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The vertebrae in the neck area of the spine, known anatomically as the cervical vertebrae, are separated by flexible disks of shock absorbing cartilage. These disks have a soft gelatinous core (known as the nucleus) and are made of flexible fibrous tissue. An injury to one of these disks, known as disk herniation, may result in pain and the compression of nerve roots or the spinal cord.

Herniated disks are often referred to as ‘slipped,’ or ‘ruptured’ disks. With a herniated disk injury, the nucleus tissue located in the center of the disk is forced out of position. While the disk itself does not ‘slip,’ pressure on the core of the disk may be so strong that a fragment of the nucleus herniates or ruptures out of the outer layer (the annulus) of the disk. Because the spinal canal into which this fragment moves has limited space, a herniated cervical disk presses against spinal nerve roots or against the entire spinal cord.

Damage to a disk may also result from a sharp bending or twisting movement, or from improperly lifting a heavy object. Sometimes traumatic injury is involved.

After determining the severity of your condition, your doctor will advise you regarding forms of treatment. Conservative methods, involving bed rest, pain medication, and physiotherapy, are normally pursued as a first course of treatment. The majority of disk herniations (90%) do not require surgery, and will resolve with 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
• 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 disk herniation
• A physical therapist may develop a course of rehabilitation based on successful modes of treatment, such as traction, ultrasound, electrical muscle stimulation, whirlpool, and so on, proven beneficial to herniated disk patients

Non-steroidal anti-inflammatory medications such as aspirin, acetaminophen or 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 is generally avoided.

Patients who have a severe episode of pain may benefit from a single treatment of a steroid epidural, injected directly into the affected part of the neck. This form of treatment can often relieve the situation to such a degree that other treatment measures can then be put into place.

Surgical procedures may be considered in the event that conservative therapy does not bring about sufficient pain relief. 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.

· Surgical treatment for herniated cervical disks varies according to the severity of the injury. One method is known as microdiskectomy. It involves the open removal of the part of the herniated disk that puts pressure on the spinal cord.
· Another common surgical method is known as anterior cervical decompression and fusion. Like microdiskectomy, this is a major operation involving open incision, dissection of muscle and tissue, and possible bone graft procedures. Both operations involve a hospital stay of 3 to 5 days. Many patients may be up walking the same evening or the next morning after surgery. Some discomfort when swallowing, from retracting the esophagus, commonly occurs, but this is usually a mild and transient symptom.

Patients who have sustained one disk herniation are at increased risk statistically for experiencing another. Approximately 5% of the time the herniation recurs at the same level; more rarely, there may be a new disk herniation at another level. Many of the factors involved in disk herniation are related to one’s level of physical conditioning and work or behavioral habits. People who are overweight have an increased risk of disk herniation, as do those who attempt strenuous physical labor (such as moving heavy objects) when they are out of shape.

People who have experienced a herniated disk, whether treated conservatively or with surgery, are advised to become knowledgeable about caring for their backs - using proper lifting techniques, practicing a specific set of stretching and strengthening exercises, and modifying their activities to protect the backbone. All of these measures may significantly reduce the chance of repeated injury to the spine.

Major surgery for cervical disk herniation usually requires a recovery and rehabilitation period of at least 4 to 6 weeks. A spine operation may involve the specialized skills of both an orthopedic surgeon, whose expertise concerns bones and joints, and a neurosurgeon, someone familiar with spinal cord injuries.