A herniated cervical intervertebral disc between C4 and C5, often called a “slipped” or “ruptured” disc at the C4–C5 level, occurs when the inner gel-like core (nucleus pulposus) pushes through a tear in the tougher outer ring (annulus fibrosus) and may press on nearby nerves or the spinal cord. Though less common than herniations at lower cervical levels, C4–C5 herniation can still cause significant neck pain, arm weakness, and sensory changes Herniated DiscWebMD.
Anatomy of the C4–C5 Intervertebral Disc
Structure & Composition
Each intervertebral disc is a fibrocartilaginous joint composed of:
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Annulus fibrosus: concentric layers of tough collagen fibers that contain and support the disc under pressure.
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Nucleus pulposus: a hydrated, gelatinous core rich in proteoglycans that absorbs shock.
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Cartilaginous endplates: thin hyaline cartilage layers that interface with the vertebral bodies, allowing nutrient exchange KenhubRadiopaedia.
Location
The C4–C5 disc sits between the fourth (C4) and fifth (C5) cervical vertebrae in the mid-neck, an area that permits forward, backward, and rotational movements Deuk Spine.
Origin & Insertion
Functionally, the disc “originates” at the inferior endplate of C4 and “inserts” onto the superior endplate of C5 through its cartilaginous endplates, anchoring it securely between the vertebrae Radiopaedia.
Blood Supply
Intervertebral discs are largely avascular; they rely on diffusion of nutrients and oxygen from capillaries in the adjacent vertebral endplates and surrounding vertebral bodies Kenhub.
Nerve Supply
Sensory fibers from the sinuvertebral (recurrent meningeal) nerves innervate the outer annulus and posterior longitudinal ligament, relaying pain sensations when the disc is stressed or injured TeachMe Orthopedics.
Functions
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Shock absorption: cushions forces from head and neck movements.
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Load distribution: spreads compressive loads evenly across vertebrae.
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Flexibility: allows flexion, extension, lateral bending, and rotation of the neck.
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Height maintenance: preserves intervertebral spacing and foraminal size for nerve roots.
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Spinal alignment: contributes to the natural cervical lordosis (inward curve).
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Protection: shields spinal cord and exiting nerve roots from direct vertebral pressure Spine InfoRadiopaedia.
Types of C4–C5 Disc Herniation
Disc herniations are classified by how much and where disc material protrudes:
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Bulging Disc: the annulus fibrosus balloons outward without tearing.
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Protrusion: inner nucleus pushes against intact annular fibers, creating a localized bulge.
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Extrusion: nucleus pulposus breaks through a tear but remains connected to the disc.
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Sequestration: a fragment of the nucleus separates and may migrate in the spinal canal.
They may also be described by location relative to the spinal canal:
Central, paracentral, foraminal, or extraforaminal herniations Verywell Healthphysiosunit.com.
Causes (Risk Factors)
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Age-related degeneration (disc dehydration and loss of elasticity) Clínic BarcelonaMayo Clinic
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Genetic predisposition to weak collagen fibers Mayo Clinic
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Smoking (impairs disc nutrition) Mayo Clinic
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Obesity (increases axial loading) Verywell Health
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Poor posture (forward head tilt adds stress) Clínic Barcelona
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Sedentary lifestyle (weak neck musculature) Clínic Barcelona
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Repetitive lifting or twisting (occupational hazards) Mayo Clinic
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Traumatic injury (falls, whiplash) Mayo Clinic
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Heavy manual labor (chronic overload) Riverside Health
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Vibration exposure (e.g., heavy machinery) Riverside Health
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High-impact sports (football tackles, gymnastics) Riverside Health
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Prolonged computer use (neck flexion) Riverside Health
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Radiation exposure (degenerative changes) Health tech for the digital age
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Steroid use (weakens disc structures) Health tech for the digital age
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Diabetes (microvascular damage to endplates) Riverside Health
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Connective tissue disorders (e.g., Ehlers–Danlos) Mayo Clinic
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Poor nutrition (inadequate building blocks for disc repair) Riverside Health
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Dehydration (reduces disc turgor) Clínic Barcelona
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Occupational driving (whole-body vibration) Riverside Health
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Previous disc herniation elsewhere (higher risk at other levels) Riverside Health.
Symptoms
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Neck pain (often sharp or throbbing) WebMD
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Stiffness reducing neck motion Acibadem HealthPoint
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Shoulder or scapular pain Spine-health
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Radicular arm pain following the C5 dermatome Spine-health
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Numbness or tingling in shoulder, arm, or hand WebMD
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Muscle weakness in the deltoid or biceps Spine-health
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Decreased reflexes (biceps reflex) Spine-health
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Muscle spasms in the neck and shoulder girdle Acibadem HealthPoint
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Occipital headaches Acibadem HealthPoint
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Loss of fine motor skills (difficulty with buttons) WebMD
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Balance issues (if spinal cord compressed) WebMD
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Lhermitte’s sign (electric shock sensation on neck flexion) Merck Manuals
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Hoffmann’s sign (finger flexion on flicking finger) Merck Manuals
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Gait disturbance (in severe myelopathy) WebMD
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Loss of bladder or bowel control (rare, emergency) WebMD
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Pain aggravated by coughing or sneezing Spine-health
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Night pain waking from sleep Acibadem HealthPoint
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Clumsiness dropping objects WebMD
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Muscle atrophy in chronic cases WebMD
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Cold intolerance in affected limb Spine-health.
