Cervical Disc Transligamentous Sequestration

Cervical disc transligamentous sequestration is a severe form of disc herniation occurring in the neck, where fragments of the nucleus pulposus push through the posterior longitudinal ligament and enter the spinal canal. This can put pressure on the spinal cord or nerve roots leading to pain, weakness, and sensory disturbances.

A transligamentous sequestration occurs when the nucleus pulposus of an intervertebral disc extrudes with complete disruption of the annular fibers and the posterior longitudinal ligament, resulting in a free fragment (sequestrum) within the spinal canal that is no longer connected to the parent disc. SpringerOpen

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Anatomy of the Cervical Intervertebral Disc

Structure

• Nucleus Pulposus: Gel-like core rich in water and proteoglycans, acting as the main shock absorber.

• Annulus Fibrosus: Concentric lamellae of collagen fibers providing tensile strength and containment of the nucleus.

• Vertebral Endplates: Thin hyaline cartilage layers that separate the disc from adjacent vertebral bodies and facilitate nutrient exchange. Wikipedia

Location

• Interposed between adjacent cervical vertebrae from C2–C3 through C7–T1, these discs account for 6 of the 23 total spinal discs. Wikipedia

Attachment (“Origin” & “Insertion”)

• The annulus fibrosus attaches peripherally to the ring apophysis of the vertebral bodies and centrally to the cartilaginous endplates, anchoring the disc within the intervertebral space. Wikipedia

Blood Supply

• In early life, small vessels penetrate the outer annulus and endplates but regress postnatally. In adulthood, discs are largely avascular; nutrients diffuse via the endplates through osmosis. KenhubNCBI

Nerve Supply

• The sinuvertebral (recurrent meningeal) nerve, formed from a somatic root of the ventral ramus and a sympathetic contribution from the gray ramus communicans, re-enters the canal via the intervertebral foramen to innervate the outer annulus fibrosus and posterior longitudinal ligament, mediating pain sensations. RadiopaediaPMC

Functions

1. Shock Absorption: Distributes compressive loads evenly.

2. Flexibility: Allows slight movement between vertebrae (flexion, extension, lateral bending, rotation).

3. Load Transmission: Transfers mechanical forces through the spine.

4. Spinal Stability: Maintains alignment of vertebral bodies.

5. Height Maintenance: Contributes to overall spinal column length (~25%).

6. Ligamentous Role: Acts as a fibrous joint (symphysis) to hold vertebrae together. Wikipedia

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Types of Disc Herniation

Intervertebral disc herniations are categorized based on displacement and continuity with the parent disc:

• Protrusion: Disc bulge without full-thickness annular tear.

• Extrusion: Nucleus material breaches the annulus but remains contained by the posterior longitudinal ligament.

• Sequestration (Extrusion with Fragment Loss): Free fragment separated from the disc; subdivided into:

  • Subligamentous Sequestration: Fragment splays beneath the posterior longitudinal ligament.

  • Transligamentous Sequestration: Fragment disrupts and passes through the posterior longitudinal ligament into the canal. Verywell HealthSpringerOpen

1. Free fragment sequestration: Disc pieces break free from the main disc and float within the canal.
2. Intradural sequestration: Rarely, fragments penetrate the dura mater and enter the dural sac.

