cervical herniated disc treatment; fusion surgery and discectomy

A herniated or “ruptured” disc is a common source of neck pain and arm pain.  Discs are the shock-absorbing pads that are between vertebrae, the series of small bones that make up your spine.  Your cervical spine is located in your neck.  At the cervical spine, the discs and joints allow your neck to move and provide stability for your head.  The discs also act as a cushion to protect the cervical vertebrae.

An opening in the center of each vertebra forms the spinal canal.  Your spinal cord and spinal nerves run through the protected canal and send messages between your body and brain.  A herniated disc occurs when its outer layer ruptures and the contents come out of the disc.  If the contents extend into the spinal canal, it can put pressure on the spinal nerves.  A herniated disc can cause shoulder, neck, or arm tingling, pain, numbness or weakness.  It can also cause headaches.

Anatomy

The spine is divided into regions defined by their curvature and function.  The cervical spine is located in your neck.  The cervical spine supports your head and connects it to your trunk.  The cervical spine supports less weight than any other portion of the spine.  It also has the greatest amount of mobility and flexibility.  Your neck can bend forward and backward or tilt from side to side.  Your neck can also turn or rotate to the right and left, a motion used when checking for traffic before crossing a street.

Seven small vertebrae make up the cervical area of your spine.  Vertebrae are the series of small bones that align to form the spine.  The back part of the vertebra arches to form the lamina.  The lamina creates a roof-like cover over the back opening in each vertebra.  The opening in the center of each vertebra forms the spinal canal.

Traveling through the protective cervical spinal canal is your spinal cord, spinal nerves that travel to your arms and hands, and arteries that supply blood.  The top section of the cervical spinal canal is very spacious.  It allows more room for the spinal cord than any other part of the vertebral column.  The extra space helps to prevent pressure on the spinal cord when you move your neck.

Intervertebral discs are located between the vertebrae in your cervical spine.  The discs are made up of strong connective tissue.  Their tough outer layer is called the annulus fibrosus.  Their gel-like center is called the nucleus pulposus.  The discs and two small spinal facet joints connect one vertebra to the next.  The discs and joints allow movement and provide stability.  The discs also act as a shock-absorbing cushion to protect the cervical vertebrae.

causes of cervical herniated disc

There is not one specific reason for the onset of a disc herniation but there are many risk factors that may make you more susceptible. The main factor to consider is disc degeneration. As you get older, the soft nucleus pulposus in the center of the disc starts to dehydrate, retaining less and less water. This decreases the discs ability to act as a shock absorber. The deterioration of the disc in this manner can increase the likelihood of the outer annulus fibrosus layer tearing. Poor posture, previous trauma and a lack of exercise leading to poor core body strength can also leave the spine weakened.  These risk factors can lead to early degeneration of the discs especially when combined with obesity and increasing age. Activities which increase the pressure within the disc such as carrying uneven weights, bending in an incorrect manner (back bent and knees straight), holding a prolonged poor seated posture (desk work, driving), direct contact sports and even sneezing can cause the already weakened structure of the disc to give.

A Cervical disc herniation occurs most commonly in the mid-levels of the neck between C4-C5 vertebrae and C6-C7. Men are twice as likely to be affected as women and it usually develops within the 25-50 year old age range with the highest incidence between 35-45 years.

CONDITIONS THAT CONTRIBUTE TO THE CAUSE

Arthritis and degenerative spine conditions, such as ankylosing spondylitis, and spinal stenosis , may also contribute to long-term problems. Herniation is usually a result of acute stress on the spine, although it can be due to longer term damage and a bulging disc that suddenly reaches breaking point and herniates.

cervical herniated disc symptoms

A herniated disc or bulging disc can present as constant neck pain and other types of shooting pains. You can also have pain traveling into your arms and hands with numbness and tingling as well. Depending on the level that is affected a cervical disc herniation can present in different ways. Lets look at the different levels in the neck to see how the symptoms can appear:

• C4/C5 Disc herniation: This affects the distribution of the C5 nerve root. It can cause the deltoid muscle to be weak and also can cause shoulder pain. This affects the lateral upper arm. It usually does not cause numbness and tingling.
• C5/C6 Disc herniation: This affects the distribution of the C6 nerve root. It can cause numbness and tingling in the lower lateral arm, affecting the thumb and index finger. The muscles affected are the biceps and the wrist extensor muscles.
• C6/C7 Disc Herniation: This affects the distribution of the C7 nerve root. It can cause numbness and tingling along the 3rd digit (the long finger) and the triceps muscle. It can affect the triceps muscle causing numbness and tingling.
• C7/T1 Disc Herniation: This affects the distribution of the T1 nerve root. It can cause weakness including the ability to squeeze and hold on to objects. Numbness and tingling and pain can radiate down the arm to the little finger side of hand.

How long does a cervical disc herniation take to heal?

The pain levels are normally most severe to begin with, particularly when the nerve is initially compressed or irritated. Over the first six weeks the herniated bulge should naturally start to shrink and reabsorb back into the disc. Due to this, most cases see a 50% improvement in symptoms with pain levels being dramatically reduced and the additional symptoms like pins and needles, weakness and numbness taking slightly longer to resolve.

Diagnosis

Your doctor can diagnose a herniated disc by performing a physical examination and viewing medical images. Your doctor will ask you about your symptoms and medical history. You will be asked to perform simple movements to help your doctor assess your muscle strength, joint motion, and stability.  Since some of the nerves from the cervical spine travel to the arms, your doctor will perform a neurological physical exam to see how the nerves are functioning.

X-rays

Your doctor will order X-rays to see the condition of the vertebrae in your cervical spine.  Sometimes doctors inject dye into the spinal column to enhance the X-ray images in a procedure called a myelogram.  A myelogram can indicate if there is pressure on your spinal cord or nerves from herniated discs, bone spurs, or tumors.

