Herniated Cervical Intervertebral Disc at the C5–C6

A herniated cervical intervertebral disc at the C5–C6 level occurs when the soft inner core of the disc (nucleus pulposus) pushes through its tougher outer layer (annulus fibrosus), often pressing on nearby nerve roots or the spinal cord. This condition is one of the most common causes of neck pain and arm pain, and it can significantly affect daily activities such as turning the head, lifting objects, or even swallowing. Understanding the anatomy, causes, symptoms, and treatment options for a C5–C6 herniated disc empowers patients to make informed decisions, aids early diagnosis, and improves outcomes through timely, appropriate care.

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Anatomy of the C5–C6 Intervertebral Disc

Structure & Location

• Disc Composition: Each cervical intervertebral disc is a fibrocartilaginous joint situated between adjacent vertebral bodies. The annulus fibrosus is the outer, fibrous ring made of concentric collagen lamellae, while the nucleus pulposus is the inner gel-like core rich in proteoglycans and water KenhubRadiopaedia.

• C5–C6 Specifics: The C5–C6 disc sits between the fifth and sixth cervical vertebrae (C5 and C6). This segment bears significant motion load, making it prone to wear and tear over time Spine-health.

Origin & Insertion

• Unlike muscles, intervertebral discs don’t have “origins” and “insertions” in the classical sense. Instead, they are anchored by collagen fibres that attach the annulus fibrosus firmly to the vertebral endplates of C5 and C6. These attachments prevent disc slippage while allowing slight deformation under load Kenhub.

Blood Supply

• Avascular Core: In adults, the inner annulus fibrosus and the nucleus pulposus are essentially avascular.

• Peripheral Supply: Small blood vessels penetrate the outer third of the annulus fibrosus and vertebral endplates. Nutrients and oxygen diffuse from these vessels through the endplates to reach the inner disc regions KenhubSamarpan Physiotherapy Clinic.

Nerve Supply

• Sinuvertebral (Recurrent Meningeal) Nerves innervate the outer annulus fibrosus and vertebral endplates.

• These nerves carry pain signals when the disc is injured or herniated Kenhub.

 Key Functions

1. Shock Absorption
   The gel-like nucleus pulposus disperses compressive forces evenly across the disc, protecting adjacent vertebrae and the spinal cord Spine Info.

2. Load Distribution
   The annulus fibrosus helps spread mechanical loads over a wider area, preventing focal stress on the vertebral endplates.

3. Flexibility & Mobility
   The disc permits slight movement in flexion, extension, lateral bending, and rotation of the cervical spine.

4. Spacing of Vertebrae
   By maintaining intervertebral height, discs preserve the size of the neural foramina through which cervical nerve roots exit.

5. Protection of Neural Elements
   Discs cushion and protect the spinal cord and nerve roots from direct mechanical shock.

6. Growth & Development
   In children, discs contribute to spinal growth by allowing vertebral bodies to expand; this function diminishes after maturity Spine Info.

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2. Types of Disc Herniation

Based on how much disc material protrudes and whether it remains contained:

1. Bulging Disc
   The entire disc circumference extends beyond its normal boundary but without focal tear of the annulus fibrosus.

2. Protrusion
   Focal herniation where the herniated segment’s width is less than its base; the annulus is intact Radiology Assistant.

3. Extrusion
   The nucleus pulposus breaks through the annulus but remains connected to the parent disc; often non-contained.

4. Sequestration
   A fragment of nucleus pulposus separates completely and may migrate within the spinal canal Radiology Assistant.

5. Migration
   Displaced disc material moves away from the extrusion site, potentially causing symptoms at different levels.

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Causes

Each of the following can contribute to weakening or injury of the C5–C6 disc:

1. Age-Related Degeneration
   Discs lose water content and elasticity over time, making tears more likely Spine-health.

2. Repetitive Strain
   Frequent neck flexion, extension, or rotation stresses the annulus fibrosus.

3. Trauma
   Sudden impacts (e.g., car accidents, falls) can rupture the annulus.

4. Poor Posture
   Forward head posture increases pressure on cervical discs.

5. Heavy Lifting
   Lifting with improper technique transmits excessive load to the cervical spine.

6. Vibration Exposure
   Prolonged vibration (e.g., driving heavy machinery) accelerates degeneration.

7. Smoking
   Reduces blood supply and impairs nutrient diffusion, hastening disc breakdown.

8. Genetic Predisposition
   Family history increases risk of early disc degeneration.

9. Obesity
   Excess weight compounds mechanical stress on discs.

10. High-Impact Sports
    Activities like football or wrestling can cause microtrauma to discs.

11. Occupational Hazards
    Jobs requiring prolonged neck extension (e.g., plumbing, painting).

12. Connective Tissue Disorders
    Conditions like Ehlers-Danlos may weaken annular fibres.

13. Inflammatory Disorders
    Autoimmune inflammation (e.g., rheumatoid arthritis) can damage disc structures.

14. Infection
    Discitis (disc infection) may degrade annulus integrity.

15. Tumors
    Spinal tumours can directly invade disc tissue.

16. Previous Spinal Surgery
    Adjacent levels may herniate after fusion surgery at other segments.

17. Sedentary Lifestyle
    Weak neck and core muscles reduce spinal support.

18. Osteoarthritis
    Bone spur formation can impinge on the disc and annulus.

19. Dehydration
    Inadequate fluid intake impairs disc hydration.

20. Malnutrition
    Poor diet limits essential nutrients for disc maintenance Spine-health.

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Symptoms

Symptoms vary based on nerve root or spinal cord involvement:

