Herniated disks usually occur in the cervical and lumbar spine. The thoracic spine is relatively non-mobile and thus rarely affected by disk herniations. Herniated disks typically occur in younger patients between ages 30 and 50 years and present primarily with appendicular pain (arm, leg) as opposed to axial pain (neck, back). Cervical and thoracic disks may present with myelopathy but more commonly with radiculopathy. Ninety percent of patients with disk herniation obtain relief with conservative treatment. Herniated disks are initial manifestations of the continuum of degenerative disk disease later manifested by development of osteophytes.

Cervical level

Patients with cervical disk herniation typically come to operation because of arm and periscapular pain, often with weakness, numbness, or paresthesias in a nerve root distribution. Since the majority of patients improve with non-surgical therapeutic options such as cervical collar, active rest, and physical therapy, patients should be considered for operation only if they have failed a reasonable trial of conservative therapy.

Central disk herniations are treated via an anterior approach. Foraminal disk herniations can be treated by either an anterior or posterior cervical approach. Anterior cervical diskectomy and fusion is the most common procedure performed for cervical disk herniations. After cervical diskectomy the disk space may be replaced with allograft or autograft. Studies have shown that using allograft leads to fusion in approximately 90% of patients. Addition of a cervical plating system increases the fusion rate to 96%.