Cervical disc intradural sequestration is a rare form of intervertebral disc herniation in which a fragment of the cervical disc breaches both the posterior longitudinal ligament and the dura mater, entering the intradural space and becoming isolated from the parent disc body RadiopaediaLippincott Journals. Fewer than 32 cases have been documented worldwide, underlining its extreme rarity and the critical need for accurate diagnosis and management ResearchGate. Patients often present with signs of spinal cord compression—such as Brown-Séquard syndrome or quadriparesis—rather than the typical radicular symptoms seen in extradural herniations PubMedthejns.org.
Anatomy of the Cervical Intervertebral Disc
Structure & Location
Intervertebral discs are fibrocartilaginous cushions situated between adjacent vertebral bodies from C2/C3 through C7/T1, providing flexibility and load transmission in the cervical spine RadiopaediaWikipedia. Each disc comprises:
-
Nucleus pulposus: a gelatinous core that absorbs compressive forces Wikipedia.
-
Annulus fibrosus: concentric layers of tough fibrocartilage encircling the nucleus, providing tensile strength Wikipedia.
-
Cartilaginous endplates: thin layers of hyaline cartilage anchoring the disc to vertebral bodies Wikipedia.
Origin & Insertion
Discs “insert” onto vertebral endplates rather than having muscle-like attachments. The cartilaginous endplates firmly secure the disc margins to the superior and inferior vertebral bodies Wikipedia.
Blood Supply
In adults, the inner two-thirds of the disc are avascular. Small vessels from the peri-annular arterial plexus—branches of the vertebral arteries—supply the outer one-third of the annulus fibrosus Wikipedia.
Nerve Supply
Pain fibers from the sinuvertebral (recurrent meningeal) nerves innervate only the outer annulus fibrosus, explaining why tears confined to the inner nucleus often remain painless Wikipedia.
Functions
-
Shock absorption: cushions axial loads transmitted along the cervical spine Wikipedia.
-
Load distribution: evenly disperses compressive forces to prevent focal stress Wikipedia.
-
Mobility: allows flexion, extension, lateral bending, and rotation of the neck Radiopaedia.
-
Height maintenance: preserves intervertebral foramen size for nerve roots Wikipedia.
-
Spinal alignment: contributes to overall cervical lordosis and posture Wikipedia.
-
Semirigid coupling: balances stability and flexibility between vertebrae Wikipedia.
Pathophysiology of Intradural Sequestration
In intradural sequestration, a disc fragment penetrates both the posterior longitudinal ligament and the dura mater, entering the thecal sac and separating from the main disc space Wikipedia. This penetration may result from chronic disc degeneration, acute trauma, or congenital adhesions between the ligament and dura, leading to dural perforation Lippincott JournalsResearchGate. Once intradural, the sequestered fragment can compress the spinal cord or nerve roots directly, provoking myelopathic and radiculopathic symptoms PubMedWikipedia.
Types of Cervical Disc Intradural Sequestration
-
Localized intradural sequestration: fragment remains near the herniation level Radiopaedia.
-
Migratory sequestration: fragment travels cranially or caudally within the subarachnoid space Radiopaedia.
-
Central vs. paramedian: based on midline (central) versus lateral (paramedian/foraminal) dural penetration JKNS.
-
Clinical syndromes:
-
Brown-Séquard presentation (hemisection signs) PubMedthejns.org.
-
Quadriparesis/myelopathy without lateralizing signs PubMed.
-
Causes
-
Age-related disc degeneration, weakening annulus fibrosus and dura interface Wikipedia.
-
Chronic mechanical stress (repetitive neck flexion/extension) causing annular tears Radiology Assistant.
-
Acute trauma (falls, accidents) driving disc material intradurally Lippincott Journals.
-
Heavy lifting or sudden axial overload Lippincott Journals.
-
Congenital adhesions between PLL and dura, facilitating dural breach Wikipedia.
-
Prior cervical surgery, creating iatrogenic dural defects PubMed.
-
Discitis (infection), eroding disc and dura integrity Wikipedia.
-
Rheumatoid arthritis, with inflammatory ligament erosion Wikipedia.
-
Spondylosis and osteophytes distorting PLL-dura interface Radiology Key.
-
Spinal tumors or metastases invading the ligament/dura .
-
Diabetes mellitus, impairing collagen repair in annulus Wikipedia.
-
Smoking, promoting disc hypoxia and degeneration Wikipedia.
-
Obesity, increasing axial cervical load Wikipedia.
-
Genetic collagen disorders, weakening annular fibers Wikipedia.
-
Vitamin deficiencies (D, C) impairing disc collagen synthesis Wikipedia.
-
Hormonal changes (e.g., postmenopausal) affecting disc metabolism Wikipedia.
-
High-impact sports causing repeated disc microtrauma Radiology Assistant.
-
Cervical stenosis, concentrating compressive forces on discs Wikipedia.
-
Occupational microtrauma (poor ergonomics, desk work) Radiology Assistant.