1. Neck Pain
   Localized aching or sharp pain around C5–C6.

2. Radiating Arm Pain
   Sharp, shooting pain down the shoulder, arm, and into the thumb (C6 distribution) WebMDSpine-health.

3. Numbness & Tingling
   “Pins and needles” in the shoulder, arm, or hand.

4. Muscle Weakness
   Difficulty lifting objects or performing simple tasks like buttoning a shirt.

5. Reflex Changes
   Diminished biceps or brachioradialis reflex on the affected side.

6. Muscle Spasms
   Involuntary contractions of neck and shoulder muscles.

7. Stiff Neck
   Reduced range of motion in flexion/extension and rotation.

8. Headaches
   Pain at the base of skull radiating forward.

9. Scapular Pain
   Dull ache between shoulder blades.

10. Hand Grip Weakness
    Trouble gripping or pinching small objects.

11. Fine Motor Loss
    Difficulty with handwriting or using utensils.

12. Balance Issues
    If spinal cord is compressed, unsteady gait may occur.

13. Shock-Like Sensations
    Electric, “Zinger” pain down the arm.

14. Night Pain
    Discomfort waking the patient from sleep.

15. Shoulder Atrophy
    Wasting of shoulder muscles over time.

16. Myelopathic Signs
    Hyperreflexia or clonus if the spinal cord is involved.

17. Sensory Loss
    Decreased touch or temperature sensation in C6 dermatome.

18. Radiographic Findings
    MRI may show herniation without symptoms (incidental finding).

19. Autonomic Changes
    Rarely, sweating changes in the arm.

20. Chronic Fatigue
    Due to persistent pain and sleep disturbance Spine-health.

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Diagnostic Tests

1. Clinical History & Physical Exam
   Initial evaluation of pain patterns, reflexes, and strength.

2. Spurling’s Test
   Neck extension with rotation reproduces radicular pain.

3. Lhermitte’s Sign
   Electric shock sensation on neck flexion indicates cord involvement.

4. MRI Scan
   Gold standard for visualizing disc herniation and nerve compression Spine-health.

5. CT Scan
   Defines bony anatomy and osteophyte formation.

6. X-Ray
   Reveals alignment, disc space narrowing, and calcifications.

7. Myelography
   Contrast injection highlights spinal canal blockages.

8. Electromyography (EMG)
   Detects nerve conduction delays in affected muscles.

9. Nerve Conduction Study (NCS)
   Measures signal speed in peripheral nerves.

10. Discography
    Provocative injection to confirm discogenic pain source.

11. Bone Scan
    Rules out infection or tumour in ambiguous cases.

12. Ultrasound
    Emerging tool for guided injections, less common for diagnosis.

13. Laboratory Tests
    ESR/CRP to exclude inflammatory or infectious causes.

14. Flexion/Extension Radiographs
    Assess segmental instability.

15. Upper Limb Tension Test
    Evaluates nerve root sensitivity.

16. Pulsed Echo Test
    Less common; assesses annular tears.

17. Vibration Sense Testing
    Assesses dorsal column involvement.

18. Sensory Pinprick Testing
    Maps dermatomal distribution of numbness.

19. Grip Strength Dynamometry
    Quantifies hand weakness.

20. Gait Analysis
    Evaluates myelopathic signs if cord compressed NCBI.

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Non-Pharmacological Treatments

1. Rest & Activity Modification

2. Ice & Heat Therapy

3. Cervical Traction

4. Physical Therapy

5. Therapeutic Exercise

6. Massage Therapy

7. Chiropractic Adjustments

8. Acupuncture

9. Yoga & Pilates

10. Posture Education

11. Ergonomic Workstation Setup

12. Cervical Collar Use

13. Transcutaneous Electrical Nerve Stimulation (TENS)

14. Ultrasound Therapy

15. Spinal Decompression (Inversion Table)

16. Hydrotherapy

17. Core Strengthening

18. Aerobic Exercise

19. Walking Programs

20. Weight Management

21. Smoking Cessation

22. Nutritional Counseling

23. Stress Reduction Techniques

24. Biofeedback

25. Soft Tissue Mobilization

26. Kinesio Taping

27. Dry Needling

28. Flexibility Drills

29. Ergonomic Lifting Training

30. Mind-Body Therapies
    All of these aim to reduce mechanical stress on the C5–C6 segment, improve muscle support, and alleviate pain Spine-health.

