What is cervical disc herniation?
Cervical disc herniation is a condition in which a disc in the neck can rupture and put pressure on the adjacent nerves. Cervical discs are the cushions between the vertebrae in the upper back and neck. If they become damaged by degeneration or injury, they may bulge abnormally or rupture causing cartilage on the inside to leak. Common terms for this condition include herniated disc, slipped disc or ruptured disc. If the affected disc puts pressure on the nerves or the spinal cord, it can cause severe and unrelenting pain radiating from the neck down the arm and into the fingertips.
How does cervical disc herniation occur?
Cervical disc herniation is usually caused by wear and tear or injury. As we age, our discs gradually lose the fluid that helps them maintain flexibility. Discs become stiffer and shorter, causing the vertebrae to move closer together. A herniated disc also may result from injuries to the spine, which can cause tiny tears or cracks in the disc's outer layer. The jellylike material inside is forced out, which causes the disc to bulge, break open or break into fragments. These fragments can put pressure on the nerves and spinal cord and cause pain, numbness or weakness.
What are the symptoms?
Symptoms of cervical disc herniation may include:
- Neck pain
- Pain that radiates down the arm to the hand or fingers
- Numbness or tingling in the shoulder, arm or hands
- Weakness of the arm or hand
- Burning pain in the shoulders, neck or arm
- Loss of balance or coordination
- Loss of hand function or grip strength
- Difficulty with fine motor skills in the hands and arms
How is cervical disc herniation diagnosed?
In addition to a complete physical exam and patient history, your doctor can use specific tests, including X-ray, MRI andCT scan,to diagnose a herniated disc. Sometimes, a test called an electromyogram is used to check electrical activity along the nerves and pinpoint the area of damage.
What is the treatment?
Many patients will improve with non-surgical treatment. This may include rest, non-steroidal anti-inflammatory medication, corticosteroids, epidural injections or physical therapy. If these conservative treatments don't work, or if symptoms get worse,surgery may be necessary. The goals of surgery are to remove the damaged disc to take pressure off of the nerves, maintain spine stability and correct spine alignment.
There are several appropriate and successful surgical options, including:
- Anterior cervical discectomy and fusion. The surgeon makes a small incision in the front of the neck to reach the spine. The affected disc between the vertebrae is removed and the vertebrae are fused together with a bone graft. Usually screws and a titanium plate are used to increase stability.
- Anterior cervical corpectomy and strut graft. This procedure is typically needed if there is pressure on the spinal cord behind the vertebrae. The surgeon makes a small incision in the front of the neck and removes the affected vertebrae, as well as the discs and bone spurs, to take pressure off the spinal cord. Usually a cage and bone graft is implanted in the space, which works like a strut to support the spine. Screws and a titanium plate are used to hold everything in place while healing occurs and the vertebrae fuse.
- Cervical laminectomy and fusion. The surgeon makes an incision in the back of the neck and removes the bony roof of the spine (the lamina) to open up the spinal canal and create more space for the nerves and the spinal cord. The vertebrae are then fused together to provide stability. Typically rods and screws are used to hold the vertebrae firm as the fusion heals.
- Posterior cervical laminoforaminotomy. The surgeon makes an incision in the back of the neck to reach the spine. The bone or disc fragment compressing the nerve root is removed, taking pressure off the nerve. Depending on the stability of the affected area, a fusion may or may not be performed at the same time.
- Cervical disc replacement. This procedure is an exciting advancement in spine surgery and, for carefully selected patients, a good alternative to the traditional fusion technique. The surgeon removes the diseased disc to relieve pressure on the nerve. Rather than using a bone graft to fuse, the disc space is fitted with a prosthetic disc. The device preserves motion and eliminates the typical complications of fusion surgery.
Your surgeon will discuss what surgical options would be best for you depending on your individual case and condition. Not everyone is a candidate for disc replacement surgery. A surgeon who is trained in both spine fusion techniques and disc replacement technology is the best person to determine the most appropriate surgical option. A consultation with the proper surgeon is crucial in making that determination.