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

Sagittal graphic shows disc extrusion
, with the base of the herniation smaller than the epidural component, effacing the thecal sac and causing cord compression.

Sagittal T2WI MR shows C5-C6 disc extrusion with the base of herniation smaller than the component extending into the epidural space.

Sagittal T1WI C+ MR shows C4-5 extrusion
impinging on the cord. Smaller C5-C6 protrusion also compresses the ventral cord
. Peripheral enhancement
is related to epidural plexus and granulation tissue.

Axial T2* GRE MR shows left-sided extrusion
effacing the left side of the thecal sac and extending toward the left neural foramen
. Note the compression of the spinal cord
.

TERMINOLOGY

Abbreviations

  • Cervical disc herniation (CDH)

Synonyms

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

  • Nonstandard: Prolapse, herniated nucleus pulposus (HNP), rupture

Definitions

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

IMAGING

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