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Spine
Diagnosis
Degenerative Diseases and Arthritides
Degenerative Diseases
Cervical Intervertebral Disc Herniation
Cervical Intervertebral Disc Herniation
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              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

              • General Features

                • CT Findings

                  • MR Findings

                    • Nonvascular Interventions

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Mazas S et al: Cervical disc herniation: which surgery? Int Orthop. 43(4):761-6, 2019
                                            2. Joaquim AF et al: Cervical spine surgery in professional athletes: a systematic review. Neurosurg Focus. 40(4):E10, 2016
                                            3. Tetreault L et al: Degenerative cervical myelopathy: a spectrum of related disorders affecting the aging spine. Neurosurgery. 77 Suppl 4:S51-67, 2015
                                            4. Boselie TF et al: Arthroplasty versus fusion in single-level cervical degenerative disc disease: a Cochrane review. Spine (Phila Pa 1976). 38(17):E1096-107, 2013
                                            5. Lawrence BD et al: Surgical management of degenerative cervical myelopathy: a consensus statement. Spine (Phila Pa 1976). 38(22 Suppl 1):S171-2, 2013
                                            6. Boselie TF et al: Arthroplasty versus fusion in single-level cervical degenerative disc disease. Cochrane Database Syst Rev. 9:CD009173, 2012
                                            7. Gebremariam L et al: Evaluation of treatment effectiveness for the herniated cervical disk: a systematic review". Spine (Phila Pa 1976). 37(2):E109-18, 2012
                                            8. Jacobs W et al: Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev. (1):CD004958, 2011
                                            9. Riew KD et al: Cervical disc arthroplasty compared with arthrodesis for the treatment of myelopathy. J Bone Joint Surg Am. 90(11):2354-64, 2008
                                            10. Abbed KM et al: Cervical radiculopathy: pathophysiology, presentation, and clinical evaluation. Neurosurgery. 60(1 Supp1 1):S28-34, 2007
                                            11. Lee SH et al: Anterior minimally invasive approaches for the cervical spine. Orthop Clin North Am. 38(3):327-37; abstract v, 2007
                                            12. Nabhan A et al: The ProDisc-C prosthesis: clinical and radiological experience 1 year after surgery. Spine (Phila Pa 1976). 32(18):1935-41, 2007
                                            13. Fardon DF et al: Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976). 26(5):E93-113, 2001
                                            14. Furusawa N et al: Herniation of cervical intervertebral disc: immunohistochemical examination and measurement of nitric oxide production. Spine. 26(10): 1110-6, 2001
                                            15. Campi A et al: Comparison of MRI pulse sequences for investigation of lesions of the cervical spinal cord. Neuroradiology. 42(9): 669-75, 2000
                                            16. Grob D: Surgery in the degenerative cervical spine. Spine. 23(24): 2674-83, 1998
                                            17. Ahlgren BD et al: Cervical radiculopathy. Orthop Clin North Am. 27(2): 253-63, 1996
                                            18. Jensen MC et al: Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 331(2): 69-73, 1994
                                            19. Radhakrishnan K et al: Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 117 ( Pt 2): 325-35, 1994
                                            20. Sze G et al: Fast spin-echo MR imaging of the cervical spine: influence of echo train length and echo spacing on image contrast and quality. AJNR Am J Neuroradiol. 14(5): 1203-13, 1993
                                            21. Jahnke RW et al: Cervical stenosis, spondylosis, and herniated disc disease. Radiol Clin North Am. 29(4): 777-91, 1991
                                            22. Boden SD et al: Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 72(8): 1178-84, 1990
                                            23. Modic MT et al: Imaging of degenerative disease of the cervical spine. Clin Orthop. (239): 109-20, 1989
                                            24. Brown BM et al: Preoperative evaluation of cervical radiculopathy and myelopathy by surface-coil MR imaging. AJR Am J Roentgenol. 151(6): 1205-12, 1988
                                            25. Simon JE et al: Diskogenic disease of the cervical spine. Semin Roentgenol. 23(2): 118-24, 1988
                                            26. Crandall PH et al: Cervical spondylotic myelopathy. J Neurosurg. 25(1): 57-66, 1966
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        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

