Cervical Disc Herniation
In order to understand your symptoms and treatment choices, it is helpful to start with a basic understanding of the anatomy of the neck. This includes becoming familiar with the various parts that make up the cervical spine and how they work together.
The cervical spine is subject to tension and pressure when the neck moves. The disc between each vertebra responds by acting as a shock absorber. Bending the neck forward compresses the discs between the vertebrae and tends to bulge the discs backward toward the spinal canal and nerve roots.
Problems may occur when the center part of the disc, the nucleus pulposus, squeezes out of the disc and puts pressure on nerves in the neck. This condition, called disc herniation, can happen when a tear in the outer ring of the disc (the annulus) allows the nucleus to squeeze through. The annulus can tear or rupture anywhere around the disc. If it tears next to the spinal canal, the nucleus can squeeze out and put pressure on the spinal cord or spinal nerves. Pressure against the nerve root from a herniated disc can cause numbness and weakness along the nerve. When the nerve root is inflamed, the added pressure from the disc may also cause vague, deep pain in the neck, shoulder, and upper arm. It can also cause sharp, shooting pain to radiate along the pathway of the nerve.
This condition may occur when too much force is exerted on an otherwise healthy intervertebral disc. Heavy forces on the neck may simply be too much for even a healthy disc to absorb.
Herniated discs are more common in middle-aged adults. This is because the natural process of aging causes the discs to become weakened from degeneration. Less force is needed to cause the degenerated disc to herniate. Not everyone with a herniated disc has degenerative problems. Likewise, not everyone with degeneration will suffer a herniated disc.
Disc herniation causes symptoms that radiate away from the neck. Although the problem is in the neck, the symptoms will be felt wherever the nerve travels-shoulder, arm, or hand. By locating the symptoms, your doctor can usually tell which nerve in the neck is having problems. Symptoms generally include pain, numbness, and weakness. The reflexes in the upper arm can also be affected.
Neck pain and headaches near the back of the head are common with cervical radiculopathy. The back of the head is called the occiput, which is why headaches in this area are called occipital headaches.
Finding the cause of your neck problem begins with a complete history and physical exam. After the history and physical exam, the doctor may have a good idea of the cause of your pain or other symptoms. To make sure of the exact cause of your neck pain, several diagnostic tests can be used. These tests are used to find the cause of the pain, not make it better. Standard x-rays, are usually a first step in looking into any neck problem. These include an oblique (angled) view, along with x-rays taken as you bend forward (flexion) and backward (extension). Your doctor will also determine whether other tests, such as an MRI, are needed.
CONSERVATIVE TREATMENT OPTIONS:
Medications are commonly used to control pain, inflammation, muscle spasm, and sleep disturbance.
A cervical collar is often used to provide support and limit motion while an injured neck is healing. It also helps keep the proper alignment. Cervical collars can be soft (made of foam) or hard (plastic). Because these collars can restrict head movement, you may need help with eating or other activities. The skin under the collar needs to be checked every day to prevent blisters or sores.
A special pillow may help ease your pain at night and allow you to sleep better. Cervical pillows are specially designed to place the right amount of curvature in the neck while you sleep and to decrease the amount of irritation on the nerve roots. These pillows can be purchased from drug stores or from a physical therapist.
Your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.
Therapists use cervical traction to gently stretch the neck and to relieve pressure on the irritated nerve root. Electrical stimulation eases muscle spasm and pain. Exercises focus on improving strength and coordination of the neck, shoulders, and upper back. Therapy sessions may be scheduled two to three times each week for up to six weeks.
The goals of physical therapy are to help you:
- learn correct posture and body movements to reduce neck strain
- maintain appropriate activity levels
- maximize your neck range of motion and strength
- learn ways to manage your condition
Epidural Steroid Injections (ESI)
If other treatments do not relieve your neck pain, you may be given an epidural steroid injection (ESI), also called a nerve block. An ESI places a small amount of cortisone into the bony spinal canal. Cortisone is a strong anti-inflammatory medicine that may control the inflammation surrounding the nerves and may ease the pain caused by irritated nerve roots. This injection is often used when other conservative measures do not work, or in an effort to postpone surgery. This treatment is not always successful but may provide short-term help. Learn more about spinal injections.
SURGICAL TREATMENT OPTIONS:
Conditions don't always improve with conservative care. Surgery may be recommended when the following conditions are present:
- unbearable pain that doesn't respond to medical management
- unacceptable weakness
- weakness that is progressing
- evidence of spinal cord compression
- bowel or bladder concerns
One of the most common operations used to treat a herniated disc is an anterior cervical fusion.
After surgery, you may be placed in some type of neck brace for up to 12 weeks while healing. Learn more about braces used to treat neck problems.