-
Spinal tuberculosis (Pott’s disease) weakening posterior elements Wikipedia.
Symptoms
-
Neck pain worsened by movement, from dura and cord irritation Wikipedia.
-
Radicular arm pain along the affected root distribution Wikipedia.
-
Paresthesia (tingling) in arms/hands Wikipedia.
-
Muscle weakness in upper limbs PubMed.
-
Hyperreflexia below lesion level Wikipedia.
-
Spasticity in arms/legs Wikipedia.
-
Gait disturbances or difficulty walking PubMed.
-
Lhermitte’s sign (electric shock on neck flexion) Wikipedia.
-
Hoffman’s sign (thumb flick reflex) Wikipedia.
-
Sensory level on the trunk marking cord involvement PubMed.
-
Brown-Séquard syndrome (ipsilateral motor loss, contralateral sensory loss) PubMedthejns.org.
-
Bladder/bowel dysfunction Wikipedia.
-
Sexual dysfunction Wikipedia.
-
Occipital headache from increased CSF pressure Wikipedia.
-
Dizziness/vertigo from proprioceptive disruption Wikipedia.
-
Neck stiffness and reduced range of motion Wikipedia.
-
Muscle spasms in neck Wikipedia.
-
Fine motor difficulty (e.g., buttoning) Wikipedia.
-
Imbalance/unsteadiness Wikipedia.
-
Sensation of neck “tightness” from dural irritation Wikipedia.
Diagnostic Tests
-
Neurological exam (strength, sensation) Wikipedia.
-
Deep tendon reflex testing Wikipedia.
-
Spurling’s test for nerve root compression Wikipedia.
-
Lhermitte’s sign test Wikipedia.
-
Hoffman’s reflex Wikipedia.
-
Cervical X-ray for alignment/degeneration Radiology Key.
-
Flexion-extension X-ray for instability Radiology Key.
-
MRI of cervical spine to visualize intradural fragments Radiopaedia.
-
T1/T2 MRI sequences for tissue and CSF differentiation Wikipedia.
-
CT scan for bone detail Wikipedia.
-
CT myelography to detect dural breaches Lippincott Journals.
-
Discography to confirm symptomatic level Wikipedia.
-
Somatosensory evoked potentials Wikipedia.
-
Motor evoked potentials Wikipedia.
-
EMG for radiculopathy Wikipedia.
-
Nerve conduction studies Wikipedia.
-
Neck ultrasound to guide interventions Wikipedia.
-
Myelo-CT (combined CT/myelogram) Lippincott Journals.
-
Urodynamic studies for bladder function Wikipedia.
-
JOA (Japanese Orthopaedic Association) score for myelopathy severity Wikipedia.
Non-Pharmacological Treatments
-
Cervical traction to gently separate vertebrae and relieve nerve pressure NCBI.
-
Physical therapy with targeted strengthening and stretching AAFP.
-
Postural training to maintain neutral neck alignment AAFP.
-
Ergonomic adjustments at workstations AAFP.
-
Heat therapy to relax muscles and improve blood flow Patient Care at NYU Langone Health.
-
Cold therapy (ice) to reduce inflammation Patient Care at NYU Langone Health.
-
Massage therapy for muscle tension relief Patient Care at NYU Langone Health.
-
Acupuncture to modulate pain pathways Wikipedia.
-
Chiropractic manipulation (with caution) Wikipedia.
-
Yoga for gentle cervical mobilization Instituto Clavel. Centro de neurocirugía.
-
Pilates for core stability and posture .
-
Stationary cycling to maintain cardiovascular fitness without axial load .
-
Aquatic therapy for low-impact exercise Instituto Clavel. Centro de neurocirugía.
-
Isometric neck exercises to strengthen deep stabilizers Wikipedia.
-
Scapular stabilization exercises to support cervical mechanics .
-
Post-injury graded activity to safely increase mobility Wikipedia.
-
Biofeedback for muscle relaxation Wikipedia.
-
Cervical collar (soft) for short-term support Wikipedia.
-
Ergonomic pillows for cervical alignment during sleep Patient Care at NYU Langone Health.
-
Mindfulness meditation to reduce pain perception Wikipedia.
-
Cognitive behavioral therapy for chronic pain coping Wikipedia.
-
TENS (transcutaneous electrical nerve stimulation) Wikipedia.
-
Ultrasound therapy to promote tissue healing Patient Care at NYU Langone Health.
-
Laser therapy (low-level) to reduce inflammation Patient Care at NYU Langone Health.
-
Extracorporeal shockwave therapy for pain relief Patient Care at NYU Langone Health.
-
Spinal decompression devices in clinical settings AAFP.
-
Weight management programs to reduce cervical load AAFP.
-
Smoking cessation to improve disc health Wikipedia.
-
Nutritional counseling for collagen support Wikipedia.
-
Activity modification to avoid painful positions AAFP.
Pharmacological Treatments
-
Ibuprofen (NSAID) for pain and inflammation AAFP.
-
Naproxen (NSAID) AAFP.
-
Diclofenac (NSAID) AAFP.