Causes

• Poor posture. Holding the head and shoulders forward for long periods places extra pressure on cervical discs, causing wear.
• Aging. Discs naturally lose water and elasticity with age, making them more prone to tearing and herniation.
• Heavy lifting. Lifting heavy objects incorrectly can increase intradiscal pressure and tear the disc.
• Sudden trauma. Falls or accidents can abruptly strain the neck, leading to disc rupture.
• Whiplash injury. Rapid back-and-forth head motion can damage the disc and surrounding ligaments.
• Repetitive strain. Repeated neck motions in sports or jobs can gradually weaken the disc structure.
• Obesity. Extra body weight adds stress to the neck discs during movement and at rest.
• Smoking. Chemicals in cigarettes reduce blood flow to discs, impairing nutrient delivery and healing.
• Genetic predisposition. Family history can influence disc strength and degeneration rate.
• Sedentary lifestyle. Lack of movement reduces nutrient exchange in discs and leads to weakness.
• Poor nutrition. Inadequate vitamins and minerals can impair disc health and repair.
• Occupational hazards. Jobs with vibration, heavy tools, or awkward postures increase risk.
• High-impact sports. Activities like football or rugby can expose the discs to extreme forces.
• Degenerative disc disease. Chronic degradation of disc tissue makes it susceptible to herniation.
• Spine deformities. Conditions like scoliosis can unevenly load discs.
• Infection. Discitis weakens disc structure and can lead to rupture.
• Tumors. Growths near the disc can erode disc tissue and ligaments.
• Metabolic disorders. Conditions like diabetes can affect disc nutrition and health.
• Chronic inflammatory conditions. Diseases like rheumatoid arthritis can damage disc and ligament tissue.
• Osteoporosis. Bone weakening alters load distribution on discs, increasing risk of damage.

Symptoms

• Neck pain. A constant or intermittent ache in the back of the neck worsens with movement.
• Radiating arm pain. Pain travels from the neck down the arm along the affected nerve path.
• Numbness. Decreased sensation in the shoulder, arm, or hand signals nerve compression.
• Tingling. A pins-and-needles feeling often accompanies numbness in the arm or hand.
• Muscle weakness. Difficulty gripping objects or lifting the arm indicates motor nerve involvement.
• Headaches. Pain at the base of the skull can result from neck disc issues.
• Loss of coordination. Difficulty with fine motor skills like buttoning a shirt may occur.
• Dizziness. Vertigo can result if the disc fragment affects blood flow or inner ear nerves.
• Balance problems. Spinal cord compression can impair walking stability.
• Muscle spasms. Involuntary contractions of neck muscles cause stiffness and pain.
• Stiffness. Reduced range of motion in the neck leads to difficulty turning the head.
• Pain when moving. Simple actions like looking up may trigger sharp pain.
• Sensory loss. Complete lack of feeling in parts of the arm or hand may develop.
• Reflex changes. Increased or decreased reflexes in the arm signal nerve involvement.
• Difficulty gripping. Weakness in hand muscles affects daily tasks.
• Throat discomfort. Disc fragments pressing on the esophagus area can cause swallowing pain.
• Voice changes. Hoarseness may occur if nearby nerves are irritated.
• Difficulty swallowing. Dysphagia can appear when the fragment presses the throat.
• Sleep disturbances. Constant pain or tingling often interrupts sleep.
• Fatigue. Chronic pain can lead to tiredness and reduced activity.

Diagnostic Tests

• Physical examination. A doctor checks neck movement, strength, and reflexes for abnormalities.
• Magnetic resonance imaging (MRI). MRI provides detailed images of soft tissues, showing disc fragments.
• Computed tomography (CT) scan. CT scans offer cross-sectional images of bone and soft tissue.
• X-ray. X-rays show bone alignment and can rule out fractures or deformities.
• Discography. Dye injection into the disc reproduces pain and pinpoints the damaged disc.
• Myelogram. Contrast dye in the spinal canal highlights nerve compression on X-ray or CT.
• Electromyography (EMG). EMG assesses muscle electrical activity to detect nerve damage.
• Nerve conduction study. Measures speed of signals in nerves to locate compression areas.
• Flexion-extension X-rays. Images taken when bending detect instability in the cervical spine.
• Blood tests. Inflammation markers and infection tests help rule out other causes.
• Ultrasound. Rarely used for superficial nerve evaluation near the neck.
• Bone scan. Highlights bone activity to detect fractures or tumors affecting the disc.
• Provocative tests. Specific movements reproduce symptoms to confirm disc involvement.
• Neurological exam. Detailed assessment of sensory and motor function identifies deficits.
• Pain questionnaires. Standardized surveys measure pain severity and impact on life.
• Gait analysis. Observation of walking pattern reveals spinal cord involvement.
• Posture assessment. Evaluates head and shoulder alignment related to disc stress.
• Range of motion test. Measures flexibility limitations in the neck.
• Spurling’s test. Gentle compression on the head reproduces arm pain if nerves are compressed.
• Lhermitte’s sign. Neck flexion causing electric shock sensations indicates spinal cord irritation.

