WHAT IS CERVICAL DISC HERNIATION?
Cervical disc herniation is one of the problems frequently encountered in the practice of neurosurgery. As is known, there are 7 vertebrae in the cervical region. Between them, there are structures called ‘discs’. There are also 2 small joints that connect two vertebrae to each other. An intervertebral disc is composed of an outer layer called ‘annulus fibrosus’ and an inner layer called ‘nucleus pulposus’. Its function is to evenly distribute the weight on the vertebrae. To use a simple analogy, it serves as a shock absorber. Another role of the discs and facet joints is to ensure cervical mobility. We can turn our neck to every direction in this way.
Cervical pain is one of the most common problems encountered in daily life. Neck pains are more commonly experienced especially after computers have become an indispensable part of business life. Such pains may be caused by improper use or misuse of the cervical vertebrae as we mentioned above, but may also be seen after traumatic injuries. People in some occupational groups tend to experience cervical pain. For example, those who work at desk jobs requiring intensive computer usage, teachers, drivers, manual workers etc.
The degenerative process that gains speed with increasing age may lead to increased neck pain in the patient by contributing to the condition colloquially known as calcification. With old age, inner water content of the intervertebral structures called ‘discs’ may decrease and this prevents discs from functioning normally. Afterwards, deteriorations and lacerations may be observed on the outer layer of the discs. If lacerations progress, inner structure of the disc protrudes from the laceration and can apply compression on the spinal cord and the nerves extending to the arms. This condition is called cervical disc hernia in medicine. Compression on the nerves extending to the arms may cause the patient to feel pain in the shoulder and/or arms, as well as numbness, tingling, and loss of strength in the arms and/or hands. The spinal cord compression created by the cervical disc hernia is less likely to cause problems in the legs and pathological reflex symptoms.
How is It Diagnosed?
The first step in diagnosis is to listen to the patient’s complaints and medical history, and then examine him/her by also considering other diseases that may be confused with cervical disc herniation. The next step is magnetic resonance imaging (MRI), the first option in the actual approach. In some cases, particularly in elderly patients, computed tomography and direct x-ray imaging are needed for a better diagnosis of any calcification in the vertebrae and/or intervertebral region.
If there are multiple cervical disc hernias or if the nerves extending to the arms are under compression, EMG (electromyography) is performed as an electrophysiological examination.
What are the Treatment Options?
Surgery is not always the first option for the treatment of pains caused by cervical disc hernia. A short-term rest period, first step analgesic treatment, and restriction of cervical movements with a cervical collar usually contribute to the pain-relieving process. Non-steroid anti-inflammatory drugs relieve pains, and reduce edemas (if any) in the nerve root. Muscle relaxants eliminate cervical muscle spasms.
My approach to the treatment of patients who have no symptom related to loss of strength and severe spinal cord compression is to refer the patient to a physiotherapy and rehabilitation specialist or an algology specialist for consultation, by thinking a little bit more academically. I most probably offer surgery to patients who have loss of strength in their arms and severe spinal cord compression. Sometimes I offer surgery even when there is no loss of strength and spinal cord compression, in cases where patients cannot be treated satisfactorily with physiotherapy, algology practices and special pharmacotherapies (neuropathic pain treatment).
If you want to be get information about surgical treatment, please see “Surgical Options for Cervical Herniated Disc”.
Hope to meet you in healthy days…