Cervical Intervertebral Disc Herniation

KEY FACTS

Terminology

• Protruded disc, extruded disc, free fragment, sequestered disc

• Localized (< 50% of disc circumference) displacement of disc material beyond edges of vertebral ring apophyses

Imaging

• Small mass in ventral spinal canal, contiguous with intervertebral disc

• Protrusion is herniated disc with broad base at parent disc

• Extrusion is herniated disc with narrow or no base at parent disc

• Sequestered or free fragment: Extruded disc without contiguity to parent disc

• Migrated: Disc material displaced away from site of herniation, regardless of continuity to parent disc

Top Differential Diagnoses

• Ossification posterior longitudinal ligament

• Osteophyte

• Tumor

• Hemorrhage

• Abscess

Pathology

• 20% of people over age 40 have cervical foraminal stenosis

Clinical Issues

• 10% of people under age 40 have cervical herniation

• Acute radiculopathy usually self-limited disorder with full recovery expected

  • Neck pain (90%)

  • Radicular pain (65%)

  • Paresthesia (89%)

• Treatment

  • Conservative treatment

  • Multiple surgical approaches without clear consensus

Diagnostic Checklist

• Use fast STIR for cord disease

• Axial GRE, T2* GRE for disc definition

TERMINOLOGY

IMAGING