A C5–C6 Cervical DiscEextrusion

Dr. Tracy L. Ansay, MD - Spine and Neurosurgery Dr. Tracy L. Ansay, MD - Spine and Neurosurgery
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Degenerative Bones, Joints, and Spine Care (A - Z)

A C5–C6 cervical disc extrusion occurs when the soft inner core (nucleus pulposus) of the intervertebral disc between the fifth and sixth cervical vertebrae pushes through a tear in the outer ring (annulus fibrosus), often pressing on nearby nerves. This condition can cause neck pain, arm pain, numbness, or weakness, and—in severe cases—spinal cord compression.

A cervical disc extrusion at C5–C6 is a type of disc herniation where the nucleus pulposus leaks beyond the annulus fibrosus but remains connected to the parent disc. It differs from a protrusion (where the annulus bulges without rupture) and a sequestration (where the nucleus fragment detaches completely). Extrusions can impinge on the C6 nerve root, causing characteristic symptoms in the thumb and forearm. NCBIPhysiopedia

Anatomy of the C5–C6 Disc

  1. Structure & Location
    The intervertebral disc between C5 and C6 is a fibrocartilaginous joint that cushions the vertebrae. It lies just above the C7 vertebra and below the C5 vertebra. PhysiopediaSpine-health

  2. Origin & Insertion

    • The annulus fibrosus fibers attach to the hyaline cartilage endplates of the C5 and C6 vertebral bodies.

    • The nucleus pulposus lies centrally, distributing pressure evenly. WikipediaPhysiopedia

  3. Blood Supply
    In adults, discs are largely avascular; small vessels from the vertebral bodies nourish the outer annulus through endplate diffusion. Wikipedia

  4. Nerve Supply
    The sinuvertebral (recurrent meningeal) nerve innervates the outer annulus fibrosus. Irritation here causes neck pain. NCBI

