Cervical disk herniation - Revision history

Danbot: Expand with concise EM-focused content: red flags for myelopathy, exam maneuvers, management algorithm

2026-03-21T01:19:23Z

Expand with concise EM-focused content: red flags for myelopathy, exam maneuvers, management algorithm

← Older revision		Revision as of 01:19, 21 March 2026
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	==Background==		==Background==
	*Nucleus pulposus protrudes through posterior annular fibrosis		*Nucleus pulposus protrudes through posterior annular fibrosis
	**Leads to radiculopathy or less ~~commonly myelopathy~~		*Leads to radiculopathy (most common) or myelopathy (less common, more serious)
			*Most common at C5-C6 and C6-C7 levels
			*Peak incidence age 30-50

	==Clinical Features==		==Clinical Features==
	*Neck/shoulder/arm pain in [[Spinal cord levels\|dermatome]] distribution, weakness, hyporeflexia		*Neck/shoulder/arm pain in [[Spinal cord levels\|dermatome]] distribution, weakness, hyporeflexia
	*Spurling test		*'''Spurling test:''' Extend neck, ipsilaterally rotate and laterally flex, then apply axial compression
	**Flex neck ~~forward~~, ipsilaterally rotate, ~~and ipsilaterally tilt~~		**Reproduction of radicular symptoms is a positive test (specific for nerve root compression)
	**Reproduction of radicular symptoms is positive test		*'''[[Eponyms_(F-L)#Lhermitte's sign\|Lhermitte sign]]:''' Electric shock sensation down spine with neck flexion → suggests cord compression (midline herniation)
	**Specific for nerve root compression		*'''Shoulder abduction test:''' Lifting arm above head relieves radicular symptoms → differentiates from shoulder pathology
	*[[Eponyms_(F-L)#Lhermitte's sign\|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 radiculopathy table}}		{{Cervical radiculopathy table}}

			===Red Flags for Myelopathy===
			*Bilateral upper extremity symptoms
			*Gait disturbance, balance difficulty
			*Bowel/bladder dysfunction
			*Upper motor neuron signs: hyperreflexia, Babinski, clonus, Hoffmann sign

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*MRI ~~required for definitive diagnosis~~; indicated if neurologic ~~signs~~		*MRI cervical spine — gold standard; indicated if neurologic deficits, red flags for myelopathy, or symptoms >6 weeks
			*X-ray if concern for fracture or instability
			*EMG/NCS for chronic symptoms — usually outpatient

	==Management==		==Management==
			*'''Radiculopathy (no myelopathy):''' NSAIDs, short course of oral corticosteroids (controversial), muscle relaxants, activity modification
			*Avoid cervical collar (no evidence of benefit, may delay recovery)
			*Most cases resolve with conservative management over 6-12 weeks
			*'''Myelopathy:''' Emergent neurosurgery consult — surgical decompression typically indicated

	==Disposition==		==Disposition==
	*~~In consultation~~ with ~~Neurosurg, admit if progression of~~ neurologic ~~signs~~		*Discharge isolated radiculopathy with pain management and PCP/neurosurgery follow-up
			*Admit or emergent consult for progressive neurologic deficits or myelopathy
			*'''Emergent MRI and neurosurgery consult''' for cauda equina-like symptoms or rapidly progressive weakness

	==See Also==		==See Also==
	*[[Neck pain]]		*[[Neck pain]]
			*[[Cervical strain]]
			*[[Spinal cord compression (non-traumatic)]]

	==References==		==References==
	<references/>		<references/>
	~~[http://www.orthobullets.com/spine/2030/cervical-radiculopathy Orthobullets]~~
	[[Category:Orthopedics]]		[[Category:Orthopedics]]
			[[Category:Neurology]]

Rossdonaldson1: /* Clinical Features */

2017-06-05T00:50:05Z

Clinical Features

← Older revision		Revision as of 00:50, 5 June 2017
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	==Clinical Features==		==Clinical Features==
	*Neck/shoulder/arm pain in [[Spinal cord levels\|dermatome]] distribution, weakness, hyporeflexia		*Neck/shoulder/arm pain in [[Spinal cord levels\|dermatome]] distribution, weakness, hyporeflexia
	~~{{Cervical radiculopathy table}}~~

	*Spurling test		*Spurling test
	**Flex neck forward, ipsilaterally rotate, and ipsilaterally tilt		**Flex neck forward, ipsilaterally rotate, and ipsilaterally tilt
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	*[[Eponyms_(F-L)#Lhermitte's sign\|Lhermitte's sign]] positive suggests cord compression from midline herniation		*[[Eponyms_(F-L)#Lhermitte's sign\|Lhermitte's sign]] positive suggests cord compression from midline herniation
	*Shoulder abduction test - lifting arm above head relieves symptoms; differentiates radiculopathy from shoulder pathology		*Shoulder abduction test - lifting arm above head relieves symptoms; differentiates radiculopathy from shoulder pathology

