Cervical C5–C6 Disc Sequestration

Cervical C5–C6 Disc Sequestration is an advanced form of cervical disc herniation in which a fragment of the nucleus pulposus completely separates from the parent intervertebral disc and migrates into the epidural space. This “free fragment” no longer maintains continuity with the original disc, and its migration can occur cranially, caudally, or laterally, often leading to nerve root or spinal cord compression and significant symptoms Radiopaedia.

Anatomy of the C5–C6 Intervertebral Disc

Structure & Composition

The C5–C6 intervertebral disc consists of:

• Nucleus pulposus: a gelatinous core rich in water and proteoglycans, providing shock absorption.

• Annulus fibrosus: concentric layers of fibrocartilage that contain the nucleus and resist tensile forces.

• Cartilaginous endplates: thin layers anchoring the disc to the superior and inferior vertebral bodies NCBI.

Location

Situated between the fifth (C5) and sixth (C6) cervical vertebrae in the lower neck, this disc bears significant axial load and permits flexion–extension and rotation of the head and neck Spine-health.

Origin & Insertion

Though discs are not muscles, they “attach” via endplates:

• Superior attachment: to the inferior endplate of C5.

• Inferior attachment: to the superior endplate of C6.
  These cartilaginous interfaces allow nutrient diffusion and slight movement.

Blood Supply

The disc is largely avascular centrally. Peripheral annular fibers receive blood from the vertebral arteries via small metaphyseal branches; diffusion through endplates nourishes central regions Home | UConn Health.

Nerve Supply

Sensory innervation arises from the sinuvertebral (recurrent meningeal) nerves, which penetrate the outer annulus fibrosus. They transmit pain signals when the annulus is torn or inflamed NCBI.

Key Functions

1. Shock Absorption: Gel-like nucleus cushions axial loads.

2. Load Distribution: Spreads compressive forces evenly across vertebral bodies.

3. Flexibility: Allows controlled bending and rotation of the neck.

4. Height Maintenance: Preserves intervertebral space for nerve root passage.

5. Tension Resistance: Annulus fibers resist tensile stresses during movement.

6. Spinal Stability: Works with ligaments and muscles to maintain alignment Spine-health.

Types of Sequestrated Disc Fragments

Sequestrated fragments are classified by their location and migration pattern:

• Paracentral sequestration: fragment lies just off midline.

• Foraminal sequestration: within the intervertebral foramen, often causing radiculopathy.

• Extraforaminal sequestration: migrates beyond the foramen, compressing exiting nerve roots.

• Cranially migrated: fragment moves upward.

• Caudally migrated: fragment moves downward.

• Intradural sequestration (rare): fragment pierces the dura mater into the subarachnoid space Radiopaedia.

