CERVICAL HERNIATED DISC
By Don O Stovall, JR MD
WHAT IS IT?
Cervical herniated disc is a rupture or protrusion of the cushioning between the vertebral bones in the neck.
The disc is the cushioning between the vertebral bones. It consists of an outer layer of rings of cartilage (annulus) and an inner layer of gel (nucleus). Healthy discs have a large content of water that acts like a hydraulic cushion.
Herniated discs usually occur by an injury. The disc is usually weakened by wear and tear over time, making it susceptible to injury. The injury may be severe (car wreck or fall) or mild (cough or sneeze). In some cases, the patient cannot remember a specific event that caused the herniation.
- Neck pain: The most common symptom. Pain can occur in the neck and radiate in between the shoulder blades.
- Headaches: There are many causes of headaches, but a herniated disc in the neck can cause posterior headaches.
- Arm pain: The disc usually ruptures to one side and pain is experienced running into the shoulder or arm on that side. The affected arm may also feel numb, tingle or burn. Weakness can also occur.
Severe symptoms are rare, but may include urinary retention (inability to empty the bladder) or leg weakness and balance problems.
Tests your doctor may order to evaluate your herniated disc include:
- History and physical examination
- MRI – to show which disc is herniated and which nerve is involved
- Neurologic testing.
- EMG/nerve conduction studies to determine if there is any nerve damage and to rule out other conditions, such as carpal tunnel syndrome or ulnar neuropathy
Most herniated discs will heal over time. The treatment depends on the severity of the symptoms. Most symptoms will improve in 6- 8 weeks if the disc is healing.
- Anti-inflammatory medications
- Pain medications
- Muscle relaxers
- Steroid pills to reduce inflammation
Corticosteroid (cortisone) injections reduce inflammation within the spinal canal and provide an environment for the disc to heal. Up to three injections may be performed over a 6 – 8 week period of time.
Surgery is always a last resort. It is sometimes required right away if severe symptoms occur, such as urinary retention or leg weakness and balance problems It is also elected if at least 6 – 8 weeks of conservative treatment fails.
TWO SURGERY OPTIONS
- Disc Replacement: The herniated disc is removed and an artificial disc is placed. This is an option for those who have an otherwise normal disc that ruptured. If the disc has too much degeneration already, a replacement cannot be performed.
- Anterior cervical discectomy and fusion: The herniated disc is removed and a bone spacer is placed to keep the disc space from collapsing. A titanium plate is placed in front to keep the bone in place and stabilize the spine.