Diagnostic Tests
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Patient history (onset, activities, prior neck issues) Spine-health
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Physical examination (palpation, range of motion) Spine-health
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Neurological exam (strength, sensation, reflexes) Merck Manuals
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Spurling’s test (neck extension + axial load provoking radicular pain) Barricaid Blog
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Lhermitte’s sign (shooting pain with neck flexion) Merck Manuals
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Hoffmann’s sign (thumb flexion test) Merck Manuals
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X-rays (rule out fracture, alignment, degenerative changes) Clínic Barcelona
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MRI (gold standard to visualize disc and nerve compression) neurosurgery.weillcornell.orgMayo Clinic
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CT scan (osseous detail, when MRI contraindicated) neurosurgery.weillcornell.orgClínic Barcelona
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CT myelogram (contrast-enhanced imaging for nerve root compression) Mayo Clinic
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Electromyography (EMG) (nerve conduction delays) Mayo Clinic
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Nerve conduction studies (quantify nerve root involvement) Mayo Clinic
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Discography (provocative injection reproducing pain) neurosurgery.weillcornell.org
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Bone scan (rule out infection, fracture) neurosurgery.weillcornell.org
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Ultrasound (for soft-tissue guidance) neurosurgery.weillcornell.org
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Provocative maneuvers (e.g., shoulder abduction relief sign) Spine-health
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Cervical traction trial (if symptom relief occurs, suggests discogenic pain) neurosurgery.weillcornell.org
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Functional fluoroscopy (dynamic assessment of instability) neurosurgery.weillcornell.org
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Laboratory tests (rule out inflammatory or infectious causes) Merck Manuals
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Pulmonary function tests (if respiratory compromise suspected in high cervical cord compression) neurosurgery.weillcornell.org.
Non-Pharmacological Treatments
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Rest (short-term activity modification) Spine-health
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Ice therapy (reduce inflammation) Spine-health
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Heat therapy (muscle relaxation) Spine-health
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Physical therapy (strength, flexibility) Spine-health
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McKenzie exercises (directional preference) The Spine Institute CSR
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Isometric neck exercises Verywell Health
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Cervical traction (mechanical or manual) Verywell Health
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Soft cervical collar (short-term support) Spine-health
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Transcutaneous electrical nerve stimulation (TENS) Spine-health
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Massage therapy (trigger point release) Spine-health
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Acupuncture Spine-health
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Ultrasound therapy The Spine Institute CSR
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Spinal manipulation (chiropractic)
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Yoga (neck-friendly poses) Verywell Health
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Pilates (core stabilization) Verywell Health
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Aquatic therapy Verywell Health
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Inversion therapy Verywell Health
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Alexander Technique Cervical Herniated Disc
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Posture retraining Spine and Pain Clinics of North America
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Ergonomic adjustments (workstation setup) Spine and Pain Clinics of North America
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Core strengthening (abdominals, back extensors) Verywell Health
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Weight management Verywell Health
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Psychological counseling (coping strategies) Cervical Herniated Disc
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Biofeedback Wikipedia
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Kinesio taping Cervical Herniated Disc
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Occupational therapy (adaptive techniques) The Spine Institute CSR
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Sleep position modification (neck support pillows) Cervical Herniated Disc
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Mindfulness meditation Spine-health
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Nutritional counseling (anti-inflammatory diet) Riverside Health
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Education (ergonomics, body mechanics) Spine-health.
Drug Treatments
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Acetaminophen (Tylenol) – mild analgesic for neck pain axionspine.com
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Ibuprofen (Advil) – NSAID to reduce pain and inflammation HealthCentral
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Naproxen (Aleve) – longer-acting NSAID HealthCentral
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Aspirin – anti-inflammatory and analgesic
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Diclofenac – prescription NSAID for moderate pain
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Celecoxib (Celebrex) – COX-2 inhibitor with fewer GI side effects
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Meloxicam – NSAID with once-daily dosing
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Indomethacin – potent NSAID for acute flare-ups
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Ketorolac – injectable NSAID for severe pain
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Cyclobenzaprine (Flexeril) – muscle relaxant for spasms Dr. Kevin Pauza
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Baclofen – spasticity-targeted muscle relaxant
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Tizanidine – short-acting spasmolytic
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Methocarbamol – central muscle relaxant
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Carisoprodol (Soma) – muscle relaxant for acute spasm
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Gabapentin (Neurontin) – neuropathic pain agent Medscape
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Pregabalin (Lyrica) – pain modulator for nerve root irritation
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Amitriptyline – TCA for chronic radicular pain
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Duloxetine (Cymbalta) – SNRI for neuropathic components
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Tramadol – weak opioid for moderate to severe pain axionspine.com
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Prednisone – short-course oral steroid to reduce nerve root inflammation Spine-health.
