Cervical Disc Central Sequestration

Cervical disc central sequestration is a severe form of herniated disc in the neck (cervical spine) where a fragment of the inner gel (nucleus pulposus) completely breaks away from the outer ring (annulus fibrosus) and migrates into the central spinal canal. This free fragment can then press directly on the spinal cord or adjacent nerve roots, often causing significant pain, neurological symptoms, or even spinal cord dysfunction PMC​Verywell Health.

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Anatomy of the Cervical Intervertebral Disc

Structure & Location

• Location: Six cervical discs sit between the vertebrae C2–C7, cushioning and connecting each bone in the neck.

• Components:

  • Annulus fibrosus: Tough, outer ring of layered collagen fibers that contains and protects the inner core.

  • Nucleus pulposus: Gel-like center rich in water and proteoglycans, acting as the primary shock absorber Wikipedia.

Origin & “Insertion”

Intervertebral discs do not attach like muscles; rather, they are sandwiched between the flat surfaces (endplates) of adjacent vertebral bodies, secured by the endplates’ cartilage and the annulus fibrosus fibers Spine-health.

Blood Supply

In healthy adults, discs are largely avascular:

• Only the outer third of the annulus fibrosus has small blood vessels branching from metaphyseal arteries near the vertebral endplates.

• The inner annulus and nucleus rely entirely on diffusion of nutrients (glucose, oxygen) across the endplates NCBI.

Nerve Supply

• The sinuvertebral nerves (recurrent meningeal branches of cervical spinal nerves) penetrate the outer annulus fibrosus and the posterior longitudinal ligament, carrying pain signals when the disc is injured PhysioPedia.

Key Functions

1. Shock Absorption: Cushions forces during movement.

2. Load Distribution: Evenly disperses weight across vertebrae.

3. Spinal Flexibility: Allows controlled bending, twisting, and flexion.

4. Vertebral Spacing: Maintains consistent gaps for nerve roots.

5. Protection: Prevents bone-to-bone contact and wear.

6. Nutrient Exchange: Transmits nutrients and waste through endplates Wikipedia.

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Types of Disc Herniation

1. Protrusion (Bulge): Annulus fibrosus intact but deformed.

2. Extrusion: Nucleus pulposus pushes through a tear but remains connected to the disc.

3. Sequestration: Fragment fully detaches and may migrate freely Verywell Health.

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Subtypes of Cervical Disc Sequestration

Based on localization in the spinal canal, Manabe and Tateishi described four rare cervical sequestration patterns:

1. Anterior to the dural tube (central sequestration compressing the cord)

2. Lateral encroachment affecting a single nerve root

3. Lateral “drop-attack” type causing intermittent arm symptoms

4. Posterior to the dural sac (very rare) PMC.

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Causes of Cervical Disc Central Sequestration

1. Age-related degeneration: Disc fibers weaken over time Onsen

2. Genetic predisposition: Family history of early disc disease Onsen

3. Smoking: Impairs disc nutrition and healing Onsen

4. Obesity: Increases axial load on discs Onsen

5. Poor posture: Chronic forward head tilt strains cervical discs Spine-health

6. Repetitive microtrauma: From typing, phone use Spine-health

7. Heavy lifting: Bending or twisting under load Qispine

8. Whiplash injuries: Sudden hyperextension-hyperflexion trauma Qispine

9. Sports-related impact: Collision sports or falls Qispine

10. Vibration exposure: From heavy machinery Qispine

11. Sedentary lifestyle: Weak neck muscles lead to disc strain Dr. Jeffrey James & Associates

12. Facet joint osteoarthritis: Alters load distribution PhysioPedia

13. Spinal instability: Spondylolisthesis or lax ligaments PhysioPedia

14. Congenital disc weakness: Rare collagen disorders Deuk Spine

15. Endplate damage: Impairs nutrient diffusion Verywell Health

16. Previous cervical surgery: Postsurgical structural changes

17. Corticosteroid overuse: Thins annulus fibers

18. Infection: Rarely weakens disc integrity

19. Tumor invasion: Extremely rare cause of fragment migration

20. Autoimmune inflammation: Rare, e.g., rheumatoid arthritis

(Causes 16–20 are recognized clinical observations drawing on orthopedic and rheumatologic literature.)

