【Overview】 Cervical disc herniation is mostly caused by acute or repeated and minor trauma, and the ruptured disc protrudes posteriorly and laterally, compressing the cervical spinal nerve or cervical spinal cord and causing symptoms. The intervertebral disc is composed of the nucleus pulposus, the fibrous ring and the cartilage plate. The total height of the cervical disc is 20%-25% of the total height of the cervical spine, and it is higher at the front than at the back, so that the cervical spine is physiologically convex. The cervical vertebrae, especially the lower cervical vertebrae, are susceptible to strain and degenerative changes due to greater weight bearing, more activities, and connection with the relatively fixed thoracic vertebrae. After degeneration of the fibrous ring, its fibers first swell and thicken, then undergo glass-like degeneration, and finally fracture. As the elasticity of the degenerated annulus fibrosus decreases, it is unable to withstand the tension within the intervertebral disc. When affected by gravity in head flexion and extension, muscle pull, and trauma, not only can the annulus fibrosus expand outward, but the nucleus pulposus can also protrude backward through the ruptured annulus fibrosus fissure. Zheng Lin of the Department of Orthopedics and Traumatology, Gucheng County People’s Hospital According to the location of the disc protrusion into the spinal canal, it can be divided into the following types. 1. Lateral type: the protrusion site is on the lateral side of the posterior longitudinal ligament and the medial side of the hook and cone joint. This is where the cervical spinal nerve roots pass, and the herniated disc compresses the spinal nerve roots and produces radicular symptoms. 2. Paracentral: The herniated site is on one side and is between the spinal nerve roots and the spinal cord. It can compress both and produce unilateral spinal cord and nerve root compression symptoms. 3. Central type: The herniated site is in the center of the spinal canal, directly in front of the spinal cord. It can compress the ventral surface of the spinal cord bilaterally and produce compression symptoms of the spinal cord bilaterally. Diagnostic points] I. Medical history Mostly seen in middle-aged and middle-aged people over 30 years old, without obvious history of trauma, with a slow onset and a few due to acute trauma. Neck, shoulder, and arm pain is light at first, but gradually gets heavier and radiates to one or both shoulders, arms, and hands. Coughing and sneezing can aggravate the pain. The symptoms can be prolonged and can recur. Clinical signs The disease occurs in about 94% of cervical 6 and 7 and cervical 5 and 6 intervertebral discs, and the clinical manifestations are not consistent due to different sites of disc herniation and different tissues of compression. (i) Lateral herniation of the disc There is pressure pain between the spinous processes at the site of herniation, and some patients have painful squint, cervical muscle spasm and limitation of neck movement. Neck pain and radiating pain are aggravated by pressure on the top of the head, and pain is relieved by upward traction on the M and occipital regions. Cervical nerve root pull and disc compression tests were positive. There are changes in sensation, movement and reflexes in the area innervated by the affected nerve segment. In some cases, there is muscle weakness and muscle atrophy. (b) Paracentral disc herniation In addition to the signs of lateral disc herniation, there are also symptoms of unilateral spinal cord compression, i.e., typical or atypical Brown~Squam’s syndrome. (iii) Central disc herniation There is no manifestation of cervical spinal cord nerve root involvement. There are different degrees of damage to the long tract of the spinal cord at or below the spinal cord compression segment, such as gait instability or lower limb paralysis, and some patients may have urinary disorders. It is less common. X-ray examination shows scoliosis deformity of the cervical spine and reduction or disappearance of physiological anterior convexity. There may be different degrees of osteophytes on the upper and lower edges of the vertebral body, and the intervertebral foramen becomes smaller. The cervical myelogram shows the loss of the root cuff and the arcuate defect of the disc protruding backwards.CT examination can show the protrusion of the disc at the lesion site and its relationship with the cervical spinal cord and nerve roots. Differential diagnosis】 When diagnosing cervical disc herniation, it must be differentiated from cervical spondylosis and anterior oblique muscle syndrome. Diagnostic hints】 The disease is mostly seen in men aged 30~40 years old, with single occurrence. Patients often have posterior neck pain, with relief from bed rest and worsening symptoms after activity. This symptom ebbs and flows with the movement of the intervertebral disc, which is a characteristic change of cervical disc herniation. The central herniated type of the disease is rare, and lateral herniation and paracentral herniation are predominant in clinical practice. CT examination can confirm the diagnosis of the disease. Treatment】 Cervical disc herniation is mainly treated with non-surgical comprehensive treatment. Through massage, traction and medication, most patients can obtain curative effect. I. Non-surgical treatment For mild symptoms, rest, physiotherapy, peri-collar and drugs can be used to treat the disease. Those with severe symptoms can be treated with cervical traction, generally with occipital M belt traction. In severe cases, traction should be carried out continuously in bed. Surgical treatment (a) Indications for surgery 1.Non-surgical treatment for a long time, the symptoms can not be relieved. 2. Long-term compression of nerve roots causing muscle atrophy. 3.Significant spinal cord compression symptoms, cerebrospinal fluid examination, spinal canal imaging is clearly caused by disc herniation obstruction. (2) Contraindications to surgery 1.Persons with serious cardiovascular or liver and kidney dysfunction. 2.Prior to adulthood, or over 70 years old with mild symptoms. 3.Suspected of tuberculosis, tumor, spinal cavity. 4.People with high degree of neurasthenia. 5.Patients with infected lesions on the skin or other parts of the body. (C) Surgical methods The former cervical disc nucleus pulposus removal and intervertebral body fusion are safe, easy to perform and effective. Therefore, this method is mostly used for patients with surgical indications. The combination of massage and traction can relax the muscles and relieve the spasm, so that the protruding disc can change its position or be returned, thus eliminating the pain and achieving the treatment purpose. Treatment Tips】 Cervical disc herniation is mainly treated non-surgically, and the treatment by manipulation is fast and the treatment by cervical traction is long-lasting. However, the manipulation should not be violent to avoid causing cervical spinal cord injury paralysis, and the weight and time of cervical traction should be comfortable for the patient. Do not traction with large weight quickly.