Neck Pain and Cervical Disk Derangements

There are several musculoskeletal disorders associated with the disks of the cervical spine that can cause pain and affect function. Let’s discuss the various types of these pain-generating disk derangements, including one that had been ignored until recently.

The intervertebral disk is a fibroelastic cartilaginous shock absorber that sits between two vertebral bodies, which are the large boney parts of the spine that bear most of our body’s weight and are stacked on top of each other like building blocks. The center of the disk (called the nucleus) is mostly water, and it acts like a ball bearing, facilitating movement. Surrounding the nucleus is the annulus, which is made up of tough, dense, and strong cartilaginous fibers. There are six intervertebral disks in the cervical spine. Under normal loads, the nucleus absorbs shock with its forces pushing up and down into the vertebral body endplates and outwards into the annulus as move.

Unfortunately, as we age and depending on our lifestyle choices, the structure of the cervical disks can weaken, the annulus can tear, and part of the nucleus can leak into or beyond the annulus. This may be referred to as disk herniation, protrusion, extrusion, or sequestration. In some cases, this can occur in such a way that the protruding nucleus does not cause pain, which is something that is commonly seen on MRI scans of asymptomatic individuals.

However, in other instances, the bulging disk may press against a nerve root, creating pain that shoots down the course of the nerve. In the case of the cervical spine, pain may follow down through the arm and into the hand. The outer edge of the annulus also has a nerve and blood supply, so injury to the annulus can cause localized pain. Additionally, these nerves and blood vessels can proliferate deeper into an injured disk, leading to pain in the immediate area.

Researchers have also observed that the force of the disk pushing into the endplates of the vertebral bodies both above and below can lead to a fracture known as Schmorl’s node. It’s long been thought that these are painless, but a 2021 study that included 582 participants identified an association between Schmorl’s nodes in the cervical spine and local, non-radiating neck pain.

Chiropractic care offers a conservative multi-modal treatment approach that has been found to be highly effective for managing patients with neck pain arising from multiple sources, including cervical disk injury.