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Symptoms

1. Central neck pain worse with movement Qispine

2. Radiating arm pain (radiculopathy) Qispine

3. Numbness/tingling in hands or fingers Qispine

4. Muscle weakness in shoulder, arm, or hand Qispine

5. Reduced reflexes at biceps or triceps Qispine

6. Stiff neck with limited rotation Spine-health

7. Headaches at the base of the skull Spine-health

8. Gait disturbances (myelopathy sign)

9. Fine motor decline (e.g., buttoning clothes)

10. Lhermitte’s sign: Electric shock-like down the spine

11. Clumsiness dropping objects

12. Balance issues when walking

13. Hyperreflexia in legs (spinal cord compression)

14. Babinski sign (upgoing toe response)

15. Bladder/bowel dysfunction (severe myelopathy)

16. Muscle spasms in neck

17. Scapular or shoulder blade pain

18. Sensory level on torso (mid-neck)

19. Pain relief when lying supine

20. Sleep disturbances due to pain

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Diagnostic Tests

1. Magnetic Resonance Imaging (MRI): Gold standard to visualize fragment and cord compression PMC

2. Computed Tomography (CT): Detects calcified fragments

3. Plain X-rays: Rule out fractures, instability

4. CT Myelography: Alternative if MRI contraindicated

5. Flexion/Extension X-rays: Assess dynamic instability

6. Electromyography (EMG): Nerve root function

7. Nerve Conduction Studies (NCS)

8. Somatosensory Evoked Potentials (SSEPs)

9. Discography: Provocative test for pain source

10. Physical Exam: Spurling’s test for nerve root irritation

11. Neurological Exam: Reflex, motor, sensory testing

12. Range of Motion Assessment

13. Quantitative Sensory Testing

14. Balance Tests: Romberg, gait analysis

15. Pain Scales: VAS or NRS

16. Ultrasound-guided injection: Diagnostic selective nerve block

17. Dynamic MRI (kinematic imaging)

18. Diffusion Tensor Imaging (DTI-MRI)

19. Blood tests: Rule out infection/inflammatory markers

20. CT-guided biopsy: Rare, for tumor exclusion

(Tests 16–20 are used selectively in complex cases.)

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Non-Pharmacological Treatments

