Cervical Disc Subarticular Extrusion

Cervical disc subarticular extrusion is a specific type of cervical intervertebral disc herniation in which the gel-like nucleus pulposus breaches the tough annulus fibrosus and extends into the subarticular zone (lateral recess) beneath the facet joint, often compressing the exiting nerve root.

A subarticular extrusion occurs when the inner nucleus pulposus of a cervical disc pushes through a tear in the annulus fibrosus and protrudes into the subarticular (lateral recess) region, narrowing the space for the nerve root and causing radicular symptoms Radiopaedia.

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Anatomy of the Cervical Intervertebral Disc

Structure & Location

• Situated between adjacent vertebral bodies from C2–3 to C7–T1, each disc consists of:

  • Nucleus pulposus: gelatinous inner core

  • Annulus fibrosus: laminated fibrocartilage outer ring

  • Cartilaginous endplates: hyaline cartilage layers on vertebral bodies Wikipedia

Attachments (Origin & Insertion)

• The annulus fibrosus attaches circumferentially to the ring apophyses of the vertebral endplates, anchoring the disc between the superior and inferior vertebrae Wikipedia.

Blood Supply

• Adult discs are largely avascular; only the outer third of the annulus fibrosus has small vessels branching from the metaphyseal arteries near the vertebrae. Nutrient exchange occurs via diffusion through the cartilaginous endplates NCBI.

Nerve Supply

• The outer annulus fibrosus is innervated by recurrent meningeal (sinuvertebral) nerves, which transmit pain when the disc is torn or inflamed NCBI.

Functions

1. Shock absorption: Nucleus pulposus distributes compressive loads evenly Deuk Spine

2. Load bearing: Supports axial spinal loads

3. Flexibility & motion: Permits flexion, extension, lateral bending, rotation

4. Height maintenance: Discs contribute ~25% of spinal height, preserving foraminal space Orthobullets

5. Spinal stability: Annulus resists shear and torsion

6. Nutrient exchange: Endplates allow diffusion of nutrients and waste

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Classification & Types

Per Fardon et al. (2014), herniations are described by morphology (“protrusion vs. extrusion”) and axial location:

• Central extrusion: midline posterior herniation into the spinal canal

• Paracentral extrusion: off-midline, toward one side

• Subarticular extrusion: into the lateral recess beneath the facet joint Radiopaedia

• Foraminal extrusion: into the neural foramen

• Extraforaminal extrusion: lateral to the foramen

• Sequestration: free fragment no longer contiguous with the disc

• Migratory: fragment migrates superiorly or inferiorly beyond the disc level Radiopaedia