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Drugs

1. Ibuprofen (NSAID)

2. Naproxen (NSAID)

3. Diclofenac (NSAID)

4. Celecoxib (COX-2 inhibitor)

5. Acetaminophen (Analgesic)

6. Tramadol (Opioid analgesic)

7. Oxycodone (Opioid)

8. Hydrocodone (Opioid)

9. Cyclobenzaprine (Muscle relaxant)

10. Tizanidine (Muscle relaxant)

11. Baclofen (Muscle relaxant)

12. Gabapentin (Neuropathic pain)

13. Pregabalin (Neuropathic pain)

14. Amitriptyline (Neuropathic pain)

15. Duloxetine (Neuropathic pain)

16. Prednisone (Oral corticosteroid)

17. Methylprednisolone (Oral corticosteroid)

18. Lidocaine Patch

19. Capsaicin Cream

20. Epidural Corticosteroid Injection
    Medications are chosen based on pain severity, side-effect profile, and patient comorbidities Mayo Clinic.

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Surgeries

1. Anterior Cervical Discectomy and Fusion (ACDF)
   Removes disc and fuses C5–C6 with bone graft and possibly hardware Wikipedia.

2. Cervical Disc Arthroplasty
   Artificial disc replacement preserves motion.

3. Posterior Cervical Foraminotomy
   Enlarges nerve exit foramen from a posterior approach.

4. Posterior Cervical Laminectomy
   Removes part of the vertebral arch to decompress the spinal cord.

5. Laminoplasty
   Hinged opening of the lamina to expand the spinal canal.

6. Anterior Corpectomy
   Removal of the vertebral body and adjacent discs with fusion.

7. Microdiscectomy
   Minimally invasive removal of herniated disc fragment.

8. Endoscopic Discectomy
   Endoscope-assisted removal through a small incision.

9. Posterior Spinal Fusion
   Fusion of adjacent vertebrae from the back of the neck.

10. Combined Anterior-Posterior Fusion
    For complex, multilevel decompression and stabilization Mayo Clinic.

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Preventions

1. Maintain Good Posture

2. Ergonomic Workstation

3. Use Safe Lifting Techniques

4. Regular Exercise & Stretching

5. Healthy Body Weight

6. Proper Nutrition & Hydration

7. Smoking Cessation

8. Frequent Activity Breaks

9. Neck Muscle Strengthening

10. Stress Management
    Prevention focuses on reducing cumulative stress and maintaining spinal health Mayo Clinic.

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When to See a Doctor

• Severe or Persistent Pain lasting more than 4–6 weeks despite conservative care.

• Progressive Neurological Deficits: worsening weakness, numbness, or reflex changes.

• Signs of Myelopathy: gait disturbance, loss of fine motor skills, or bowel/bladder dysfunction.

• Unremitting Night Pain that disrupts sleep.

• Systemic Symptoms: fever, unexplained weight loss, suggestive of infection or malignancy.

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FAQs

1. What is a C5–C6 herniated cervical disc?
   It’s a condition where the inner disc material at the fifth and sixth cervical vertebrae bulges or ruptures, pressing on nerves or the spinal cord.

2. What are the first signs?
   Early signs include neck pain and radiating arm pain in the C6 dermatome (thumb side).

3. How is it diagnosed?
   Diagnosis combines a clinical exam, MRI imaging, and sometimes EMG/NCS to confirm nerve compression.

4. Can it heal on its own?
   Many herniations improve with rest, physical therapy, and medications over 4–6 months.

5. When is surgery needed?
   Surgery is considered if severe pain, progressive weakness, or myelopathy persists after 6–12 weeks of conservative treatment.

6. Which surgery is best?
   ACDF is most common; disc arthroplasty is an option if motion preservation is desired.

7. What exercises help?
   Gentle neck stretches, isometric strengthening, and postural corrections under a therapist’s guidance.

8. Will I lose neck motion after fusion?
   Fusion reduces motion at that level but overall neck mobility often remains acceptable due to compensation by adjacent levels.

9. Are there long-term risks?
   Adjacent segment degeneration can occur years later due to altered biomechanics.

10. Can I drive?
    Avoid driving during acute pain or while taking narcotics; resume when neck mobility and reflexes normalize.

11. Is epidural steroid injection safe?
    Generally safe, but carries small risks of infection or nerve injury; often effective for pain relief.

12. How soon can I work out?
    Most begin gentle therapy after 2–4 weeks; high-impact sports should wait until cleared by a specialist.

13. Does smoking affect recovery?
    Yes—smoking impairs disc nutrition and slows fusion after surgery.

14. What if I have sudden loss of bladder control?
    This is an emergency—seek immediate medical attention for possible spinal cord compression.

15. How can I prevent recurrence?
    Maintain good posture, perform regular strengthening exercises, and avoid risky lifting techniques.

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 28, 2025.

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