1. Physical Therapy (PT): Neck strengthening & posture training Spine-health

2. Ergonomic Adjustment: Desk/chair optimization Wikipedia

3. Traction Therapy: Mechanical or manual cervical traction Wikipedia

4. Heat/Cold Packs: Pain relief & muscle relaxation

5. Transcutaneous Electrical Nerve Stimulation (TENS)

6. Ultrasound Therapy

7. Laser Therapy

8. Acupuncture

9. Massage Therapy

10. Chiropractic/Spinal Manipulation

11. Osteopathic Manipulation

12. Yoga & Pilates

13. Alexander Technique

14. Feldenkrais Method

15. Postural Taping (Kinesio Taping)

16. Hydrotherapy (aquatic exercises)

17. Dry Needling

18. Myofascial Release

19. Cognitive Behavioral Therapy (CBT) for pain

20. Mindfulness & Meditation

21. Deep Breathing Exercises

22. Ergonomic Sleep Pillow

23. Soft Cervical Collar (short-term) Wikipedia

24. Inversion Therapy

25. Dietary Counseling & Weight Loss

26. Smoking Cessation

27. Activity Modification & Education

28. Core Stabilization Exercises

29. Neural Mobilization (nerve gliding)

30. Stress Management Techniques

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Pharmacological Treatments

First-Line & Adjunctive Medications

1. NSAIDs: Ibuprofen, naproxen, diclofenac WebMD

2. Acetaminophen (Paracetamol) WebMD

3. Selective COX-2 Inhibitors: Celecoxib SingleCare

4. Muscle Relaxants: Cyclobenzaprine, baclofen Spine-health

5. Oral Corticosteroids: Prednisone taper NCBI

6. Gabapentinoids: Gabapentin, pregabalin Medscape

7. SNRIs: Duloxetine, venlafaxine Medscape

8. TCAs: Amitriptyline for neuropathic pain Medscape

9. Opioids (short-term): Tramadol, oxycodone Spine-health

10. Topical Analgesics: Lidocaine patches

11. Capsaicin Cream

12. NMDA Antagonists: Ketamine (rare use)

13. Alpha-2 Delta Ligands: Gabapentin derivatives

14. Bisphosphonates: Adjunct in osteoporotic patients

15. Calcitonin: Rare, for bone pain

16. NSAID-Opioid Combinations: Hydrocodone/acetaminophen

17. Muscle Spasm Agents: Tizanidine

18. Neuromodulators: Pregabalin extended release

19. Steroid Injections: Epidural corticosteroid (neck) Wikipedia

20. NMDA Modulators: Dextromethorphan (experimental)

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Surgical Options

1. Anterior Cervical Discectomy and Fusion (ACDF) Wikipedia

2. Posterior Cervical Laminectomy

3. Cervical Laminoplasty

4. Anterior Cervical Corpectomy

5. Cervical Disc Arthroplasty (Artificial Disc Replacement)

6. Posterior Foraminotomy

7. Micro-discectomy (minimally invasive)

8. Endoscopic Cervical Discectomy

9. Anterior Cervical Corpectomy and Fusion (ACCF)

10. Hybrid Constructs: Combination of fusion & arthroplasty

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Prevention Strategies

1. Ergonomic Workstation Setup: Monitor at eye level Wikipedia

2. Proper Lifting Techniques: Bend knees, keep back straight Wikipedia

3. Regular Exercise: Strengthen neck and core muscles Wikipedia

4. Maintain Healthy Weight Onsen

5. Smoking Cessation Onsen

6. Posture Awareness: Avoid forward head posture

7. Frequent Breaks: Change position every 30–60 minutes

8. Use Supportive Pillows: Neutral neck alignment during sleep

9. Stay Hydrated: Maintain disc turgor

10. Balanced Nutrition: Adequate calcium, vitamin D, protein

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When to See a Doctor

• Red-flag symptoms: Progressive arm/leg weakness, loss of bowel or bladder control, gait disturbances, or signs of spinal cord compression (e.g., hyperreflexia).

• Severe pain unresponsive to 4–6 weeks of conservative care.

• Neurological deficits: Numbness, tingling, or muscle weakness.

• After trauma: Significant neck injury or sudden onset of severe pain.

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Frequently Asked Questions

1. What exactly is central sequestration?
   A free disc fragment in the central canal, often compressing the spinal cord.

2. How common is central sequestration in the cervical spine?
   It’s rare—most sequestrations occur in the lumbar region.

3. Can sequestrated fragments reabsorb on their own?
   Yes, small fragments sometimes shrink and are absorbed by the body.

4. Is surgery always needed?
   No—if symptoms are mild, conservative care often suffices.

5. What imaging best shows sequestration?
   MRI, because it visualizes soft tissue and neural structures.

6. Are there risks to cervical epidural steroid injections?
   Yes—rare but serious risks include infection, bleeding, or neurological injury Wikipedia.

7. How long does recovery take after ACDF?
   Typically 6–12 weeks for bone fusion and symptom relief.

8. Can physical therapy make sequestration worse?
   Improper techniques can aggravate symptoms; always follow a guided program.

9. Will I need a neck collar after surgery?
   Often a soft collar is used briefly, but prolonged immobilization isn’t recommended.

10. Is central sequestration a form of myelopathy?
    It can cause myelopathy if the spinal cord is compressed.

11. How can I prevent recurrence?
    Maintain good posture, exercise regularly, and avoid high-risk activities.

12. Are injections safer than oral steroids?
    Injections target the affected area but carry procedural risks; both have pros and cons.

13. Can osteoporosis contribute to sequestration?
    Yes—weak vertebral bodies alter load distribution on discs.

14. What’s the difference between ACDF and disc arthroplasty?
    ACDF fuses vertebrae; arthroplasty replaces the disc to preserve motion.

15. When is fusion preferred over arthroplasty?
    Fusion is chosen when severe degeneration or instability makes motion preservation inadvisable.

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

Last Updated: May 01, 2025.

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