                                                        • General Features

                                                          • CT Findings

                                                            • MR Findings

                                                              • Nonvascular Interventions

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Mazas S et al: Cervical disc herniation: which surgery? Int Orthop. 43(4):761-6, 2019
                                                                                      2. Joaquim AF et al: Cervical spine surgery in professional athletes: a systematic review. Neurosurg Focus. 40(4):E10, 2016
                                                                                      3. Tetreault L et al: Degenerative cervical myelopathy: a spectrum of related disorders affecting the aging spine. Neurosurgery. 77 Suppl 4:S51-67, 2015
                                                                                      4. Boselie TF et al: Arthroplasty versus fusion in single-level cervical degenerative disc disease: a Cochrane review. Spine (Phila Pa 1976). 38(17):E1096-107, 2013
                                                                                      5. Lawrence BD et al: Surgical management of degenerative cervical myelopathy: a consensus statement. Spine (Phila Pa 1976). 38(22 Suppl 1):S171-2, 2013
                                                                                      6. Boselie TF et al: Arthroplasty versus fusion in single-level cervical degenerative disc disease. Cochrane Database Syst Rev. 9:CD009173, 2012
                                                                                      7. Gebremariam L et al: Evaluation of treatment effectiveness for the herniated cervical disk: a systematic review". Spine (Phila Pa 1976). 37(2):E109-18, 2012
                                                                                      8. Jacobs W et al: Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev. (1):CD004958, 2011
                                                                                      9. Riew KD et al: Cervical disc arthroplasty compared with arthrodesis for the treatment of myelopathy. J Bone Joint Surg Am. 90(11):2354-64, 2008
                                                                                      10. Abbed KM et al: Cervical radiculopathy: pathophysiology, presentation, and clinical evaluation. Neurosurgery. 60(1 Supp1 1):S28-34, 2007
                                                                                      11. Lee SH et al: Anterior minimally invasive approaches for the cervical spine. Orthop Clin North Am. 38(3):327-37; abstract v, 2007
                                                                                      12. Nabhan A et al: The ProDisc-C prosthesis: clinical and radiological experience 1 year after surgery. Spine (Phila Pa 1976). 32(18):1935-41, 2007
                                                                                      13. Fardon DF et al: Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976). 26(5):E93-113, 2001
                                                                                      14. Furusawa N et al: Herniation of cervical intervertebral disc: immunohistochemical examination and measurement of nitric oxide production. Spine. 26(10): 1110-6, 2001
                                                                                      15. Campi A et al: Comparison of MRI pulse sequences for investigation of lesions of the cervical spinal cord. Neuroradiology. 42(9): 669-75, 2000
                                                                                      16. Grob D: Surgery in the degenerative cervical spine. Spine. 23(24): 2674-83, 1998
                                                                                      17. Ahlgren BD et al: Cervical radiculopathy. Orthop Clin North Am. 27(2): 253-63, 1996
                                                                                      18. Jensen MC et al: Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 331(2): 69-73, 1994
                                                                                      19. Radhakrishnan K et al: Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 117 ( Pt 2): 325-35, 1994
                                                                                      20. Sze G et al: Fast spin-echo MR imaging of the cervical spine: influence of echo train length and echo spacing on image contrast and quality. AJNR Am J Neuroradiol. 14(5): 1203-13, 1993
                                                                                      21. Jahnke RW et al: Cervical stenosis, spondylosis, and herniated disc disease. Radiol Clin North Am. 29(4): 777-91, 1991
                                                                                      22. Boden SD et al: Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 72(8): 1178-84, 1990
                                                                                      23. Modic MT et al: Imaging of degenerative disease of the cervical spine. Clin Orthop. (239): 109-20, 1989
                                                                                      24. Brown BM et al: Preoperative evaluation of cervical radiculopathy and myelopathy by surface-coil MR imaging. AJR Am J Roentgenol. 151(6): 1205-12, 1988
                                                                                      25. Simon JE et al: Diskogenic disease of the cervical spine. Semin Roentgenol. 23(2): 118-24, 1988
                                                                                      26. Crandall PH et al: Cervical spondylotic myelopathy. J Neurosurg. 25(1): 57-66, 1966