Cervical disk herniation

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Background

  • Nucleus pulposus protrudes through posterior annular fibrosis
    • Leads to radiculopathy or less commonly myelopathy

Clinical Features

  • Neck/shoulder/arm pain in dermatome distribution, weakness, hyporeflexia
  • Spurling test
    • Flex neck forward, ipsilaterally rotate, and ipsilaterally tilt
    • Reproduction of radicular symptoms is positive test
    • Specific for nerve root compression
  • Lhermitte's sign positive suggests cord compression from midline herniation
  • Shoulder abduction test - lifting arm above head relieves symptoms; differentiates radiculopathy from shoulder pathology

Cervical Exam by Level

Radiculopathy Motor Deficit Sensory Deficit Diminished Reflex
C4 Levator Scapulae & Shoulder elevation
C5 Deltoid & Biceps Biceps
C6 Brachioradialis & Wrist extension Thumb Paresthesia Brachioradialis
C7 Triceps & Wrist flexion Index/Middle/Ring Paresthesia Triceps
C8 Index/Middle distal phlnx flexion Small Finger Paresthesia

Differential Diagnosis

Neck pain

Evaluation

  • MRI required for definitive diagnosis; indicated if neurologic signs

Management

Disposition

  • In consultation with Neurosurg, admit if progression of neurologic signs

See Also

References

Orthobullets