musculoskeletal and connective tissue disorders
Cervical Herniated Nucleus Pulposus
Diagnosis of Cervical Herniated Nucleus Pulposus
MRI or CT Diagnosis is usually suspected based on history and physical examination findings and confirmed by MRI or CT. Physical examination should assess cervical spine movement and how it relates to the patient's symptoms. Neurological examination should include assessment of motor strength, sensation, and deep tendon reflexes. Passively extending the cervical spine, rotating the head to the side of the patient symptoms, and applying axial compression (Spurling or nerve compression test) may produce radicular pain in the upper extremity on the side to which the head is rotated. MRI or CT can identify the cause and precise level of the lesion. Rarely (ie, when MRI is contraindicated and CT is inconclusive), CT myelography is necessary. Electrodiagnostic testing may help identify the involved root. Because an asymptomatic herniated disk is common, the clinician must carefully correlate symptoms with MRI abnormalities before invasive procedures are considered. 