  5. Functions
    Intervertebral discs at C5–C6:

    • Shock absorption for forces on the neck

    • Load distribution between vertebral bodies

    • Flexion/extension movement

    • Rotation and lateral bending support

    • Maintaining spacing for nerve root exit

    • Protecting the spinal cord and nerve roots Spine-healthPhysiopedia

Types of Cervical Disc Herniation

  1. Protrusion (bulge without annular tear)

  2. Extrusion (nucleus herniates through annulus but remains connected)

  3. Sequestration (fragment separates completely)

  4. Contained vs. Non-contained (depends on annular integrity) adrspine.comPhysiopedia

Causes

  1. Age-related degeneration of the annulus​NCBIPhysiopedia

  2. Repetitive neck strain (e.g., poor posture)

  3. Whiplash injuries (auto accidents)

  4. Heavy lifting with improper form

  5. Sudden axial load (fall onto head)

  6. Smoking (accelerates disc degeneration)

  7. Obesity (increases spinal load)

  8. Genetic predisposition (family history)

  9. Vibration exposure (heavy machinery)

  10. Collagen disorders (weaken annulus)

  11. Dehydration (disc loses height)

  12. Sedentary lifestyle (weak support muscles)

  13. Occupational hazards (e.g., long driving)

  14. High-impact sports (football, gymnastics)

  15. Osteoporosis (vertebral endplate weakening)

  16. Metabolic diseases (diabetes affecting disc health)

  17. Infections (discitis weakening annulus)

  18. Inflammatory conditions (e.g., ankylosing spondylitis)

  19. Radiation exposure (post-cancer therapy)

  20. Previous neck surgery (altered biomechanics) NCBIAlleviate pain clinic

Symptoms

  1. Neck pain

  2. Radiating arm pain along C6 dermatome

  3. Numbness/tingling in thumb and forearm

  4. Muscle weakness (e.g., wrist extension)

  5. Reflex changes (biceps reflex ↓)

  6. Shoulder pain

  7. Headaches (cervicogenic)

  8. Stiff neck

  9. Crepitus (“crackling” with movement)

  10. Scapular pain

  11. Chest discomfort (rare referral)

  12. Difficulty turning head

  13. Fatigue in neck muscles

  14. Balance issues (if cord compression)

  15. Fine motor difficulty (hand coordination)

  16. Muscle spasms

  17. Sleep disturbance from pain

  18. Sensory loss in C6 distribution

  19. Radiating pain into fingers

  20. Bowel/bladder changes (very rare, red flag) NCBIPMC

Diagnostic Tests

  1. Clinical history & exam

  2. Spurling’s test (reproduce radicular pain)

  3. Lhermitte’s sign (electric shock feeling)

  4. Range of motion assessment

  5. Muscle strength testing

  6. Reflex testing (biceps, brachioradialis)

  7. Sensory exam (light touch, pinprick)

  8. X-rays (alignment, degeneration)

  9. MRI (gold standard for soft tissue)

  10. CT scan (bone detail)

  11. Myelography (contrast-enhanced CSF outline)

  12. CT myelogram (if MRI contraindicated)

  13. Electromyography (EMG)

  14. Nerve conduction study

  15. Discogram (reproduce pain)

  16. Ultrasound (rare for cervical)

  17. Flexion-extension X-rays (instability)

  18. Bone scan (rule out tumor/infection)

  19. Blood tests (infection markers)

  20. CSF analysis (if cord involvement) NCBIScoliosis Reduction Center®

Non-pharmacological Treatments

  1. Physical therapy (strengthening & stretching)

  2. Cervical traction

  3. Cervical collar (short-term use)

  4. Heat therapy

  5. Ice packs

  6. Transcutaneous Electrical Nerve Stimulation (TENS)

  7. Acupuncture

  8. Chiropractic mobilization

  9. Massage therapy

  10. Yoga

  11. Pilates (core stabilization)

  12. Postural training

  13. Ergonomic workstation setup

  14. McKenzie exercises

  15. Cervical stabilization exercises

  16. Ultrasound therapy

  17. Hydrotherapy

  18. Laser therapy

  19. Shockwave therapy

  20. Spinal mobilization

  21. Neck stretches

  22. Core strengthening

  23. Weight loss

  24. Sleep posture optimization

  25. Stress reduction techniques

  26. Ergonomic lift training

  27. Activity modification

  28. Breathing exercises

  29. Ergonomic pillow support

  30. Patient education CLEAR Scoliosis InstitutePhysiopedia

Pharmacological Treatments

  1. Acetaminophen (pain relief)

  2. Ibuprofen (NSAID)

  3. Naproxen (NSAID)

  4. Celecoxib (COX-2 inhibitor)

  5. Diclofenac (NSAID)

  6. Prednisone (short-term steroid)

  7. Gabapentin (neuropathic pain)

  8. Pregabalin (neuropathic pain)

  9. Duloxetine (SNRI)

  10. Tramadol (opioid analgesic)

  11. Morphine (severe pain)

  12. Cyclobenzaprine (muscle relaxant)

  13. Methocarbamol (muscle relaxant)

  14. Baclofen (spasm relief)

  15. Tizanidine (spasm relief)

  16. Diazepam (benzodiazepine)

  17. Epidural steroid injection (targeted)

  18. Oral steroids (short course)

  19. Topical NSAIDs (diclofenac gel)

  20. Opioid combinations (acetaminophen + codeine) Patient.infoNCBI

Surgical Options

  1. Anterior Cervical Discectomy and Fusion (ACDF)

  2. Cervical Disc Arthroplasty (artificial disc)

  3. Posterior Cervical Foraminotomy

  4. Laminectomy

  5. Laminoplasty

  6. Microdiscectomy

  7. Endoscopic Discectomy

  8. Posterior Instrumented Fusion

  9. Costotransversectomy

  10. Corpectomy (removal of vertebral body) Spine-healthNCBI

Prevention

  1. Maintain good posture

  2. Regular neck exercises

  3. Ergonomic workstations

  4. Proper lifting techniques

  5. Weight management

  6. Smoking cessation

  7. Stay hydrated

  8. Balanced nutrition (disc health)

  9. Take frequent breaks (during desk work)

  10. Use supportive pillows Alleviate pain clinicCleveland Clinic

When to See a Doctor

  • Pain persisting beyond 6 weeks despite treatment

  • Severe or worsening arm weakness or numbness

  • Loss of bladder or bowel control

  • Signs of spinal cord compression (gait difficulties, balance problems)

  • Infection signs (fever, chills) in neck region NCBIPhysiopedia

Frequently Asked Questions

  1. What is the difference between a protrusion and an extrusion?
    A protrusion bulges the annulus without rupture, whereas in an extrusion, the nucleus breaks through but stays connected to the disc. adrspine.com

  2. Can a C5–C6 extrusion heal on its own?
    Mild extrusions may shrink over months with conservative care; large ones often need intervention. Deuk Spine

  3. How long does recovery take after ACDF?
    Most patients improve within 3–6 months, though full fusion may take up to a year. Spine-health

  4. Are there risks to long-term NSAID use?
    Yes—stomach ulcers, kidney issues, and cardiovascular risks. Use under medical guidance. Patient.info

  5. Will physical therapy help?
    Yes, tailored exercises improve strength and reduce pain in 80% of cases. Spine-health

  6. Is surgery always required?
    No—conservative treatments succeed in most cases; surgery is for severe or refractory symptoms. NCBI

  7. Can I work with a C5–C6 extrusion?
    Light duty and ergonomic adjustments are often possible; heavy labor may need modification. Alleviate pain clinic

  8. What exercises should I avoid?
    Avoid deep neck flexion under load and high-impact activities until cleared by a therapist. Spine-health

  9. Do extrusions recur?
    They can; 30–40% recurrence with conservative care, lower after fusion surgery. NCBI

  10. Is an MRI always necessary?
    MRI is the gold standard for visualizing soft tissue and nerve compression. NCBI

  11. Can cervical collars cause stiffness?
    Prolonged use (>2 weeks) may weaken muscles and reduce motion. Scoliosis Reduction Center®

  12. What lifestyle changes help prevent recurrence?
    Posture correction, regular exercise, smoking cessation, and weight control. Cleveland Clinic

  13. Are alternative therapies effective?
    Acupuncture and chiropractic care show benefit as adjuncts. CLEAR Scoliosis Institute

  14. How do I manage flare-ups?
    Short rest, ice/heat, and adjusting activity levels under guidance. Physiopedia

  15. When is epidural steroid injection indicated?
    For persistent radicular pain despite oral medications and therapy. Patient.info

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: April 29, 2025.

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