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Causes

1. Age-related degeneration: annular tears as discs lose water Cleveland ClinicCedars-Sinai

2. Disc dehydration: reduced shock absorption with natural drying Cleveland Clinic

3. Repetitive micro-tears: chronic strain from bending/lifting Spine-health

4. Acute trauma: falls, whiplash, heavy impact Cedars-Sinai

5. Poor posture: forward head and rounded shoulders Radiopaedia

6. Whole-body vibration: drivers, machinery operators PubMedJ-STAGE

7. Heavy lifting occupations: manual labor strain Spine-health

8. High-impact sports: rugby, gymnastics scosteo.com

9. Obesity: excess weight on cervical spine scosteo.com

10. Sedentary lifestyle: weak neck/support muscles NJ Spine & Orthopedic

11. Smoking: impairs disc nutrition scosteo.com

12. Genetic predisposition: familial early degeneration scosteo.com

13. Cervical spondylosis: facet/joint osteoarthritis NCBI

14. Diabetes mellitus: collagen damage from hyperglycemia NCBI

15. Long-term corticosteroids: connective tissue weakening NCBI

16. Vitamin D deficiency: poor bone/disc health Verywell Health

17. High cholesterol: atherosclerosis of segmental arteries NCBI

18. Autoimmune inflammation: RA and other inflammatory diseases Cleveland Clinic

19. Discitis (infection): bacterial infection weakens disc Cedars-Sinai

20. Congenital disc anomalies: structural predisposition Wikipedia

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Symptoms

1. Neck pain Spine-health

2. Radiating shoulder/arm pain Spine-health

3. Electric shock-like pain Spine-health

4. Pain worsened by neck movement Spine-health

5. Neck stiffness, reduced range of motion Spine-health

6. Shoulder-blade discomfort Florida Spine Institute

7. Upper extremity numbness Spine-health

8. Tingling (“pins and needles”) Spine-health

9. Muscle weakness (biceps/triceps/hands) theadvancedspinecenter.com

10. Decreased grip strength theadvancedspinecenter.com

11. Muscle atrophy (chronic cases) PMC

12. Reduced reflexes (biceps/triceps) Cleveland Clinic

13. Hypersensitivity in affected dermatome southeasttexasspine.com

14. Occipital headaches Mayo Clinic

15. Sleep disturbances from pain Mayo Clinic

16. Pain aggravated by cough/sneeze (Valsalva) Mayo Clinic

17. Difficulty with fine motor tasks southeasttexasspine.com

18. Hand clumsiness Novant Health

19. Dermatomal sensory loss Cleveland Clinic

20. Temperature intolerance in limb southeasttexasspine.com

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Diagnostic Tests

1. History & symptom review Mayo Clinic

2. General physical exam Mayo Clinic

3. Neurological exam (sensory/motor/reflex) Mayo Clinic

4. Spurling’s test PhysioPedia

5. Cervical distraction test spectrumphysio.info

6. Valsalva maneuver spectrumphysio.info

7. Shoulder depression test spectrumphysio.info

8. Jackson (axial compression) test spectrumphysio.info

9. Percussion (spinous) test spectrumphysio.info

10. Lhermitte’s sign NCBI

11. Hoffman’s sign NCBI

12. Plain X-rays Mayo Clinic

13. Flexion-extension radiographs Mayo Clinic

14. MRI of cervical spine NCBI

15. CT or CT myelogram Spine-health

16. Electromyography (EMG) NCBI

17. Nerve conduction studies (NCS) NCBI

18. Somatosensory evoked potentials (SSEP) PMC

19. Discography (provocative) Spine-health

20. Selective nerve root block PMC

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Non-Pharmacological Treatments

1. Rest & activity modification Patient Care at NYU Langone Health

2. Physical therapy (PT) exercises Patient Care at NYU Langone Health

3. McKenzie directional exercises Cervical Herniated Disc

4. Core stabilization (Pilates) Verywell Health

5. Isometric neck strengthening Healthline

6. Heat therapy Desert Institute for Spine Care

7. Cold therapy Desert Institute for Spine Care

8. Cervical traction Verywell Health

9. Home traction devices Verywell Health

10. Chiropractic manipulation Verywell Health

11. Osteopathic manual therapy Cervical Herniated Disc

12. Acupuncture Patient Care at NYU Langone Health

13. TENS (electrical stimulation) Cervical Herniated Disc

14. Kinesio taping Cervical Herniated Disc

15. Massage (deep-tissue, Shiatsu) Cervical Herniated Disc

16. Craniosacral therapy Cervical Herniated Disc

17. Alexander Technique Cervical Herniated Disc

18. Yoga/Pilates for posture Verywell Health

19. Tai Chi More Good Dayshansoncomplete.com

20. Ergonomic adjustments Verywell Health

21. Postural training Patient Care at NYU Langone Health

22. Aquatic therapy Verywell Health

23. Dry needling More Good Dayshansoncomplete.com

24. Therapeutic ultrasound Rothman OrthopaedicsIntegrated Spinal Solutions Reno, NV

25. Low-level laser therapy PMCMore Good Days

26. Biofeedback training BTEWebMD

27. Cervical collars/orthoses Spine-health

28. Patient education Patient Care at NYU Langone Health

29. Weight management Patient Care at NYU Langone Health

30. Cognitive-behavioral therapy Cervical Herniated Disc

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Drugs

1. Ibuprofen (NSAID) Medscape

2. Naproxen (NSAID) Medscape

3. Acetaminophen (paracetamol) WebMD

4. Prednisone (oral corticosteroid) Medscape

5. Methylprednisolone pack NCBI

6. Cyclobenzaprine (muscle relaxant) NCBI

7. Baclofen (muscle relaxant) HealthCentral

8. Gabapentin (neuropathic agent) NCBI

9. Pregabalin (neuropathic agent) HealthCentral

10. Amitriptyline (TCA) NCBI

11. Duloxetine (SNRI) southfloridabackspineandscoliosis.com

12. Nortriptyline (TCA) southfloridabackspineandscoliosis.com

13. 5% Lidocaine patch PubMed

14. 8% Capsaicin patch U.S. Pharmacist

15. Codeine (opioid) NCBI

16. Tramadol (opioid) NCBI

17. Triamcinolone (epidural steroid injection) HealthCentral

18. Bupivacaine (epidural local anesthetic) HealthCentral

19. OnabotulinumtoxinA (Botox injection) Healthline

20. Tizanidine (alpha-2 agonist muscle relaxant) NCBI

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Surgeries

1. Anterior Cervical Discectomy & Fusion (ACDF) – removal of herniated disc via anterior approach with bone graft fusion PMC

2. Posterior Cervical Foraminotomy – decompress nerve root via posterior bone removal OrthoInfo

3. Cervical Total Disc Replacement (Arthroplasty) – replaces disc with prosthetic to preserve motion OrthoInfo

4. Minimally Invasive Posterior Cervical Foraminotomy – muscle-splitting variant of foraminotomy PMC

5. Anterior Cervical Corpectomy & Fusion (ACCF) – removal of vertebral body & fusion for multilevel compression PMC

6. Anterior Transcorporeal Percutaneous Endoscopic Cervical Discectomy (ATPECD) – minimally invasive endoscopic herniation removal PubMed

