Cervical disk herniation
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, hyperreflexia
| 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
- Musculoskeletal
- Torticollis
- Dystonic reaction
- Cervical spondylosis
- Cervical stenosis
- Cancer
- Epidural abscess
- Vertebral osteomyelitis
- Transverse myelitis
- Temporal arteritis
- Epidural hematoma (anticoagulation, hemophilia)
- Cervical disk herniation
- Blunt neck trauma
- Anterior horn disease
- Cervical fractures and dislocations
- Cervical radiculopathy
Workup
- Spurling test
- Flex neck forward flexed, ipsilaterally rotate, and ipsilaterally tilt
- Reproduction of radicular symptoms is positive test
- Specific for nerve root compression
- MRI required for definitive diagnosis