Nursing review section of surgical neurology international: Evaluation of cervical disc disease and when surgery is warranted

BACKGROUND Patients with cervical disc disease may present with radiculopathy (root compression), myelopathy (cord compression), or myeloradiculopathy. These complaints must be correlated with x-ray, magnetic resonance (MR) imaging, and computed tomographic (CT) scans. Although most patients can be managed nonsurgically, those with significant neurological deficits and larger disc herniations may require surgery. METHODS The symptoms of cervical radiculopathy include pain radiating down one or both arms, while myelopathy may result in more diffuse numbness tingling or weakness in the upper and/or lower extremities. The neurological signs for cervical discs include; focal or diffuse loss of motor strength changes in reflexes (hyporeflexic, normal reflexes, or hyperreflexia), a loss of sensation (e.g., to pin, vibration, touch, and position), and cerebellar dysfunction (e.g., loss of coordination). Patients' symptoms and signs must correlate with focal nerve root and/or spinal cord compression seen on MR and/or CT studies. RESULTS MR examinations best document soft disc herniations, while CT scans most readily demonstrate calcification/ossification of cervical discs and accompanying arthritic changes. Bulging/protruding can typically be managed nonsurgically. Alternatively, significantly extruded or sequestrated discs, resulting in moderate/marked spinal cord and/or nerve root compression may warrant surgery. Most operations from front of the neck for cervical discs are called anterior cervical discectomy/fusion (ACDF), while those performed from the back of the neck are called laminoforaminotomies. CONCLUSION Patients with cervical radiculopathy (root compression) and/or myelopathy (cord compression) with disc herniations on MR/CT studies may or may not require surgery.