-
Acetaminophen for mild pain AAFP.
-
Cyclobenzaprine (muscle relaxant) AAFP.
-
Prednisone (oral corticosteroid) for short-term reduction of swelling AAFP.
-
Methylprednisolone (oral or IV) AAFP.
-
Tramadol (weak opioid) for refractory pain AAFP.
-
Gabapentin (anticonvulsant) for neuropathic pain AAFP.
-
Pregabalin (anticonvulsant) AAFP.
-
Amitriptyline (TCA) for chronic neuropathic pain AAFP.
-
Duloxetine (SNRI) AAFP.
-
Lidocaine patch for local analgesia AAFP.
-
Capsaicin cream for topical pain relief AAFP.
-
Epidural steroid injection (cervical) Patient Care at NYU Langone Health.
-
Facet joint injection with steroid/anesthetic Patient Care at NYU Langone Health.
-
Botulinum toxin injection (off-label) for spasm relief Wikipedia.
-
Oral muscle relaxants (e.g., methocarbamol) AAFP.
-
Cyclooxygenase-2 inhibitors (e.g., celecoxib) AAFP.
-
NMDA receptor antagonists (e.g., ketamine infusion in refractory cases) Wikipedia.
Surgical Treatments
-
Anterior cervical discectomy and fusion (ACDF) with fragment removal and dural repair PubMedVerywell Health.
-
Posterior cervical laminectomy with intradural fragment excision PubMed.
-
Cervical laminoplasty for posterior decompression PubMed.
-
Microdiscectomy via anterior approach to extract sequestered fragment thejns.org.
-
Corpectomy to decompress multi-level disease Wikipedia.
-
Foraminotomy to widen nerve root exit zones Radiology Key.
-
Artificial disc replacement (arthroplasty) after fragment removal Wikipedia.
-
Endoscopic intradural discectomy (minimally invasive) PMC.
-
Dural repair/patch grafting for dural tears Lippincott Journals.
-
Spinal stabilization with instrumentation if instability follows decompression Wikipedia.
Preventive Measures
-
Maintain good posture to reduce disc stress AAFP.
-
Ergonomic workstations AAFP.
-
Regular neck-strengthening exercises AAFP.
-
Proper lifting techniques AAFP.
-
Maintain healthy weight AAFP.
-
Quit smoking to preserve disc health Wikipedia.
-
Adequate hydration for disc nutrition Wikipedia.
-
Balanced diet rich in collagen-supporting nutrients Wikipedia.
-
Avoid prolonged neck flexion (e.g., looking down at devices) AAFP.
-
Use supportive pillows during sleep Patient Care at NYU Langone Health.
When to See a Doctor
-
Severe neck pain unrelieved by rest or medications
-
Progressive neurological deficits (weakness, numbness)
-
Signs of myelopathy (gait disturbance, spasticity, hyperreflexia)
-
Bowel or bladder changes (incontinence, retention)
-
Sudden onset of Brown-Séquard syndrome features (hemicord signs)
Early medical evaluation is critical to prevent permanent spinal cord injury PubMed.
Frequently Asked Questions
-
What exactly is cervical disc intradural sequestration?
It is when a cervical disc fragment tears through the ligament and dura, entering the intradural space and compressing the spinal cord outside the normal disc confines Radiopaedia. -
How common is this condition?
Extremely rare—fewer than 32 cases reported in the literature to date ResearchGate. -
What causes it?
Causes include degeneration, trauma, congenital dural adhesions, infection, and prior surgery, all of which can weaken the ligament-dura barrier Lippincott Journals. -
What symptoms should I watch for?
Neck pain, numbness, weakness, gait problems, hyperreflexia, and possible bladder/bowel issues Wikipedia. -
How is it diagnosed?
MRI is the gold standard; CT myelography may confirm intradural fragments Radiopaedia. -
Can it be treated without surgery?
Conservative measures help in mild cases, but true intradural sequestration often requires surgical removal PMC. -
What are the surgical risks?
Risks include nerve injury, CSF leak, infection, and spinal instability Lippincott Journals. -
What is recovery like?
Recovery depends on neurological status pre-surgery; many patients improve significantly if treated early thejns.org. -
Can it recur?
Recurrence is rare but possible if underlying risk factors persist Wikipedia. -
Are there long-term complications?
Potential chronic pain, spinal instability, or residual neurological deficits Wikipedia. -
How can I prevent it?
Good posture, ergonomics, neck strengthening, quitting smoking, and weight management reduce risk AAFP. -
Is imaging always necessary?
Yes—plain X-rays may miss intradural fragments; MRI or CT myelography is essential Radiopaedia. -
Can injections help?
Epidural steroids may relieve inflammation but will not remove sequestered fragments Patient Care at NYU Langone Health. -
When is surgery urgent?
Worsening myelopathy signs or bladder/bowel dysfunction require prompt surgery PubMed. -
What specialists manage this?
Neurosurgeons or orthopedic spine surgeons with experience in intradural pathologies PubMed.
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 01, 2025.