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Herniated Cervical Disc
Each of the vertebral bodies that make up the spine are separated by round, fluid filled soft discs that act like shock absorbers. As we grow older, these discs lose some of their fluid and their ability to serve as a shock absorber. In addition, tiny tears or cracks in the outer layer of the disc may occur as a result of injuries to the spine. If these discs become damaged, they may bulge abnormally or rupture. This is referred to as a herniated disc, which can press against the spinal cord or directly against spinal nerve roots. Pressure on the spinal cord and/or nerve roots can lead to numbness, pain, or loss of strength in the neck, shoulders, arms, chest, hands, and legs.
Damage to a disc may be degenerative, meaning that it occurs over time with aging. It can also, however, result from a sharp bending or twisting movement or from improperly lifting a heavy object. Furthermore, trauma, such as a fall or car accident, can lead to disc injury.
Treatment
After determining the severity of your condition, your doctor will advise you regarding forms of treatment. Conservative methods, involving activity modification, pain medication, and physical therapy, are normally pursued as a first course of treatment. The majority of disc herniations (90%) do not require surgery, and will resolve with conservative, nonoperative treatment. Features of conservative treatment typically include:
*Resting the neck area by maintaining a comfortable posture and painless activity level for period of a few days to several weeks, sometimes using a cervical collar or neck brace.
*Using non-steroidal anti-inflammatory medication (for example ibuprofen or naproxen).
*An epidural steroid injection may be performed in cases of severe pain, utilizing a spinal needle under X-ray guidance to direct the medication to the exact level of the disc herniation.
*A physical therapist may develop a course of rehabilitation based on modes of treatment known to be beneficial to herniated disc patients, including exercises, traction, ultrasound, electrical muscle stimulation, and whirlpool treatment.
Non-steroidal anti-inflammatory medications, such as ibuprofen, may be recommended to decrease swelling and relieve pain. Sometimes time-released medication is most effective. While other painkillers may be prescribed, narcotic pain medication (for example, oxycodone or hydrocodone) is generally avoided.
Patients who have a severe episode of pain may benefit from a single treatment of an epidural steroid, injected directly into the affected part of the cervical spine. This form of treatment can often relieve the symptoms to such a degree that other treatment measures can then be comfortably performed.
Surgical Treatment
Surgical procedures may be considered in the event that conservative therapy does not bring about sufficient improvement in symptoms (that is, pain, numbness, tingling, and/or weakness in the arms). Surgery should also be considered when there is significant compression of the spinal cord with signs of cord dysfunction or myelopathy, as these symptoms and signs may be permanent even after surgical decompression. Symptoms of spinal cord dysfunction or myelopathy include decreased balance, difficulty walking, feeling of clumsiness in the legs, loss of coordination and fine movement skill of the hands, and problems with urination.
Surgical treatment for herniated cervical discs varies according to the severity of the injury. One method is known as a foraminotomy and microdiskectomy. It involves the open removal of the part of the herniated disc that puts pressure on the nerve root. The entire disc is not removed. This procedure is performed through an incision in the back of the neck. This is usually an outpatient procedure, meaning that the patients usually goes home the same day of surgery.
The most common surgical method used to treat a cervical disc herniation is known as anterior cervical decompression and fusion. Like a foraminotomy and microdiskectomy, this operation involves an open incision, dissection of muscle and tissue. This procedure is performed through an incision in the front of the neck. Unlike a foraminotomy and microdiskectomy, this procedure involves removal of the entire disc, placement of a bone graft, plate and screws. This procedure achieves a fusion at the involved level of the cervical spine. Many patients may be up walking the same evening or the next morning after surgery. Most patients stay overnight in the hospital and then go home the next day. Some discomfort when swallowing, from retracting the esophagus, commonly occurs, but this is usually a mild resolves in the first few days to weeks after surgery.
People who have experienced a herniated disc, whether treated conservatively or with surgery, are advised to become knowledgeable about caring for their neck - using proper lifting techniques, practicing a specific set of stretching and strengthening exercises, and modifying their activities to protect the neck. All of these measures may significantly reduce the chance of repeated injury to the spine. |
