Can a cervical disc herniation be diagnosed based solely on MRI findings?

Cervical disc disease is a condition in which a disc between the neck vertebrae can irritate a nerve and cause pain, numbness or weakness extending through the neck and arm. However, disc changes are often found on imaging even without specific symptoms, so we do not determine the cause of current pain based solely on imaging findings.

Even in individuals without symptoms, disc changes can be commonly observed with aging; therefore, the diagnostic approach is determined by reviewing both the actual symptoms and the results of neurological examinations.

In cases where cervical disc herniation is suspected, symptoms such as numbness radiating to specific areas of the arm along with neck pain, a sensation of weakness in the hand, and worsening arm symptoms when moving or tilting the neck in certain directions may occur.

Not all cervical disc herniations require surgery; in many cases, conservative treatment can be considered first based on history taking and physical/neurological examinations.

If arm or leg strength progressively weakens, walking becomes unsteady, or fine hand movements become clumsy, the possibility that nerve compression is worsening must be assessed.

If symptoms appear on both sides in the arms or legs, or bowel or bladder control changes, prompt emergency evaluation is needed.

During the interview, we confirm the onset timing, location, and aggravating/alleviating movements of pain and numbness. Using physical examination to observe positions that reproduce neck movement and pain, and using neurological examination to check arm muscle strength, sensation, and reflexes.

Imaging studies are selectively considered when there are warning signs or when the results will change the treatment direction, for example, when symptoms persist or progress.

When there are no warning signs and restricted neck-joint movement and muscle tension appear related to the symptoms, a combination of Chuna manual therapy, acupuncture and pharmacopuncture may be considered. We do not aim for strong traction or rotation, but approach with an intensity appropriate to the patient's condition.

Once symptoms are stable, exercises to restore strength around the neck and shoulders are undertaken; if neurological abnormalities are progressing, consultation with another medical institution is recommended.