Cervical Herniated Disc or Ruptured Disc

Symptoms of Cervical or Herniated Disc:

  • Pain in neck, shoulder, and arms
  • Dull or sharp pain in the neck or between the shoulder blades
  • Pain that radiates down the arm to the hand or fingers
  • Numbness or tingling in the shoulder or arm.
  • Certain positions or movements of the neck can intensify the pain.

The symptoms of a cervical herniated disc often resemble other disorders such as carpal tunnel syndrome, problems with the rotator cuff and gout. In some patients, a cervical herniated disc can cause spinal cord compression where disc material pushes on the spinal cord. This is a much more serious condition and may require a more aggressive treatment plan. Spinal cord compression symptoms include awkward or stumbling gait, difficulty with fine motor skills in the hands and arms, and tingling or “shock” type feelings down the torso or into the legs.

Anatomy – Normal Cervical Disc

In between each of the vertebrae (bones) in the spine is a disc, a tough fibrous shock-absorbing pad. Endplates line the ends of each vertebra and help hold individual discs in place. Each disc contains a tire-like outer band (called the annulus fibrosus) that encases a gel-like substance (called the nucleus pulposus).Nerve roots exit the spinal canal through small passageways between the vertebrae and discs. Pain and other symptoms can develop when the damaged disc pushes into the spinal canal or nerve roots.

Symptoms of Cervical or Herniated Disc:

  • Pain in neck, shoulder, and arms
  • Dull or sharp pain in the neck or between the shoulder blades
  • Pain that radiates down the arm to the hand or fingers
  • Numbness or tingling in the shoulder or arm.
  • Certain positions or movements of the neck can intensify the pain.

The symptoms of a cervical herniated disc often resemble other disorders such as carpal tunnel syndrome, problems with the rotator cuff and gout. In some patients, a cervical herniated disc can cause spinal cord compression where disc material pushes on the spinal cord. This is a much more serious condition and may require a more aggressive treatment plan. Spinal cord compression symptoms include awkward or stumbling gait, difficulty with fine motor skills in the hands and arms, and tingling or “shock” type feelings down the torso or into the legs.

Anatomy – Normal Cervical Disc

In between each of the vertebrae (bones) in the spine is a disc, a tough fibrous shock-absorbing pad. Endplates line the ends of each vertebra and help hold individual discs in place. Each disc contains a tire-like outer band (called the annulus fibrosus) that encases a gel-like substance (called the nucleus pulposus).Nerve roots exit the spinal canal through small passageways between the vertebrae and discs. Pain and other symptoms can develop when the damaged disc pushes into the spinal canal or nerve roots.

Cervical disc herniation occurs when the annulus fibrosus breaks open or cracks, allowing the nucleus pulposus to escape. This is called a Herniated Nucleus Pulposus (HNP) or herniated disc.

Progressive Steps Toward a Cervical Disc Herniation

Many factors increase the risk for disc herniation:

1. Lifestyle choices:

  • Smoking
  • Lack of exercise
  • Poor nutrition leading to weight gain

2. Age: As the body ages, there are some natural biochemical changes that causes discs to dry out, therefore, reducing disc strength and resilience. 3. Poor posture can place additional stress on the cervical spine.

A combination of the above factors with the effects from daily wear and tear, injury, incorrect lifting, or twisting and it is easy to understand why a disc may herniate. A herniation may develop suddenly or gradually over weeks or months.

The four stages to a herniated disc include:

  1. Disc Degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation.
  2. Disc Prolapse: the form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion.
  3. Extrusion: the gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
  4. Sequestration or Sequestered Disc: the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP).

Non-Surgical Treatment of Cervical Herniated Disc

Locating the Cause of Pain

NOT every herniated disc causes symptoms. Some people discover they have a bulging or herniated disc after an x-ray for an unrelated reason. Most patients go in for a consultation when they have symptoms. Your visit with your orthopedist may include:

  • Physical exam
  • Neurological examination
  • Review of medical history
  • Symptom evaluation – patient tells doctor what pain symptoms he is experiencing
  • Review of history of treatments and medications the patient has tried
  • X-rays - may be ordered to rule out other causes of back pain such as osteoarthritis
  • A CT Scan or MRI can verify the extent and location of disc damage
  • Myelogram

Cervical Herniated Disc Treatment – Non-Surgical

Most patients do not need surgery! The following are treatment modalities:

Ice/Heat Therapy - During the first 24 to 48 hours cold therapy helps to reduce swelling, muscle spasm and pain by reducing blood flow. After the first 48 hours, heat therapy can be applied. Heat increases blood flow to warm and relax soft tissues. Increased blood flow helps to flush away irritating toxins that may accumulate in tissues as a result of muscle spasm and disc injury. Never apply ice or heat directly to skin; instead, wrap the cold or heat source in a thick towel for no longer than 15-20 minutes. Medications - may include an anti-inflammatory to reduce swelling, a muscle relaxant to calm spasm, and a pain-killer (narcotic) to alleviate intense but short-lived pain (acute pain). NSAIDS are often prescripted to treat mild to moderate pain. These medications may be one of the following: Naproxen, Piroxicam, Dicflofen. They work by reducing both swelling and pain. Physical Therapy - The doctor may recommend physical therapy to decrease pain and increase flexibility. Ice and heat therapy, gentle massage, stretching, and neck traction are some examples.

Cervical Herniated Disc: Surgical Treatment

Spine surgery is considered if non-surgical treatment does not relieve symptoms or if spinal cord compression is suspected.

To relieve nerve pressure and neck pain, surgery usually involves a partial disc removal or discectomy. This surgery is usually done from the front of the neck (called an anterior discectomy). In addition, the surgeon may need to access the problem disc by removing a portion of the bone covering the nerve. This procedure is called a laminotomy and is usually done from the back of the neck (posterior laminotomy).

Fortunately, these procedures can often be done utilizing minimally invasive spine surgery techniques. Minimally invasive spine surgery does not require large incisions, but instead uses smaller cuts and tiny specialized instruments and devices such as a microscope and endoscope during the operation.

Prevention Aging is inevitable, but certain lifestyle changes can help prevent cervical disc disease. These include : good posture, regular exercise, good body mechanics, strong neck muscles, proper diet, and cessation of smoking. By adopting good habits now, you may preserve your spine for the future.

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