis and myelopathy. Adv Orthop. 2012. 2012:908324. [QxMD MEDLINE Link]. [Full Text].
Grasso G. Clinical and radiological features of hybrid surgery in multilevel cervical degenerative disc disease. Eur Spine J. 2015 Nov. 24 Suppl 7:842-8. [QxMD MEDLINE Link].
Cole T, Veeravagu A, Zhang M, Azad TD, Desai A, Ratliff JK. Anterior Versus Posterior Approach for Multilevel Degenerative Cervical Disease: A Retrospective Propensity Score-Matched Study of the MarketScan Database. Spine (Phila Pa 1976). 2015 Jul 1. 40 (13):1033-8. [QxMD MEDLINE Link].

Media Gallery

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.
Axial magnetic resonance imaging (MRI) scan (C3-C4) demonstrating left-sided posterolateral protrusion of the nucleus pulposus with compression of the cerebrospinal fluid.
Sagittal magnetic resonance imaging (MRI) scan demonstrating cervical intervertebral disc protrusions at C3-C4 and C7-T1.
Right C7 cervical transforaminal epidural steroid injection demonstrating epidural and radicular spread of radiologic contrast dye.
Cervical epidural steroid injection at the C7-T1 interlaminar space.
Cervical discography. Anteroposterior fluoroscopic image.
Cervical discography. Lateral fluoroscopic image.
Postdiscography axial computed tomography (CT) scan demonstrating right posterolateral subligamentous protrusion.

of 8

Author

Michael B Furman, MD, MS Physiatrist, Interventional Spine Care Specialist, Electrodiagnostics, Pain Medicine, Director, Spine and Sports Fellowship, OSS Health

Michael B Furman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, North American Spine Society, Pennsylvania Medical Society, Spine Intervention Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: OSS Health<br/>Serve(d) as a speaker or a member of a speakers bureau for: Spine Intervention Society; North American Spine Society<br/>Received research grant from: Mesoblast/ Cascade<br/>Received income in an amount equal to or greater than $250 from: Elsevier (Royalties).

Coauthor(s)

Gene Tekmyster, DO Assistant Professor, Department of Orthopedic Surgery, Physician in Interventional Spine Care, Regenerative and Sports Medicine, Keck School of Medicine of the University of Southern California

Gene Tekmyster, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, Association of Academic Physiatrists, International Spine Intervention Society, North American Spine Society

Disclosure: Nothing to disclose.

Jeremy Simon, MD Attending Physician, Department of Physical Medicine, The Rothman Institute

Jeremy Simon, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, North American Spine Society, Physiatric Association of Spine, Sports and Occupational Rehabilitation, International Spine Intervention Society

Disclosure: Nothing to disclose.

Kirk M Puttlitz, MD Consulting Staff, Pain Management and Physical Medicine, Arizona Neurological Institute

Kirk M Puttlitz, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Phi Beta Kappa

Disclosure: Nothing to disclose.

Frank John English Falco, MD Clinical Assistant Professor, Director of the Pain Management Fellowship Program, Temple University Hospital

Frank John English Falco, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Society of Regional Anesthesia and Pain Medicine, Association of Academic Physiatrists, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Received consulting fee from St. Jude's Medical for speaking and teaching; Received consulting fee from Joimax for speaking and teaching.

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.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

Dean H Hommer, MD Chief Medical Officer, Corpus Christi Medical Center

Dean H Hommer, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association for Physician Leadership, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Healthcare Executives, Texas Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Everett C Hills, MD, MS Principal Consultant, Function Focused PMR Care+, LLC

Everett C Hills, MD, MS is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Physical Medicine and Rehabilitation, American Association for Physician Leadership, American Congress of Rehabilitation Medicine, American Medical Association, American Society of Neurorehabilitation, Pennsylvania Medical Society

Disclosure: Nothing to disclose.