Conditions involving the cervical discs can produce several clinical
syndromes or groups of symptoms.
The annulus can tear.
This may be a silent event or it can produce pain, usually referred
to the posterior neck, occipital region, or between the shoulder
blades. No radiculopathy or myelopathy occurs because there is no
neurologic compromise.
Disc herniation
Sometimes along with an annular tear the inner disc
gel can herniated or ooze outward. This can be asymptomatic, or it
can produce pain, pressure on a nerve (radiculopathy), pressure on
the spinal cord (myelopathy), or a combination of neurologic
findings.
Radiculopathy
A radiculopathy involves nerve roots and may produce
muscle weakness, abnormal sensations such as numbness or tingling,
or pain along a particular nerve pathway. Remember, the nerves of
the upper extremity are composed of fibers from several different
nerve roots. A radiculopathy may develop when the disc material
herniates posterolaterally toward the nerve root.
Myelopathy
A disc herniation may also produce myelopathy. This
occurs when the herniation occurs directly posteriorly, compressing
the spinal cord directly. This causes spinal cord malfunction below
the level of the herniation. Your spinal physician will look for
signs of this while examining you. Several signs include the
Hoffman’s sign, Babinski’s sign, the scapulohumeral reflex, the
inverted radial reflex, and clonus. Some of these are difficult to
perform or to detect and may not be present in all cases. In
addition, acute bowel or bladder deficits may occur.
Disc degeneration
Another form of disc pathology involves
degeneration. As the disc degenerates or wears out, it begins to
bulge. Anterior bulge is insignificant. A posterior bulge
gradually decreases space for the spinal cord. In addition as the
disc height decreases, the pathway for the nerve roots decreases.
After continued disc degeneration, osteophytes (bone spurs) may
begin to form. These spurs may also compress nerve roots or the
cord. A “disc-osteophyte complex” develops. Cervical disc
degeneration may cause neck pain, referred pain, radiculopathy, or
myelopathy, but tends to develop slowly. Often patients may have
slight difficulty with activities such as knitting, buttoning
shirts, handling coins, or they may notice a change in the way they
walk (wider shorter steps). Sometimes these changes are difficult
to detect, but your spinal physician has the skills and training to
recognize these signs.