HERNIATED DISC (CERVICAL)

Herniation of a disc is an anomalous spine condition characterized by leakage of the inner contents of the intervertebral disc, due to cracks in its outer wall. Herniated disc is commonly seen in the cervical or neck region, a condition called cervical herniated disc (CHD). CHD is followed by arm or neck pain that may arise due to compression of the spinal nerves by the protruding disc material. This condition is frequently reported in people between 30-40 years of age as well as elderly people. Treatment of CHD begins with conservative (non-surgical) methods, as reports show that around 90% of patients may return to normal activity by employing these interventions for at least 6 weeks. The patients which are not experiencing benefits from conservative interventions are recommended for surgery.

The cervical region consists of 7 cervical vertebrae (C1-C7), with intervertebral discs between each vertebra that function to provide flexibility to the back bone. Intervertebral discs are soft, compressible structures consisting of a hard-outer ring called the annulus and a gel-like center, called the nucleus.

The foremost causes and risk factors involved in the development of cervical herniated disc are advanced age, trauma or injury, abrupt neck movements, smoking and genetic factors. The usual symptoms associated with cervical herniated disc are pain and numbness in the neck, shoulders, chest, arms, and hands, followed by weakness in the associated region. 

The diagnosis of a cervical herniated disc involves taking a medical history and performing a physical examination of the patient. Physical examination may also involve analysis of the neck movements to determine the source of pain and related injured tissues. Furthermore, various new advanced imaging techniques such as MRI scan, myelogram, CT scan, X-rays, electromyography (EMG) and nerve conduction velocity (NCV) tests, are widely used for accurate diagnosis, as confirmatory tests.

The well-established non-surgical interventions for CHD include adequate rest, massage of the neck, ice or heat compression, physical therapy, strengthening exercises, chiropractic care, and medications, including epidural steroid injections. In addition, widely accepted holistic therapies such as acupuncture, acupressure, and nutritional supplements are also extensively used.

Surgery is recommended for those patients who are not responding to non-surgical measures. Moreover, numerous other factors such as patient’s age, other medical conditions, previous neck surgeries, and duration of suffering are considered, before making the decision to have surgery. Highly advanced surgical techniques such as anterior cervical discectomy and fusion (ACDF), artificial disc replacement and posterior cervical discectomy, have shown tremendous results and explore a new era of cervical herniated disc treatment. Due to further advancement in technology, discectomy can be performed through minimally invasive techniques that employ a small incision for the operation. These advanced techniques have diminished recovery time, followed by an improved success rate.

 

 

CERVICAL DISC PROTRUSION

Cervical disc protrusion, commonly known as disc bulge occurs when the spinal discs and associated ligaments are intact, but may form a bulge that will press on the spinal nerves. This condition causes pain in the neck, shoulder and the arms. Usually, the symptoms include a dull, aching, or sharp pain in the neck or the shoulder blades. Sometimes, the pain may radiate along the arms to the hands and fingers. Tingling sensation and numbness may be felt at the fingertips. It generally develops in individuals in age group of 30–50 years because of trauma to the cervical spine.

It is necessary to seek medical care before your symptoms get worse. Initial visit to your doctor may include a physical examination, evaluation of your symptoms and medical history and a neurological examination. A computed tomography (CT) scan or magnetic resonance imaging (MRI) may be advised to assess the disc damage.

Both surgical and non-surgical treatment approaches are available for management of cervical disc protrusion.

The first line of treatment your doctor may suggest is conservative methods such as cold or heat therapy. During the first 2-3 days, applying ice (wrapped in a towel) can reduce swelling and pain by limiting the blood flow. Heat therapy can be started after 3 days to increase the blood circulation and relax the soft tissues. Cold/heat therapy should not be continued for more than 20 minutes each time. Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants may be prescribed. Physical therapy treatments which include massage, stretching exercises and neck traction may be recommended. Most of the time, these self-care measures alleviate your pain in about 4-6 weeks. If the condition is severe that cannot be treated with conservative approaches or in case of spinal cord compression, your doctor may recommend surgery. Cervical disc protrusion can be corrected by partial discectomy, discectomy (removal of disc), or laminotomy. These spine surgeries can be done using the minimally invasive method involving smaller cuts and tiny instruments.

 

 

NECK PAIN

The first 7 vertebral bones on the spinal column form the cervical spine and are in the neck region. The neck bears the weight of the head, allows significant amount of movement, and is also less protected than other parts of the spine. All these factors make the neck more susceptible to injury or other painful disorders. Common neck pain may occur from muscle strain or tension in everyday activities including poor posture, prolonged use of a computer and sleeping in an uncomfortable position.

The most common cause of neck pain is injury to the soft tissues (muscles, ligaments, or nerves) or prolonged wear and tear. Traumatic accidents or falls and contact sports can cause severe neck injuries causing pain in the neck. Neck pain can also come from infections, tumors or congenital abnormalities of the vertebrae.  Common conditions producing neck pain include:

  • Rheumatoid arthritis: It is an auto-immune disease in which the body's immune system attacks healthy joints, tissues and organs. The condition occurs most often in the upper neck area causing inflammation of the lining (or synovium) of joints resulting in neck pain, stiffness, swelling and loss of function.

