It occurs when the gel-like center of a spinal disc breaks through a weak area in the hard outer wall, similar to the filling that is squeezed out of a jelly donut.
Pain in the neck or arm, numbness or tingling may occur when the disc material touches or compresses a spinal nerve .
Treatment with rest, analgesics, spinal injections and physiotherapy is the first step to recovery. Most people improve in 6 weeks and return to normal activity. If symptoms continue, surgery may be recommended.
Anatomy of the Disks
To understand a herniated disc, it is helpful to understand how your spine works. Your spine is made of 24 mobile bones called vertebrae.
The cervical section (neck) of the spine supports the weight of your head (approximately 10 pounds) and allows you to tilt your head back and forth, from side to side, and turn 180 degrees.
There are 7 cervical vertebrae numbered C1 to C7. The vertebrae are separated by discs, which act as buffers that prevent the vertebrae from rubbing together.
The outer ring of the disc is called annulus. It has fibrous bands that join between the bodies of each vertebra. Each disc has a center filled with gel called a nucleus.
At each disc level, a pair of spinal nerves exit the spinal cord and branch off to your body.
The spinal cord and spinal nerves act as a “phone”, allowing messages or impulses to move back and forth between the brain and the body to convey the sensation and control movement.
What is a cervical herniated disc?
A herniated disc occurs when the gel-shaped center of your disc ruptures through a tear in the disc wall (ring).
The gel material irritates the spinal nerves, causing something like chemical irritation. Pain is the result of inflammation and inflammation of the spinal nerve caused by the pressure of the herniated disc.
Over time, the hernia tends to shrink and you may experience partial or complete pain relief. In most cases, if the neck and / or arm pain is going to resolve, it will be in about 6 weeks.
Different terms can be used to describe a herniated disc. A protruding disc (protrusion) is produced when the disk ring remains intact, but forms an outlet that can press against the nerves.
A true herniated disc (also called a ruptured disc) occurs when the disc ring cracks or breaks, allowing the gel-filled center to drain.
Sometimes, the hernia is so severe that a free fragment occurs, which means that a piece has been completely broken free of the disc and is in the spinal canal.
What are the symptoms?
The symptoms of a herniated disc vary greatly depending on the location of the hernia and your own response to pain. If you have a cervical herniated disc, you may feel pain radiating from your arm and possibly your hand. You may also feel pain in or near your shoulder blade and pain in your neck when you turn your head or bend your neck.
Sometimes you can have muscle spasms (that is, the muscles contract uncontrollably). Sometimes, the pain is accompanied by numbness and tingling in the arm. You may also have muscle weakness in the biceps, triceps and grip.
You may have noticed pain for the first time when you woke up, without any traumatic event that could have caused an injury. Some patients find relief by holding their arm in an elevated position behind their head because this position relieves pressure on the nerve.
What are the causes?
The discs may bulge or herniate due to improper injury and lift or they may occur spontaneously.
Aging plays an important role. As you get older, your discs dry up and become more difficult. The tough fibrous outer wall of the disc may be weakened, and it may no longer be able to contain the core similar to a gel in the center.
This material can bulge or break through a tear in the disc wall, causing pain when it touches a nerve. Genetics, smoking and a series of occupational and recreational activities lead to early disc degeneration.
Herniated discs are more common in people between 30 and 40 years old, although people of middle age and older are a little more at risk if they are involved in strenuous physical activities. Only about 8% of the herniated discs occur in the neck region.
When you experience pain for the first time, consult your general practitioner. Your doctor will make a complete medical history to understand your symptoms, any previous injury or condition, and determine if any type of lifestyle is causing the pain.
Next, a physical examination is performed to determine the source of the pain and evaluate any muscle weakness or numbness.
Your doctor may order one or more of the following imaging studies:
Magnetic resonance imaging (MRI) scan is a noninvasive test that uses a magnetic field and radiofrequency waves to obtain a detailed view of the soft tissues of the spine.
Unlike an x-ray, nerves and discs are clearly visible. It allows your doctor to see your spine in three dimensions in portions, as if it were cut layer by layer like a loaf of bread with a picture of each slice.
