The spine is made up of a series of bones called “vertebrae” that are joined together. The vertebrae surround the spinal cord and protect it from damage. Nerve roots emanate from the spinal cord and travel to other parts of the body, allowing communication between the brain and the body. The brain can send signals down to the spinal cord, which then travels outward through the nerves to move the muscles. Nerves also send information from the body to the brain, such as pain and temperature. The vertebrae are connected by an intervertebral disc and two small joints called “vertebral tuberosities”. The intervertebral discs are composed of strong connective tissue that connects adjacent vertebrae and act as a cushion or shock absorber between the vertebrae. The discs and vertebral tuberosities allow the vertebrae to move, so your neck and back can bend and turn. The intervertebral disc consists of a tough outer “annulus fibrosus” and a central gelatinous “nucleus pulposus. As we age, the center of the disc begins to lose water, reducing the cushioning effect of the disc. As the disc degenerates, the outer layer also tears. This causes the nucleus pulposus to dislocate from the outer layer of the disc (called a herniated or ruptured disc) and the nucleus pulposus tissue to protrude from the rupture, compressing the nerves and spinal cord. A herniated disc pressing on a nerve can cause pain, numbness, tingling or weakness in your shoulder or arm. Your doctor may test for changes in reflexes, sensation and muscle strength in the arm caused by a herniated disc in the cervical spine. In rare cases, a herniated disc may compress the spinal cord and cause discomfort in the legs. How to Diagnose A thorough clinical evaluation to determine the nature and location of the pain, along with an examination of the neck and careful evaluation of any weakness, loss of sensation or abnormal reflexes, is usually all that is needed to diagnose and localize a herniated disc. The physician’s diagnosis can be confirmed by x-ray, CT or MRI. x-rays can show bone spurs and narrowing of the intervertebral spaces due to aging degeneration of the spine, but they cannot show herniated discs or nerve tissue within the spine. CT and MRI scans provide more detailed information on all spinal structures (spine, discs, spinal cord and nerves) and can identify most disc herniations. In addition, electromyography (nerve conduction) may be performed to look for signs or evidence of nerve damage caused by the herniated disc. What treatment options are available? Many patients with symptomatic cervical disc herniation can have their symptoms improve without any treatment. For patients with persistent pain, there are many other treatment options. There are many medications that can help reduce the pain associated with a cervical disc herniation. Many patients improve with “non-surgical” or “conservative” treatment. Your doctor may give you a non-surgical treatment plan that includes short periods of rest, wearing a neck brace, taking anti-inflammatory medications to reduce swelling, pain medications to control pain, physical therapy, exercise or epidural steroid injections. The goal of non-surgical treatment is to reduce nerve irritation from the herniated disc material, relieve pain, and improve the patient’s physical condition. Most patients with herniated discs can achieve these goals with regular conservative treatment combined with multiple therapies.