  • Cervical disc herniation: Disc herniation is the bulging or rupture of the soft fibrous tissue, discs, cushioning the vertebrae. Cervical disc herniation refers to herniation of discs in cervical spine region or neck region. Because of this the soft central portion called nucleus pulposus bulges out through the tear in the capsule. The condition can be caused by the normal ageing or by traumatic injury to the spine. The condition results in painful, burning, tingling or numbing sensations in the neck.

  • Cervical Spondylosis: Cervical spondylosis refers to abnormal degeneration of the cartilage and bones in the neck region.  The condition results in neck pain radiating to arms or shoulder and neck stiffness that gets worse over time.

  • Cervical Stenosis: Cervical stenosis refers to narrowing of the spinal canal that protects the spinal cord and its branching nerves. The condition causes neck pain radiating to arms and hands.

  • Degenerative disc disease: Degenerative disc disease refers to gradual deterioration of the disc between the vertebrae and is caused due to ageing. As people age, intervertebral discs lose their flexibility, elasticity and shock absorbing characteristics, resulting in neck pain. 

Diagnosis of neck pain is made with physical examination and other imaging techniques including electromyography (EMG), X-ray, MRI scan, CT scan, blood tests and bone density assessment.

Treatment options include rest, ice application, elevation of the injured area, using a soft neck collar and neck immobilization using a splint, cast, or sling. Medications such as anti-inflammatory drugs, analgesics and muscle relaxants may be prescribed to reduce the pain and inflammation. Certain stretching and strengthening exercises may be recommended to strengthen the neck muscles.

Surgical treatment by anterior cervical discectomy with spinal fusion is typically recommended only after non-surgical treatment methods fail to relieve the pain. An anterior cervical discectomy is a surgical procedure performed to remove a herniated or degenerative disc in the cervical (neck) spine. Spinal fusion may be performed to provide stability to the spine.

The following steps may help you prevent or improve your neck pain:

  • Practice relaxation exercises to prevent undesirable stress and tension to the neck muscles

  • Perform stretching exercises for your neck before and after exercise

  • Keep good posture if you work at a computer and adjust the monitor at your eye level.  Stretch your neck frequently.

  • If you use the telephone a lot, use a headset

  • Use a pillow that keeps your neck straight

  • Wear seat belts and use bike helmets to reduce injuries

 

 

CERVICAL DEGENERATIVE DISORDERS

Cervical refers to the 7 vertebrae of the neck. The cervical spine consists of other anatomic structures including muscles, bones, ligaments and joints. Normally, the cervical spine permits quite a range of flexibility and motion. However, it is susceptible to physical forces during traumatic injuries. This high range of motion encourages changes associated with spinal wear and tear or age.

Some of the cervical degenerative disorders include:

Degenerative disc disease: Degenerative disc disease refers to gradual deterioration of the disc between the vertebrae and is caused due to ageing. As people age, intervertebral discs lose their flexibility, elasticity and shock absorbing characteristics. Depending on the location of degenerative disc, it could cause back pain, radiating leg pain, neck pain and radiating arm pain.

Compression of the spinal cord: Degenerative disc disease may cause narrowing of the spaces between the vertebral bodies, which indicate that the disc has become very thin or has collapsed. Thus, the space available for the nerve roots starts to shrink. The nerve roots leave the spinal canal through a bony tunnel called the neural foramen and it is at the neural foramen that the nerve roots may get compressed. Compression of the spinal cord causes pain, difficulties with mobility, bladder control problems, weakness and fatigue.

Cervical Stenosis: Cervical stenosis refers to narrowing of the spinal canal that protects the spinal cord and its branching nerves. The condition causes neck pain radiating to arms and hands, numbness or weakness in the legs. This condition causes cervical myelopathy and cervical radiculopathy. The abnormal pressure placed on the spinal cord causes damage and results in spinal cord dysfunction. This condition is known as myelopathy. Cervical radiculopathy occurs when the nerve root connecting the spinal cord is injured or pinched as they exit the spinal canal. Myeloradiculopathy occurs when there is damage to the spinal cord and nerve roots.

Cervical Disc Herniation: A cervical disc herniation is a condition affecting the neck, in which the outer fibers surrounding the disc (annulus fibrosis) may cause tears or cracks. Because of this, the soft central portion called nucleus pulposus bulges out through the tear in the capsule. The condition can be caused by the normal ageing or by traumatic injury to the spine. The condition results in painful burning, tingling or numbing sensations in the neck, shoulders, arms and hands.

Cervical Spondylosis: Cervical spondylosis refers to a disorder in which there is abnormal degeneration of the cartilage and bones of the neck.  The condition results in neck pain radiating to arms or shoulder and neck stiffness that gets worse over time.

Rheumatoid Arthritis: It is an auto-immune disease in which the body's immune system attacks healthy joints, tissues and organs. The condition occurs most often in women of childbearing age, causing inflammation of the lining (or synovium) of joints resulting in pain, stiffness, swelling and loss of function in the joints.

  • Diagnosis:

Diagnosis of cervical spine disorders is made with physical examination and other imaging techniques including electromyography (EMG), X-ray, MRI scan, CT scan, blood tests and bone density assessment.

  • Treatment:

    Conservative Treatment

  • Medications: Anti-inflammatory drugs, analgesics and muscle relaxants may be prescribed to reduce the pain and inflammation.

  • Physical Therapy: A wide range of exercises for flexibility, toning, strengthening, stability and restoration of range of motion may be recommended.

Surgical Treatment

  • An anterior cervical discectomy with spinal fusion is typically recommended only after non-surgical treatment methods fail.