Cervical Disc Bulge: Do I Need Surgery?

Disc bulge in neck

Disc bulges usually do not need surgery

Now, before I state that our office does very well with disc bulges in the neck, I need to preface this with the fact that we’ve had 2 patients in the past 6 months end up in surgery.

That being said, the vast majority of patients who have cervical disc bulges accompanied by pain in the arm due to that disc bulge that are seen in our office recover nicely. Because back and leg pain are more widely publicized, there is more knowledge about sciatica from back pain; patients frequently come in stating that his or her “Atica” or “schizophrenia” is flared up. Most of these cases are not actually true sciatica (despite what he or she has been told) but are either local pain (no leg pain) or a referred pain from the hip or sacroiliac joint.

Pain in the arm originating from the neck is also very common, but less patients who walk through the door seem to be aware of this relationship. The typical patterns of disc pain in the arm or leg follow a very typical pattern called dermatomes. The problem is that there are many other things that also cause pain into the arm such as the rotator cuff, problems in the forearm such as carpal tunnel and problems stemming from the muscles around the neck such as the anterior scalene or pec minor.

Because there are so many causes of pain into the arm, it can be challenging to nail down exactly what may be causing your problem. For me, sometimes the answer isn’t clear on the first visit or two, but rather, takes some time to clarify exactly what’s causing the pain. Disc bulges in the neck causing pain in the arm can look an awful lot like a rotator cuff referral into the arm. If I work on the rotator cuff for a visit or two and nothing changes, we shift gears towards a treatment of a disc bulge.

Treatment of a cervical disc bulge in our office involves soft tissue work (Graston, stretching, fascial work), chiropractic adjusting and traction. I’m a big fan of home traction devices as well that can allow you to treat the disc bulge several times a day (we recommend this one from Amazon: Instapark® Cervical Neck Traction).

With this approach, the vast majority of patients respond well. This particular study supports this position. In it, chiropractic researchers looked at a group of studies to get a better idea of how long it takes someone to recover from a cervical disc herniation. Here’s what they found:

  • On the down side, they found that complete recovery could take as long as 24-36 months.
  • Luckily, patients were already noting substantial improvements within the first 4-6 months.
  • Overall 83% of patients resolved completely.
  • Patients with a workers’ compensation claim appeared to have a poorer prognosis.

Before you start getting depressed about the 4-6 months timeframe, in our office, if we are going to be able to help a disc pain patient, improvement starts within a few visits and usually progresses forward from there. The use of the traction device helps.

As for the worker’s compensation portion of the equation, I wonder if the poorer prognosis has to do with less of these patients making it into chiropractic offices in a timely matter. Many primary care doctors don’t consider chiropractic for disc problems and will usually use medications and pain injections first.

James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.