The images can be taken from one side or from the top as a cross section. It may or may not be done with a dye (contrast agent) injected into the bloodstream. This test can detect which disc is damaged and if there is nerve compression.
It can also detect bone overgrowth, spinal cord tumors or abscesses.
The myelogram: is a specialized radiograph in which dye is injected into the spinal canal through a lumbar puncture. Then, an X-ray fluoroscope records the images formed by the dye.
Myelograms can show a nerve pinched by a herniated disc, excessive bone growth, tumors of the spinal cord and spinal abscesses. Regular x-rays of the spine only give a clear picture of the bones.
The dye used in a myelogram appears white on the x-ray, which allows the doctor to see the spinal cord and the canal in detail. A CT scan can follow this test.
Computed tomography (CT) scan is a safe, non-invasive test that uses an X-ray beam and a computer to create two-dimensional images of your spine.
Similar to an MRI, it allows your doctor to see your spine sliced, as if it were cut layer by layer with a picture of each cut. It may or may not be done with a dye (contrast agent) injected into the bloodstream. This test is especially useful to confirm which disk is damaged.
Electromyography (EMG): often with a study of nerve conduction velocity (VCN) measures the nervous and muscular response to electrical stimulation.
Small needles, or electrodes, are placed in the muscles, and the results are recorded on a special machine. Because a herniated disc causes pressure on the nerve root, the nerve can not supply sensitivity and movement to the muscle in a normal way. These tests can detect nerve damage and muscle weakness.
X-ray exams: use X-rays to see the bony vertebrae in your spine and you can tell your doctor if any of them are too close or if you have arthritic changes, bone spurs or fractures. It is not possible to diagnose a herniated disc with this test alone.
Non-surgical : the good news is that most cases of cervical disc herniation do not require surgery. There are a number of non-surgical treatments that can help relieve symptoms. These include the following:
- Pain medications such as anti-inflammatories to reduce swelling and pain, muscle relaxants to calm spasms and narcotic analgesics to relieve acute pain.
- Heat / cold therapy, especially during the first 24-48 hours.
- Physiotherapy exercises such as soft massage, neck stretch or traction to reduce pain and increase flexibility.
Along with these treatments, the medical staff will educate patients about risk factors, healthy posture, good body mechanics and proper exercises. Quality education can lead to a healthier long-term spine.
Surgical : if non-surgical measures do not work, surgery may be recommended. An anterior cervical discectomy (from the front) is the most common surgical procedure to treat damaged cervical discs.
The purpose of this procedure is to relieve pressure on the nerve roots or on the spinal cord by removing all or part of the damaged disc.
During surgery, the soft tissues of the neck separate to expose the offensive disc. The disc is removed to decompress the spinal cord or nerve roots.
If necessary, the space left by the removed disc will be filled with a bone graft, a small piece of bone that is usually removed from the patient’s hip. The bone graft is used to join or fuse the vertebrae. This is called fusion.
In some cases, some instruments (such as plates or screws) can be used to help promote fusion and to add stability to the spine.
During posterior cervical surgery, a part of the bone that covers the nerve may also need to be removed. This procedure is called laminotomy.
Fortunately, these procedures can often be performed using minimally invasive techniques. Minimally invasive surgery uses smaller incisions and small specialized instruments such as microscopes and endoscopes
Recovery and prevention
Back pain affects 8 out of 10 people at some point in their lives and usually resolves in 6 weeks. A positive mental attitude, a regular activity and an early return to work are very important elements of recovery.
If your usual work can not be done initially, it is best for the patient to return to some type of modified work (light or restricted). Your doctor can give prescriptions for that activity for limited periods of time.
The key to avoiding recurrence is prevention:
- Appropriate lifting techniques.
- Good posture when sitting, standing, moving and sleeping.
- Appropriate exercise program to strengthen weak abdominal muscles and prevent new injuries.
- An ergonomic work area.
- Healthy weight and lean body mass.
- A positive attitude and stress management
- No Smoking.