Surgical Options
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Anterior Cervical Discectomy and Fusion (ACDF) – remove disc and fuse C4–C5 David Barnett MDCleveland Clinic
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Anterior Cervical Disc Arthroplasty (Disc Replacement) – remove and replace with artificial disc Verywell Health
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Posterior Cervical Foraminotomy – enlarge nerve exit canal via posterior approach Spine-health
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Posterior Cervical Discectomy – remove herniated fragment from back of spine Spine-health
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Laminoplasty – hinge opening of lamina to decompress spinal cord
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Laminectomy – remove lamina to relieve cord compression
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Corpectomy – remove vertebral body and adjacent discs for multilevel decompression
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Microendoscopic Discectomy – minimally invasive disc removal
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Endoscopic Anterior Discectomy – small-portal front approach
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Spinal fusion with instrumentation – stabilize multiple levels David Barnett MD.
Prevention Strategies
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Maintain good posture – neutral cervical alignment Spine and Pain Clinics of North America
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Ergonomic workspace – monitor at eye level, supportive chair Spine and Pain Clinics of North America
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Regular exercise – strengthen neck and core Verywell Health
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Use proper lifting techniques – bend hips/knees, not back Spine and Pain Clinics of North America
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Weight management – reduce disc loading Verywell Health
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Quit smoking – improve disc nutrition Mayo Clinic
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Stay hydrated – maintain disc water content Clínic Barcelona
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Stretch before activity – prepare soft tissues Verywell Health
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Use a supportive pillow – cervical contour to support neck
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Take frequent breaks – avoid prolonged static neck positions Spine and Pain Clinics of North America.
When to See a Doctor
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Severe or worsening pain lasting >6 weeks despite treatment.
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Progressive neurological deficits (weakness, numbness).
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Loss of bowel/bladder control (emergency).
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Signs of spinal cord compression (balance problems, gait changes).
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Acute severe trauma to the neck.
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Red-flag symptoms like fever (infection) or unexplained weight loss (tumor) WebMDMerck Manuals.
Frequently Asked Questions
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What causes a C4–C5 disc herniation?
Wear-and-tear degeneration, poor posture, sudden trauma, or repetitive stress can weaken the annulus fibrosus, allowing the nucleus pulposus to herniate at C4–C5 Clínic BarcelonaMayo Clinic. -
How is a C4–C5 herniated disc diagnosed?
Through patient history, physical exam (Spurling’s test, neurological assessment), and imaging—especially MRI, which clearly shows disc and nerve involvement neurosurgery.weillcornell.orgMayo Clinic. -
Can a herniated C4–C5 disc heal on its own?
Yes—many improve with conservative care (physical therapy, rest) over 4–6 weeks as inflammation subsides and the disc resorbs partially Spine-health. -
What exercises help a C4–C5 disc herniation?
McKenzie extension exercises, gentle isometrics, cervical retractions, and core stabilization are often prescribed to unload the disc and strengthen supporting muscles Verywell Health. -
When is surgery necessary?
Surgery is considered if there is progressive neurological loss, intractable pain despite 6–12 weeks of conservative care, or acute spinal cord compression Verywell Health. -
What is ACDF?
Anterior Cervical Discectomy and Fusion involves removing the herniated disc via a front-of-neck incision and fusing C4–C5 with a bone graft or cage to stabilize the spine Cleveland Clinic. -
What are the risks of cervical disc surgery?
Potential risks include infection, nerve injury, swallowing difficulties, non-union (failed fusion), and adjacent-level degeneration Cleveland Clinic. -
How long is recovery after ACDF?
Most patients wear a soft collar briefly and can resume light activities in days; full fusion and return to normal activities take 6–12 weeks Verywell Health. -
Are there alternatives to fusion?
Yes—cervical disc arthroplasty (artificial disc replacement) preserves motion and may reduce adjacent-level stress Verywell Health. -
What medications relieve C4–C5 herniation pain?
NSAIDs, muscle relaxants, neuropathic agents (gabapentin), short-term opioids, and corticosteroids as needed for flare-ups HealthCentralMedscape. -
Is rest always recommended?
Short-term rest (1–2 days) can ease acute pain, but prolonged inactivity risks muscle weakening; gradual return to activity is best Spine-health. -
Can posture correction prevent recurrence?
Yes—maintaining neutral neck alignment at work and during activities reduces disc stress and recurrence risk Spine and Pain Clinics of North America. -
What is the difference between a bulging and herniated disc?
A bulge involves symmetric outward expansion of the annulus without tearing, while herniation implies a focal tear through which nucleus material extrudes Verywell Health. -
How do I sleep with a disc herniation?
Use a cervical contour pillow and sleep on your back or side with moderate pillow support under the neck Cervical Herniated Disc. -
Can weight loss help?
Reducing excess body weight decreases axial loads on cervical discs, thereby lowering herniation risk and aiding recovery Verywell Health.
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The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members
Last Updated: April 28, 2025.