			{{Cervical radiculopathy table}}

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Clinical Features */

2017-06-05T00:46:41Z

Clinical Features

@@ Line 5: / Line 5: @@
 ==Clinical Features==
 *Neck/shoulder/arm pain in [[Spinal cord levels|dermatome]] distribution, weakness, hyporeflexia
-{|  class="wikitable"  style="text-align:center"
+{{Cervical radiculopathy table}}
-! Radiculopathy
 *Spurling test
 **Flex neck forward, ipsilaterally rotate, and ipsilaterally tilt

Rossdonaldson1: /* Workup */

2017-06-05T00:45:31Z

Workup

← Older revision		Revision as of 00:45, 5 June 2017
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	{{Neck pain DDX}}		{{Neck pain DDX}}

	==~~Workup~~==		==Evaluation==
	*MRI required for definitive diagnosis; indicated if neurologic signs		*MRI required for definitive diagnosis; indicated if neurologic signs

Josgood: /* Clinical Features */

2017-05-28T16:10:17Z

Clinical Features

← Older revision		Revision as of 16:10, 28 May 2017
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	\|}		\|}
	*Spurling test		*Spurling test
	**Flex neck forward ~~flexed~~, ipsilaterally rotate, and ipsilaterally tilt		**Flex neck forward, ipsilaterally rotate, and ipsilaterally tilt
	**Reproduction of radicular symptoms is positive test		**Reproduction of radicular symptoms is positive test
	**Specific for nerve root compression		**Specific for nerve root compression

Josgood at 23:33, 27 May 2017

2017-05-27T23:33:15Z

← Older revision		Revision as of 23:33, 27 May 2017
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	==Disposition==		==Disposition==
			*In consultation with Neurosurg, admit if progression of neurologic signs
	==See Also==		==See Also==
	*[[Neck pain]]		*[[Neck pain]]

Josgood: /* Clinical Features */

2017-05-27T21:30:19Z

Clinical Features

← Older revision		Revision as of 21:30, 27 May 2017
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	**Specific for nerve root compression		**Specific for nerve root compression
	*[[Eponyms_(F-L)#Lhermitte's sign\|Lhermitte's sign]] positive suggests cord compression from midline herniation		*[[Eponyms_(F-L)#Lhermitte's sign\|Lhermitte's sign]] positive suggests cord compression from midline herniation
			*Shoulder abduction test - lifting arm above head relieves symptoms; differentiates radiculopathy from shoulder pathology

	==Differential Diagnosis==		==Differential Diagnosis==

Josgood: /* Workup */

2017-05-27T21:20:41Z

Workup

← Older revision		Revision as of 21:20, 27 May 2017
Line 36:		Line 36:

	==Workup==		==Workup==
	*MRI required for definitive diagnosis		*MRI required for definitive diagnosis; indicated if neurologic signs

	==Management==		==Management==

Josgood at 21:14, 27 May 2017

2017-05-27T21:14:14Z

← Older revision		Revision as of 21:14, 27 May 2017
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	==Clinical Features==		==Clinical Features==
	*Neck/shoulder/arm pain in [[Spinal cord levels\|dermatome]] distribution, weakness, hyporeflexia		*Neck/shoulder/arm pain in [[Spinal cord levels\|dermatome]] distribution, weakness, hyporeflexia
	*Spurling test
	**Flex neck forward flexed, ipsilaterally rotate, and ipsilaterally tilt
	**Reproduction of radicular symptoms is positive test
	**Specific for nerve root compression
	{\| class="wikitable" style="text-align:center"		{\| class="wikitable" style="text-align:center"
	! Radiculopathy		! Radiculopathy
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	\|\|Index/Middle distal phlnx flexion\|\|Small Finger Paresthesia\|\|		\|\|Index/Middle distal phlnx flexion\|\|Small Finger Paresthesia\|\|
	\|}		\|}
			*Spurling test
			**Flex neck forward flexed, ipsilaterally rotate, and ipsilaterally tilt
			**Reproduction of radicular symptoms is positive test
			**Specific for nerve root compression
	*[[Eponyms_(F-L)#Lhermitte's sign\|Lhermitte's sign]] positive suggests cord compression from midline herniation		*[[Eponyms_(F-L)#Lhermitte's sign\|Lhermitte's sign]] positive suggests cord compression from midline herniation

Josgood at 21:10, 27 May 2017

2017-05-27T21:10:45Z

← Older revision		Revision as of 21:10, 27 May 2017
Line 30:		Line 30:
	\|\|Index/Middle distal phlnx flexion\|\|Small Finger Paresthesia\|\|		\|\|Index/Middle distal phlnx flexion\|\|Small Finger Paresthesia\|\|
	\|}		\|}
	*[[Eponyms_(F-L)#Lhermitte's sign]] positive suggests cord compression from midline herniation		*[[Eponyms_(F-L)#Lhermitte's sign\|Lhermitte's sign]] positive suggests cord compression from midline herniation

	==Differential Diagnosis==		==Differential Diagnosis==