Herniated Disc (Cervical )
Cervical Herniated Disc
In between the vertebrae are spongy cushions called cervical discs. The cervical discs stabilize the neck and allow it to turn smoothly from side to side and bend forward to back. They act like shock absorbers for regular movements, as well as jumping, running, and other activities that put wear and tear on your body.
Causes
A herniated Cervical Disc often comes on slowly with no clear cause. But sometimes the reason can be narrowed down to:
- Age. In young people, disks have a lot of water in them. But over time the amount of water decreases. Less water in the disks means they can become less flexible. And that means that movement, twisting, or turning, can increase the chance of it rupturing, or herniating. In older people, discs can rupture with less force.
- Genetics. Herniated disks also can run in families.
- Movement. Sudden, jarring motions can cause a disc to herniate.
- Sudden strain. Lifting a heavy object, turning or twisting the upper body too quickly, can damage a disk.
Symptoms
A herniated cervical disk is one of the most common causes of neck pain. If the disk is pressing on a nerve root, other symptoms can include:
- Numbness or tingling in a shoulder or arm that may go down to the fingers
- Weakness in a hand or arm
If the disc presses on the spinal cord, there can be more serious symptoms such as
- Stumbling or awkward walking
- Tingling or a shock-like feeling running down your body into your legs
- Problems using your hands and arms for fine motor skills
- Loss of balance and coordination
Diagnosis
A doctor usually can diagnose a cervical herniated disc from the history of symptoms and a physical exam. The doctor will ask about pain and numbness that might be caused by irritation of one or more of the nerves in the cervical spine. If symptoms suggest a cervical herniated disc, rest and rehabilitation (rehab) often are recommended before further testing is done. If other conditions are suspected, or if there is no improvement in symptoms after a period of rest and rehab, imaging tests such as X-ray, magnetic resonance imaging (MRI), or computerized tomography (CT scan) may be done.
Treatment
In most cases, cervical herniated discs are first treated conservatively with
- Rest or modified activities
- Medicines to relieve pain and inflammation
- Exercise to protect the neck, as recommended by the physician or a physical therapist.
- Traction if symptoms persist or worsen other treatments such as gentle, steady pulling on the head to stretch the neck and allow the small joints between the neck bones to spread a little.
- Corticosteroids may be ordered if symptoms continue
- Surgery will be considered if the herniated disc is squeezing the spinal cord or nerves. If weakness, constant pain, or decreased control of the bladder or bowels is present, surgery may be recommended.
- In rare cases, an artificial disc may be used to replace the disc that is removed.
Cervical Disc Disease
Cervical degenerative disc disease (DDD) is a condition that affects the strength, resiliency and structural integrity of the intervertebral discs due to increasing age, trauma, injury, repetitive movement, improper posture, or poor body mechanics. It is commonly seen in adults after 50 years of age. The intervertebral discs act as shock absorbers. With ageing the rate at which the old, worn-out cells are replaced is gradually reduced, resulting in degenerative changes in the discs. This can be accelerated by trauma or injury.
These structural changes can result in nerve compression and pain due to reduction in the disc height, and presence of bone spurs or bony overgrowths (osteophytes).
Cervical spinal stenosis and osteoarthritis (spondylosis) can also affect the intervertebral joints and cervical stability.
Symptoms
Most people with Cervical Disc Disease are asymptomatic; however, cervical disc disease may be associated with a gradual development of symptoms that may further deteriorate with time. Patients may experience pain and other symptoms in their shoulders and arms; known as radiculopathy. Some of the common symptoms of cervical disc disease include:
- Mild to intense pain
- Increased pain with movement
- Burning, tingling or numbness
- Stiffness in hand or arm
- Improper balance and gait
- In rare cases, bowel and bladder dysfunction can develop
Diagnosis
An accurate diagnosis of cervical disc disease may include:
- Medical and family history of the patient
- Physical and neurological examinations
- Testing of reflexes to evaluate muscle weakness, sensitivity, and other signs of neurological injury
- Diagnostic imaging techniques such as X-ray, CT scan, MRI scans, discography or fluoroscopy may be employed to confirm the diagnosis.
- X-rays help in identification of the collapsed disc space. X-ray images of the spine, at different positions, also help evaluate stability of the spine.
- CT and MRI scans are more precise in evaluating the disc and endplate changes.
- Discography uses a special dye that is injected into one or more discs to identify damage such as a crack or tear. Real time x-ray (fluoroscopy) helps to locate the origin of pain.
Treatment
Both conservative and surgical methods can be used in the treatment of Cervical DDD depending on the severity of the Disease.
Conservative treatment may include:
- Medications such as analgesics, muscle relaxants and narcotics
- Spinal injections
- Back braces to relieve pain
- Physiotherapy
- Acupuncture
Surgical treatment may be recommended for patients who fail to respond to non-surgical treatment, or in those patients with spinal instability and neurological dysfunction. Minimally invasive spine surgery can be performed in these patients. Spinal stabilization and fusion can be considered in a few cases to prevent further deterioration of the patient’s condition.