Non-Pharmacological Treatments

• Rest and activity modification. Avoid actions that worsen pain to allow healing.
• Posture correction. Training and ergonomic adjustments reduce pressure on the discs.
• Physical therapy. Guided exercises strengthen neck muscles and improve flexibility.
• Cervical traction. Gentle pulling separates vertebrae and relieves nerve pressure.
• Heat therapy. Warm packs relax muscles and increase blood flow to the area.
• Cold therapy. Ice packs reduce inflammation and numb painful areas.
• Ultrasound therapy. Sound waves stimulate tissue healing deep in the neck.
• Transcutaneous electrical nerve stimulation (TENS). Mild electrical pulses block pain signals.
• Acupuncture. Fine needles stimulate nerve pathways to ease pain.
• Chiropractic care. Spinal adjustments realign vertebrae to reduce nerve impingement.
• Massage therapy. Soft tissue manipulation eases muscle tension around the neck.
• Yoga. Gentle poses improve neck strength and flexibility.
• Pilates. Core-strengthening exercises support spine stability.
• Core strengthening. Strong abdominal and back muscles help stabilize the neck.
• Neck stretching. Regular stretches maintain mobility and reduce stiffness.
• Ergonomic workstation setup. Proper desk and monitor placement prevent strain.
• Weight management. Losing excess weight lowers pressure on spinal structures.
• Smoking cessation. Quitting improves disc nutrition and healing capacity.
• Hydrotherapy. Warm water exercises reduce load on the neck while exercising.
• Tai Chi. Slow, controlled movements enhance balance and posture.
• Inversion therapy. Hanging upside down briefly decompresses spinal discs.
• Manual therapy. Hands-on techniques by therapists improve joint mobility.
• Neural mobilization. Gentle nerve gliding exercises relieve tension along nerves.
• Education on body mechanics. Learning safe movement patterns prevents further injury.
• Cognitive-behavioral therapy. Addresses pain perception and coping strategies.
• Relaxation techniques. Deep breathing and meditation lower muscle tension.
• Biofeedback. Real-time feedback helps patients control muscle activity.
• Water exercise. Low-impact aquatic workouts strengthen neck-supporting muscles.
• Anti-inflammatory diet. Foods like fruits and vegetables reduce systemic inflammation.
• Mindfulness meditation. Increases pain tolerance and reduces stress-related tension.

Drugs

• Ibuprofen (NSAID). Reduces inflammation and relieves mild to moderate pain.
• Naproxen (NSAID). Offers longer-lasting pain control than ibuprofen.
• Diclofenac (NSAID). Strong anti-inflammatory effects for moderate disc pain.
• Celecoxib (COX-2 inhibitor). Targets inflammation with fewer stomach side effects.
• Acetaminophen. Eases pain but does not reduce inflammation.
• Cyclobenzaprine. A muscle relaxant that eases neck spasms.
• Baclofen. Reduces muscle spasticity by acting on the central nervous system.
• Methocarbamol. Calms muscle spasms with sedative properties.
• Prednisone (oral corticosteroid). Short-term course reduces severe inflammation.
• Methylprednisolone. Intravenous steroid for acute nerve swelling relief.
• Gabapentin. Nerve pain medication that blocks abnormal nerve signals.
• Pregabalin. Similar to gabapentin but with faster absorption.
• Amitriptyline. A tricyclic antidepressant that can relieve chronic nerve pain.
• Nortriptyline. A milder tricyclic antidepressant option for pain control.
• Duloxetine. An SNRI that helps with both pain and mood symptoms.
• Tramadol. A mild opioid for short-term relief of severe pain.
• Oxycodone. A stronger opioid reserved for extreme cases under close supervision.
• Lidocaine patch. Topical anesthetic applied directly over the painful area.
• Capsaicin cream. Topical treatment that desensitizes nerve endings over time.
• Topical diclofenac gel. Local NSAID effect with minimal systemic absorption.

