Cervical Disc Herniation

A herniated disc occurs when the gel-like center of a spinal disc ruptures through a weak area in the tough outer wall, similar to the filling being squeezed out of a jelly doughnut. Neck or arm pain, numbness or tingling may result when the disc material touches or compresses a spinal nerve. Treatment with rest, pain medication, spinal injections, and physical therapy is the first step to recovery. Most people improve in 6 weeks and return to normal activity. If symptoms continue, surgery may be recommended. Symptoms of a herniated disc vary greatly depending on the location of the herniation and your own response to pain. If you have a herniated cervical disc, you may feel pain that radiates down your arm and possibly into your hand. You may also feel pain on or near your shoulder blade, and neck pain when turning your head or bending your neck. Sometimes you may have muscle spasms (meaning the muscles tighten uncontrollably). Sometimes the pain is accompanied by numbness and tingling in your arm. You may also have muscle weakness in your biceps, triceps, and handgrip.

You may have first noticed pain when you woke up, without any traumatic event that might have caused injury. Some patients find relief by holding their arm in an elevated position behind their head because this position relieves pressure on the nerve. Discs can bulge or herniate because of injury and improper lifting or can occur spontaneously. Aging plays an important role. As you get older, your discs dry out and become harder. The tough fibrous outer wall of the disc may weaken. The gel-like nucleus may bulge or rupture through a tear in the disc wall, causing pain when it touches a nerve. Genetics, smoking, and a number of occupational and recreational activities lead to early disc degeneration.

Conservative nonsurgical treatment is the first step to recovery and may include medication, rest, massage, physical therapy, home exercises, hydrotherapy, chiropractic care, and pain management. Over 95% of people with arm pain due to a herniated disc improve in about six weeks and return to normal activity. If you don’t respond to conservative treatment or your symptoms get worse, your doctor may recommend surgery.

Conservative nonsurgical treatment is the first step to recovery and may include medication, rest, massage, physical therapy, home exercises, hydrotherapy, chiropractic care, and pain management. Over 95% of people with arm pain due to a herniated disc improve in about six weeks and return to normal activity. If you don’t respond to conservative treatment or your symptoms get worse, your doctor may recommend surgery.

NONSURGICAL TREATMENTS
Self Care: In most cases, the pain from a herniated disc will get better within a couple days and completely resolve in 4 to 6 weeks. Restricting your activity, ice/heat therapy, and taking over the counter medications will help your recovery

Medication: Your doctor may prescribe pain relievers, nonsteroidal anti-inflammatory medications (NSAIDs), and steroids. Sometimes muscle relaxers are prescribed for muscle spasms.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen (Alleve, Naprosyn), ibuprofen (Motrin, Nuprin, Advil), and celecoxib (Celebrex), are examples of nonsteroidal anti-inflammatory drugs used to reduce inflammation and relieve pain.

Analgesics, such as acetaminophen (Tylenol), can relieve pain but don’t have the anti-inflammatory effects of NSAIDs. Long-term use of analgesics and NSAIDs may cause stomach ulcers as well as kidney and liver problems.

Muscle relaxants, such as methocarbamol (Robaxin), carisoprodol (Soma) and cyclobenzaprine (Flexeril), may be prescribed to control muscle spasms.

Steroids may be prescribed to reduce the swelling and inflammation of the nerves. They are taken orally (as a Medrol dose pack) in a tapering dosage over a five-day period. It has the advantage of providing almost immediate pain relief within a 24-hour period.

Steroid Injections: The procedure is done under x-ray fluoroscopy and involves an injection of steroids and a numbing agent into the epidural space of the spine. The medicine is delivered next to the painful area to reduce the swelling and inflammation of the nerves. About 50% of patients will notice relief after an epidural injection, although the results tend to be temporary. Repeat injections may be given to achieve the full effect. Duration of pain relief varies, lasting for weeks or years. Injections are done in conjunction with a physical therapy and/or home exercise program.

Physical Therapy: The goal of physical therapy is to help you return to full ac­tivity as soon as possible and prevent re-injury. Physical therapists can instruct you on proper posture, lifting, and walking techniques, and they’ll work with you to strengthen and stretch your neck, shoulder, and arm muscles. They’ll also encourage you to stretch and increase the flexibility of your spine and arms. Exercise and strengthening exercises are key elements to your treatment and should become part of your life-long fitness.

Holistic Therapies: Some patients find acupuncture, acupressure, yoga, nutrition / diet changes, meditation and biofeedback helpful in managing pain as well as improving overall health.

SURGICAL TREATMENTS
When symptoms progress or do not resolve with conservative treatment, surgery may be an option. Factors such as patient age, how long the problem has persisted, other medical problems, previous neck operations, and expected outcome are considered in planning surgery.

The most common approach to cervical disc surgery is anterior (front of the neck). A posterior (from the back) approach may be performed if you require decompression for other conditions such as stenosis.

Anterior cervical discectomy & fusion (ACDF): The surgeon makes a small incision in the front of your neck. The neck muscles, vessels and nerves are moved aside to expose the bony vertebra and disc. The portion of the ruptured disc that is pressing on the nerve is removed. After removing the herniated material, the disc space may be filled with a bone graft or cage to create a fusion (Fig. 3). Fusion is the process of joining two or more bones. Over time the graft will fuse to the vertebra above and below to make one solid piece of bone. Metal plates and screws may be used to provide stability during fusion and possibly a better fusion rate.