Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

Cervical Disc Herniation and Radiculopathy

Introduction

Cervical disc herniation occurs when disc material compresses a cervical nerve root, producing radiculopathy.

Typical manifestations include:

Neck pain
Radiating arm pain
Sensory symptoms
Weakness
Reflex abnormalities

Common Levels

The most commonly affected levels are:

C6–C7
C5–C6

These account for the majority of cervical radiculopathies.

Pathophysiology

Disc herniation leads to:

Compression and inflammation of cervical nerve roots

This produces:

Pain
Sensory disturbance
Motor weakness
Reflex changes

Clinical Features

Pain

Typical pain pattern includes:

Neck pain radiating into the ipsilateral upper limb
Dermatomal distribution of symptoms

Associated Symptoms

Patients may complain of:

Numbness
Paresthesia
Weakness

Aggravating Factors

Symptoms may worsen with:

Coughing
Sneezing
Neck movement

Clinical Examination

Each cervical nerve root should be evaluated for:

Motor function
Reflex changes
Sensory deficit

A systematic examination is essential.

Root-wise Clinical Findings

Disc Level	Root Affected	Motor Deficit	Reflex Change	Sensory Distribution
C3–C4	C4	Diaphragm (phrenic nerve)	None	Shoulder region
C4–C5	C5	Deltoid, elbow flexion	Reduced biceps reflex	Lateral shoulder
C5–C6	C6	Wrist extension, elbow flexion	Reduced brachioradialis reflex	Thumb and index finger
C6–C7	C7	Triceps, wrist flexion, finger extension	Reduced triceps reflex	Middle finger
C7–T1	C8	Finger flexion	No reliable reflex	Medial two fingers
T1–T2	T1	Interossei muscles	No reliable reflex	Medial forearm

Important Clinical Correlations

C4 Root

Contributes to the phrenic nerve
Severe involvement may affect diaphragmatic function and respiration

C5 Root

Features include:

Weak shoulder abduction
Reduced biceps reflex

C6 Root

Typical findings:

Weak wrist extension
Sensory loss involving thumb and index finger

C7 Root

Most common cervical radiculopathy.

Features include:

Weak triceps
Reduced triceps reflex
Middle finger numbness

C8 Root

Findings include:

Weak finger flexion
Reduced grip strength
No dependable reflex

T1 Root

Involvement produces:

Weak finger abduction and adduction
Interossei weakness

Important Examination Principles

Always correlate:

Motor weakness
Reflex changes
Sensory loss

Dermatomal distribution is a key diagnostic clue.

Important Cervical Spine Rule

In the cervical spine:

Disc herniation usually affects the lower nerve root

Example:

C6–C7 disc herniation affects the C7 root

This is called the:

Lower root rule

Management

Conservative Treatment

First-line treatment includes:

NSAIDs
Physiotherapy
Activity modification

Most patients improve without surgery.

Indications for Surgery

Surgery may be indicated for:

Persistent symptoms beyond 6–12 weeks
Progressive neurological deficit
Significant weakness
Myelopathy

High-Yield Clinical Pearls

Most common cervical disc level: C6–C7
Most common radiculopathy: C7
Middle finger numbness suggests C7 involvement
Thumb and index finger symptoms suggest C6 involvement
Biceps reflex corresponds mainly to C5
Triceps reflex corresponds mainly to C7
There is no reliable reflex for C8 radiculopathy

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