Surgeries

• Anterior cervical discectomy and fusion (ACDF). Removes the diseased disc and fuses adjacent vertebrae.
• Cervical disc arthroplasty. Replaces the bad disc with an artificial one to preserve motion.
• Posterior cervical discectomy. Accesses the disc from the back of the neck to remove fragments.
• Laminoplasty. Expands the spinal canal by reconstructing the lamina to relieve pressure.
• Laminectomy. Removes part of the lamina to widen the canal and reduce cord compression.
• Microdiscectomy. Uses a microscope to remove disc fragments precisely.
• Endoscopic cervical discectomy. A minimally invasive removal of herniated disc through small incisions.
• Foraminotomy. Enlarges the nerve exit pathway to relieve root compression.
• Corpectomy. Removes part of the vertebral body along with the disc for severe cases.
• Artificial disc replacement. Uses a mechanical disc to maintain natural spine movement.

Prevention Strategies

• Maintain good posture. Keep the head aligned over the shoulders to reduce disc strain.
• Regular exercise. Strengthen neck and core muscles to support the cervical spine.
• Neck strengthening exercises. Targeted workouts help stabilize the neck and discs.
• Ergonomic workspace. Proper desk height and chair support prevent neck flexion.
• Proper lifting technique. Bend the knees and keep the back straight when lifting heavy items.
• Healthy weight. Maintaining a normal body weight lowers stress on the neck.
• Quit smoking. Improves disc health by restoring proper blood flow.
• Balanced diet. Nutrients like protein and calcium support spine and disc integrity.
• Take frequent breaks. Standing and stretching every hour during desk work relieves tension.
• Use supportive pillows. A pillow that keeps the neck in alignment reduces disc pressure.

When to See a Doctor

If you experience severe neck pain that does not improve with rest, sudden weakness or numbness in your arms or hands, difficulty walking, loss of bladder or bowel control, or symptoms lasting more than a few days, you should seek medical attention promptly to prevent permanent nerve damage.

Frequently Asked Questions

• 1. What is cervical disc transligamentous sequestration? It is when fragments of the neck disc break through the ligament at the back of the spine and press on nerves or the spinal cord.
• 2. What causes it? Common causes include aging, injury, repetitive strain, poor posture, and degenerative disc disease.
• 3. What are the main symptoms? You may feel neck pain, arm pain, numbness, tingling, weakness, headaches, and muscle spasms.
• 4. How is it diagnosed? Diagnosis uses physical exams, MRI, CT scans, X-rays, discograms, and nerve conduction studies to pinpoint the issue.
• 5. Can it heal on its own? Small herniations may improve with rest and conservative treatments, but severe cases may need surgery.
• 6. What non-surgical treatments help? Physical therapy, traction, heat or cold therapy, massage, acupuncture, and posture correction are beneficial.
• 7. When is surgery needed? Surgery is considered if severe pain does not respond to treatment, or if you have significant weakness or cord compression.
• 8. Are there risks to surgery? All surgeries carry risks like infection, bleeding, nerve damage, and failure to relieve symptoms.
• 9. How long is recovery after surgery? Recovery can range from a few weeks to several months, depending on the procedure and individual health.
• 10. Can it come back after treatment? There is a risk of recurrence, especially if preventive measures like proper posture are not maintained.
• 11. How can I prevent it? Good posture, regular exercise, ergonomic adjustments, healthy diet, and quitting smoking help prevent recurrence.
• 12. What activities should I avoid? Avoid heavy lifting, jerky head movements, long periods of flexed posture, and high-impact sports without proper technique.
• 13. Is physical therapy effective? Yes, guided exercises and manual techniques can relieve pain and strengthen supporting muscles.
• 14. Can lifestyle changes help? Improving posture, reducing weight, and quitting smoking all support disc health and reduce symptoms.
• 15. When should I schedule a follow-up? Follow your doctor’s advice, but typically you should return if symptoms worsen or do not improve in 4 to 6 weeks.

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: May 02, 2025.

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