Orthopedic Surgery

Dec. 02, 2025

In this article, Arjun S. Sebastian, M.D., an orthopedic surgeon specializing in spinal injury at Mayo Clinic in Rochester, Minnesota, talks about the common, yet sometimes challenging to diagnose, condition of a cervical herniated disk. He talks about how surgeons can offer far more than operations to help alleviate patients' pain and help them return to their usual activities.

What symptoms do patients with cervical herniated disk commonly present with, and what causes them?

The most common symptoms with which these patients present are pain and numbness in the upper extremities. When there is a disk herniation, a tear occurs in the outer covering of the disk, causing the nucleus to come out and put pressure on the nerve, leading to pain and inflammation, or radiculopathy. This is essentially mechanical compression.

During physical evaluation of these patients, we often pick up sensory deficits in the upper extremities or nerve weaknesses.

What are the demographics of patients with this injury?

Patients with cervical herniated disk are in all age groups — there is no group more affected than others. This injury also affects both sexes equally. As far as professions go, people who do certain manual types of work, such as electricians or plumbers, can have more strain on the neck with flexion and extension.

What increases patients' risk of cervical herniated disk?

The No. 1 factor that increases the risk of this injury is a poor ergonomic setup at work. For those who use computers or other electronic devices, they need to be mindful and use them in an ergonomic way.

If individuals are in an occupation that requires neck flexion or extension, they or their employers can get devices to help with this.

Why are cervical herniated disks tricky to diagnose?

This condition can be difficult to diagnose due to its symptomatic overlap with other conditions, such as ulnar nerve issues. This is why we feel it is advantageous to refer patients with numbness or pain in the extremities to a center such as Mayo Clinic where we have a whole team composed of different specialists who work together to arrive at a diagnosis.

In our case, Mayo Clinic orthopedic spine surgeons have some overlap with the neurosurgical spine practice, so we collaborate: We have a combined spine meeting to discuss patient cases, and we consult with each other regularly.

What would you say are the primary causes of cervical herniated disk?

This injury does not require the mechanism of trauma. It can even arise from causes such as "tech neck" or cervical kyphosis from leaning toward a device for many hours.

When the mechanism of this injury is trauma, most commonly it occurs through:

• Sports injury, especially in basketball and football.
• Accidents, such as a fall or a motor vehicle crash.
• Heavy lifting.

What is the diagnostic path for patients with cervical herniated disk? Where are patients on this journey when you meet them?

For patients who see us at Mayo Clinic, we'd love to see them earlier in their disk injury so we can diagnose and treat them faster. Unfortunately, often patients don't get triaged effectively and get sent to the wrong specialty group.

Some patients come to us from external medical centers with a diagnosis already and want to know about their surgical options. Other patients still don't know the cause of their symptoms.

Is surgery the only option for patients with this injury? If not, do you, as a surgeon, get involved in nonsurgical therapy?

About 80% to 90% of patients can improve with conservative care — nonsurgical therapy. We try nonoperative treatments first, such as NSAIDs, gabapentin, pregabalin and steroid injections. Only a small percentage of these patients need to have surgery.

Our attitude is that if patients don't need surgery, that's OK. Our goal is to treat them holistically. I see a significant percentage of patients who don't end up having surgery. We can still help them by making them better.

One of the things I love about practicing at Mayo Clinic is that there are no external motivators to perform surgery on a given patient. This is a nice part of our patient-centered practice where surgery can be the last resort.

When is surgery inevitable for a patient with this injury?

Patients who have progressive cervical deficits will benefit from surgery. These patients have severe, intractable pain and can't do their daily activities.

If a patient needs surgical intervention, what are the options for management?

Here are some options, which include motion-preserving repair:

• Unpinching foraminotomy, which relieves pressure on compressed spinal nerves.
• Disk replacement, which maintains range of motion and uses metal such as titanium with a synthetic, mobile core.
• Fusion, the traditional approach, is now performed less invasively with a smaller incision and 3D stereoscopic scopes.

For patients who have surgery for cervical herniated disk, what is recovery like?

These are relatively small procedures, so the recovery is dependent on the stenosis and the levels affected. Most patients go home the same day as the surgery or the next day. They take it easy for six weeks and then do physical therapy. Three months after surgery, these patients are back to their usual activities.

How are the outcomes for surgeries on these disks?

Surgeries on cervical herniated disks are one of the more successful surgeries in Mayo Clinic's spinal practice.

Why would you recommend physicians refer to Mayo Clinic for cervical herniated disk repair?

I think patients and their local physicians can feel comforted that this is a multidisciplinary, world-class group of physicians with the ability to address any issue that may arise with the patient. It also focuses on what is in the best interest of the patient, even if surgery is not an option. Patients comment they appreciate seeing healthcare professionals who offer operative and nonoperative choices, and they leave Mayo Clinic feeling very informed.

Diagnostics often go much quicker at Mayo Clinic than at other medical institutions with the coordination of outpatient care. For instance, in a single visit, a patient can undergo testing, see a nonoperative physician and a surgeon, and maybe have some therapy. It's very efficient.

For more information

Refer a patient to Mayo Clinic.