Causes

1. Age-related degeneration – disc dehydration and annular tears onsen.eu

2. Repetitive microtrauma – poor posture, occupational hazards

3. Acute trauma – falls, motor vehicle collisions

4. Heavy lifting – axial overload

5. Twisting injuries – sudden rotational forces

6. Smoking – impairs disc nutrition

7. Obesity – increases mechanical stress

8. Genetic predisposition – familial disc disease

9. Sedentary lifestyle – disc deconditioning

10. Poor ergonomics – workstation/posture issues

11. Nutritional deficiencies – vitamin D, protein

12. Inflammatory arthritides – RA, ankylosing spondylitis

13. Previous cervical surgery – altered biomechanics

14. High-impact sports – contact injuries

15. Spinal infections – weaken disc structures

16. Metabolic disorders – diabetes mellitus

17. Endplate damage – microfractures

18. Ligamentous laxity – hypermobility syndromes

19. Spinal tumors – invade or erode disc

20. Radiation exposure – disc tissue damage Home | UConn Healthonsen.eu.

Symptoms

1. Severe neck pain – often unilateral (C5–C6 level) NCBI

2. Radiating arm pain – follows C6 dermatome to thumb/index finger

3. Paresthesia – tingling/numbness in thumb/forearm

4. Muscle weakness – biceps, wrist extensors drkevinpauza.com

5. Diminished reflexes – biceps and brachioradialis

6. Spasm of trapezius/neck muscles

7. Reduced range of motion – pain on flexion/extension

8. Crepitus – crackling during movement

9. Headaches – cervicogenic type

10. Shoulder pain – referred from cervical roots

11. Grip weakness

12. Arm heaviness

13. Radicular shooting pain – sharp, electric-like

14. Muscle atrophy – chronic denervation

15. Balance issues – if cord involved

16. Hyperreflexia – upper motor neuron signs

17. Gait disturbance – in severe myelopathy

18. Bladder/bowel dysfunction – rare, severe cases

19. Night pain – wakes patient from sleep

20. Pain relief with neck extension – positional NCBIVerywell Health.

Diagnostic Tests

1. Detailed history & physical exam – red flags

2. MRI (gold standard) – visualizes fragment & cord compression NCBI

3. CT scan – bony anatomy, calcified fragments

4. X-rays – alignment, degenerative changes

5. Myelography – contrast-enhanced CSF spaces

6. Flexion–extension radiographs – assess instability

7. EMG/NCS – nerve root function

8. SSEPs – spinal cord conduction

9. Discogram – provocative disc testing

10. Ultrasound – dynamic soft-tissue view

11. Bone scan – rule out infection/tumor

12. Dynamic MRI – positional changes

13. CT myelogram – detailed nerve root imaging

14. Laboratory tests – inflammatory markers

15. Electromyography – muscle denervation

16. Somatosensory evoked potentials

17. Visual evoked potentials – if myelopathy suspected

18. Blood glucose/HbA1c – metabolic comorbidities

19. Vitamin D levels – bone health

20. Nutritional panel – overall health status RadiopaediaNCBI.

Non-Pharmacological Treatments

1. Physical therapy – posture, muscle balance Spine-health

2. Cervical traction – unloads disc space

3. Chiropractic manipulation

4. Acupuncture

5. Massage therapy

6. Heat & cold therapy

7. Transcutaneous electrical nerve stimulation (TENS)

8. Yoga & Pilates

9. Ergonomic workstation adjustments

10. Postural training devices

11. Cervical collar (short-term)

12. Activity modification

13. Spinal decompression tables

14. Inversion therapy

15. Ultrasound therapy

16. Electro-stimulation

17. Kinesio taping

18. Hydrotherapy

19. Occupational therapy

20. Manual mobilization/manipulation

21. Dry needling

22. Cognitive behavioral therapy (CBT)

23. Relaxation techniques

24. Weight management

25. Smoking cessation support

26. Nutritional counseling

27. Vitamin D/calcium optimization

28. Ergonomic sleep systems

29. Neck exercise devices

30. Education on body mechanics alleviatepainclinic.comSpine-health.

Commonly Used Drugs

1. Acetaminophen – mild analgesia

2. NSAIDs (ibuprofen, naproxen) – anti-inflammatory Scoliosis Reduction Center®

3. Muscle relaxants (cyclobenzaprine, baclofen)

4. Corticosteroids (oral or epidural injection) alleviatepainclinic.com

5. Opioids (tramadol, oxycodone) – short-term

6. Gabapentin – neuropathic pain Verywell Health

7. Pregabalin

8. Amitriptyline

9. Duloxetine

10. Carbamazepine

11. Topiramate

12. Tizanidine

13. Cyclobenzaprine

14. Lidocaine patch

15. Capsaicin cream

16. Hydrocodone/acetaminophen

17. Codeine/acetaminophen

18. Methocarbamol

19. Ketorolac

20. Ketamine (low-dose infusion) drkevinpauza.comScoliosis Reduction Center®.

Surgical Options

1. Anterior Cervical Discectomy and Fusion (ACDF) David Barnett MD

2. Posterior cervical foraminotomy

3. Cervical disc arthroplasty (artificial disc)

4. Posterior laminectomy

5. Microscopic anterior discectomy

6. Percutaneous endoscopic cervical discectomy

7. Laminoplasty

8. Corpectomy

9. Posterior cervical fusion

10. Minimally invasive microendoscopic discectomy Radiopaedia.

 Prevention Strategies

1. Maintain neutral neck posture during work onsen.eu

2. Ergonomic workstation setup

3. Regular exercise – strengthen neck/back

4. Core stabilization

5. Proper lifting techniques

6. Optimal body weight

7. Smoking cessation

8. Adequate hydration & nutrition

9. Frequent breaks from static positions

10. Supportive sleep systems (pillow/mattress) onsen.euRadiopaedia.

When to See a Doctor

Seek prompt evaluation if you experience:

• Progressive weakness in arms or hands

• Loss of fine motor skills (e.g., buttoning)

• Severe, unremitting pain not relieved by medication

• Bowel or bladder dysfunction

• Signs of myelopathy: gait instability, hyperreflexia NCBIPMC.

Frequently Asked Questions

1. What exactly is disc sequestration?
   A free fragment of disc nucleus completely separates and migrates into the epidural space, often compressing nerve roots Radiopaedia.

2. How does sequestration differ from protrusion or extrusion?
   Protrusion: bulge without annular tear.
   Extrusion: nucleus breaks through annulus but remains attached.
   Sequestration: fragment fully detached Verywell Health.

3. Why is C5–C6 most commonly affected?
   It bears high load and allows greatest neck motion, making it prone to degeneration Spine-health.

4. Can sequestrated fragments reabsorb naturally?
   Yes, small fragments may be phagocytosed over weeks to months, reducing symptoms Dr. Jeffrey James & Associates.

5. What is the gold-standard diagnostic test?
   MRI with contrast best visualizes free fragments and nerve compression NCBI.

6. Are non-surgical treatments effective?
   Many patients improve with PT, traction, and pain management, especially if no significant weakness alleviatepainclinic.com.

7. When is surgery recommended?
   Intractable pain, progressive neurological deficits, or myelopathy signs David Barnett MD.

8. What does ACDF involve?
   Removal of the disc via an anterior approach, fusion with bone graft/plate to stabilize segments David Barnett MD.

9. What are surgery risks?
   Infection, adjacent segment disease, hardware failure, persistent pain David Barnett MD.

10. How long is recovery after ACDF?
    Most return to light activities in 4–6 weeks; full fusion in 3–6 months David Barnett MD.

11. Can exercises worsen the condition?
    Improper or aggressive exercises may exacerbate pain; always follow a guided PT program Spine-health.

12. Is cervical disc arthroplasty better than fusion?
    Arthroplasty preserves motion but has strict candidate criteria; long-term outcomes are comparable David Barnett MD.

13. How can I prevent recurrence?
    Maintain ergonomic posture, regular exercise, avoid smoking, and adhere to spine-safe techniques onsen.eu.

14. Do sequestrated fragments always cause symptoms?
    Some fragments are asymptomatic if they don’t impinge nerves Verywell Health.

15. When should I consider a second opinion?
    If recommended surgery is high-risk or if symptoms persist despite treatment, seek specialist consultation PMC.

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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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