Herniated Disc (Cervical)
When a disc in the cervical spine ruptures, soft material from inside the disc can form a bulge that presses painfully against the spinal cord and nerve roots.
A herniated disc, also known as a ruptured or slipped disc, is a damage spinal cushion between two bones in the spine (vertebrae). Normally, the gelatinous discs between the vertebrae hold the bones in place and act as shock absorbers, permitting the spine to bend smoothly. When a disc protrudes beyond its normal parameters and its tough outer layer of cartilage cracks, the disc is considered to be herniated. The inner material of the disc bulges through the torn cartilage, sometimes pressing on a nerve in the spinal canal.
Herniated discs can occur in any part of the spine, though they are most common in the neck, or cervical, region, and the lower back, or lumbar, region. Cervical herniated discs typically result in pain in the neck and shoulders.
Causes of a Cervical Herniated Disc
Cervical herniated discs are usually caused by wear and tear of a disc, also known as disc degeneration. During the normal process of aging, the discs in the back lose flexibility and wear down. Additional stress may result in herniation. Such stress may result from obesity, heavy lifting or sudden traumatic injury. Smoking is also a risk factor for cervical disc herniation.
Symptoms of a Cervical Herniated Disc
The most common symptoms of a cervical herniated disc include:
- Sharp, shooting pain in the neck and shoulders
- Numbness in one arm
- Muscle spasms
- Weakness in one arm
- A tingling sensation in one arm
- Pain following sudden movements, such as bending or coughing
Diagnosis of a Cervical Herniated Disc
A cervical herniated disc may be diagnosed after a medical history is taken and a physical examination is conducted. It is important for the doctor to evaluate whether the pain has been increasing gradually or was precipitated by a traumatic injury. The physical examination will include a check of the patient's reflexes, sensation or numbness around the neck, shoulders and arms. This comprehensive type of assessment can help the doctor to determine if the patient's numbness or pain is caused by an irritation of the nerves in the cervical spine.
In most cases, imaging tests are administered to provide a more precise visualization of the cervical spine. This can enable the doctor to determine whether there is a disc injury and, if there is one, to delineate its size and location. These tests may include X-rays, MRI or CT scans, electromyography to measure nerve impulses and a myelogram, in which contrast dye illuminates the structures of the neck region.
Treatment of a Cervical Herniated Disc
Cervical herniated discs are usually first treated with conservative methods, such as the use of anti-inflammatory and pain medications and bed rest. Taking muscle relaxants may help reduce the frequency of spasms. Applying cold and/or hot compresses can help alleviate symptoms as well. Sometimes a course of physical therapy to stretch and strengthen the neck and shoulder muscles can provide effective relief. If the symptoms persist, an epidural injection of a corticosteroid may also be administered to reduce nerve irritation and facilitate healing.
When conservative measures fail to offer substantial relief, surgery may be necessary to relieve a cervical herniated disc. There are several surgical options and the type of procedure performed often depends on the severity of the damage. These include:
- Anterior cervical discectomy and fusion
- Anterior cervical discectomy without fusion
- Posterior cervical discectomy
All of these operations are performed in the hospital, with the patient under general anesthesia. Anterior cervical disectomy and spinal fusion is the most common method of surgery used to treat cervical herniated discs. During this procedure, the disc is removed through a small, one-inch incision in the front of the neck. Once the disc has been removed, the disc space is fused with a bone graft to provide stability within the neck. Anterior cervical disectomy without fusion is very similar to anterior cervical disectomy and spinal fusion, except that after the disc is removed no bone is added to stimulate a fusion. Posterior cervical disectomy involves removing the cervical herniated disc through an incision at the back of the neck.