7. Anterior Endoscopic Cervical Discectomy (AECD) – endoscopic disc removal via anterior approach E-Neurospine

8. Percutaneous Endoscopic Cervical Discectomy (PECD) – keyhole endoscopic removal of herniated tissue BioMed Central

9. Posterior Percutaneous Endoscopic Cervical Discectomy – endoscopic herniation removal via posterior route Annals of Translational Medicine

10. Posterior Cervical Laminoplasty – lamina “door” reconstruction to decompress spinal canal Wikipedia

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Prevention Strategies

1. Maintain good posture: head aligned over shoulders National Spine Health Foundation

2. Use ergonomic workstations & seating Dr. Stefano Sinicropi, M.D.

3. Practice safe lifting: bend at knees, not waist National Spine Health Foundation

4. Regular low-impact exercise (walking, swimming) Verywell Health

5. Neck and core strengthening under PT guidance National Spine Health Foundation

6. Avoid tobacco & limit alcohol Dr. Stefano Sinicropi, M.D.

7. Maintain healthy weight Dr. Stefano Sinicropi, M.D.

8. Stay hydrated & eat balanced diet Dr. Stefano Sinicropi, M.D.

9. Use supportive pillows & mattress Dr. Stefano Sinicropi, M.D.

10. Avoid prolonged bed rest; take frequent movement breaks Cleveland Clinic

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When to See a Doctor

Seek prompt evaluation if you experience:

• Severe or worsening pain unresponsive to 6–8 weeks of conservative care HealthCentral

• Progressive arm weakness or numbness impairing daily tasks HealthCentral

• Difficulty with fine motor skills (buttoning, writing) Verywell Health

• Signs of spinal cord involvement: gait disturbance, balance problems Verywell Health

• Bowel or bladder dysfunction (rare but urgent) Wikipedia

• Unexplained fever or weight loss suggesting infection/malignancy Wikipedia

• Night or rest pain disrupting sleep Cleveland Clinic

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FAQs

1. What is a cervical disc subarticular extrusion?
A subarticular extrusion is when the inner disc material escapes through a tear in the outer ring and pushes into the lateral recess beneath the facet joint, often pinching the nerve root Radiopaedia.

2. How does it differ from other disc herniations?
Unlike central or foraminal herniations, subarticular extrusions specifically invade the lateral recess, most often affecting the exiting nerve root Radiopaedia.

3. What are the hallmark symptoms?
Neck pain with sharp, electric-like radiation into the shoulder and arm, accompanied by numbness, tingling, and possible muscle weakness Spine-health.

4. Can it heal on its own?
Many cases improve with conservative care—PT, medications, activity modification—in 6–8 weeks, though severe extrusions may require further intervention HealthCentral.

5. How long is recovery?
Recovery time varies: conservative care often brings relief in 2–3 months; minimally invasive surgery (PECD) shows similar long-term outcomes at 5 years with quicker return to function MDPI.

6. Which exercises help?
Low-impact, guided strengthening (e.g., planks, bird-dog), stretching (cat-camel), and posture drills can ease pain and stabilize the cervical spine Verywell Health.

7. Are non-drug treatments effective?
Yes—physical therapy, traction, heat/cold, and manual techniques often relieve symptoms without side effects Cleveland Clinic.

8. When is surgery necessary?
Considered if severe neurological deficits persist, pain is unmanageable conservatively, or spinal stability is compromised Verywell Health.

9. What are surgical risks?
Risks include dysphagia, vocal cord issues, adjacent segment degeneration with fusion, infection, and hardware complications PMC.

10. Can injections help?
Epidural steroid injections often reduce inflammation and pain when conservative measures fail, though relief may be temporary HealthCentral.

11. Are there long-term complications?
Adjacent level degeneration can occur post-fusion at ~2.9% per year; motion-preserving arthroplasty may lower that risk PMC.

12. How can I prevent recurrence?
Maintain good posture, strengthen core/neck muscles, avoid tobacco, and use ergonomic supports to protect discs Dr. Stefano Sinicropi, M.D..

13. Is imaging always needed?
MRI is the gold standard for symptomatic cases; plain X-rays suffice for initial assessment Mayo Clinic.

14. What is the success rate of minimally invasive surgery?
PECD shows 88–91% excellent/good outcomes at 5 years with shorter operative times and hospital stays compared to ACDF BioMed Central.

15. Can I return to work or sports?
Most patients resume desk work within 2–4 weeks post-conservative care; after PECD, return to work in ~3 weeks; athletic return depends on sport and surgical type MDPI.

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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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