CT scan or MRI

Your doctor may also order Computed Tomography (CT) scans  or Magnetic Resonance Imaging (MRI) scans to get a better view of your spinal structures.  CT scans provide a view in layers, like the slices that make up a loaf of bread.  The CT scan shows the shape and size of your spinal canal and the structures in and around it.  The MRI scan is very sensitive.  It provides the most detailed images of the discs, ligaments, spinal cord, nerve roots, or tumors.  X-rays, myelograms, CT scans, and MRI scans are painless procedures.

NCV test

In some cases, doctors use nerve conduction studies to measure how well the cervical spinal nerves work and to help specify the site of compression.  Doctors commonly use a test called a Nerve Conduction Velocity (NCV) test.  During the study, a nerve is stimulated in one place and the amount of time it takes for the message or impulse to travel to a second place is measured.  Your doctor will place sticky patches with electrodes on your skin that covers a spinal nerve.  The NCV may feel uncomfortable, but only during the time that the test is conducted.

Electromyography (EMG) test

An Electromyography (EMG) test is often done at the same time as the NCV test. An EMG measures the impulses in the muscles to identify nerve problems. Healthy muscles need impulses to perform movements. Your doctor will place fine needles through your skin and into the muscles that the spinal nerve controls. Your doctor will be able to determine the amount of impulses conducted when you contract your muscles. The EMG may be uncomfortable, and your muscles may remain a bit sore following the test.

treatment options

If a ruptured disc is diagnosed by a physician, the next step is to discuss available treatment options. In most cases, the most prudent initial approach to treating the symptoms of a ruptured disc is a combination of nonsurgical conservative techniques. While these treatments aren’t necessarily designed to offer immediate relief, over the course of several weeks or months, it is often possible to relieve the discomfort caused by a ruptured disc and potentially maintain or regain flexibility in the area around the deteriorated disc.

The most important thing you can do is to work closely with your doctor to identify the treatment options that will give you the best chance at overcoming your pain. There are many different ruptured disc treatment methods currently available, but the wrong approach could prove ineffective or even make matters worse, which is why you should never attempt a new treatment without consulting a medical professional. Treatments that work for some don’t work for all, and depending on your specific condition, overall health and the cause of your herniated disc, any number of treatments could possibly be recommended, including:

surgery

Spine surgery for a cervical herniated disc is generally reliable. The success rate is about 95 to 98% in terms of providing relief of arm pain.

With an experienced spine surgeon, the surgery should carry a low risk of failure or complication, and can be done with a minimal amount of postoperative pain and morbidity (unwanted aftereffects).

The surgery for a cervical herniated disc can be done a number of different ways:

Anterior cervical discectomy and spine fusion (ACDF)

This is the most common method among spine surgeons for most cervical herniated discs. In this surgery, the disc is removed through a small one-inch incision in the front of the neck. After removing the disc, the disc space itself is fused. A plate can be added in front of the graft for added stability and possibly a better fusion rate.

Posterior cervical discectomy

This is similar to a posterior (from the back) lumbar discectomy, and for discs that occur laterally out in the neural foramen (the “tunnel” that the nerve travels through to exit the spinal canal) it may be a reasonable approach. However, it is technically more difficult than an anterior approach because there are a lot of veins in this area that can result in a lot of bleeding, and the bleeding limits visualization during the surgery. This approach also necessitates more manipulation to the spinal cord.

Cervical artificial disc replacement

Like an ACDF, an artificial disc surgery involves removing the affected disc through a small incision in the front of the neck. However, instead of a fusion in the disc space, an artificial disc is placed in the disc space. The goal of the artificial disc is to mimic the form and function of the original disc.

Although any major surgery has possible risks and complications, with an experienced spine surgeon serious complications from  cervical disc surgery should be rare. The two most common surgeries, ACDF and artificial disc, are both considered reliable surgeries with favorable outcomes in terms of reducing the patients pain.

Postoperative Care for Cervical Herniated Disc Surgery

For anterior surgery, such as an ACDF and artificial disc, there usually is not a great deal of postoperative pain. The surgery is done through a small incision in the front of the neck, and the spine can be accessed in between tissue planes that do not require cutting. This type of surgery usually can be done either outpatient (going home the same day as surgery) or with one overnight stay in the hospital.

The pain in the arm usually goes away fairly quickly, although it may take weeks to months for the arm weakness and numbness to subside. It is not uncommon to have some neck pain for a while.

Postoperatively, most spine surgeons prescribe a neck brace, although the type of brace and length of usage is variable. Also, most spine surgeons will ask their patients to limit their activities postoperatively, although the amount of restrictions and the length of time tend to vary. Ask your spine surgeon before the surgery what his or her usual protocol is regarding postoperative care.

non-surgical treatment

Rest

Limited rest is often advised to take pressure off the neck and let the body naturally heal. That said, you want to be careful not to become too sedentary as prolonged inactivity can weaken muscles and actually exacerbate the problem.

Modified activity

Sometimes, lifestyle adjustments might be recommended to help relieve strain on the spine and keep it healthy. This might include anything from losing a little extra weight to quitting smoking, limiting alcohol consumption and avoiding activities like high-impact sports that can strain the spine.

Medication

The use of nonsteroidal anti-inflammatory drugs can help reduce inflammation and provide short-term relief. Pain relievers, muscle relaxers and other medication may also be recommended on an as-needed basis.

Cold and hot packs

An easy at-home treatment is the use of either hot or cold compresses. Heating packs help improve blood flow, promote circulation and facilitate the healing process; ice packs numb pain and reduce swelling and inflammation.

Stretching and strengthening exercises

In some instances, one of the most effective ruptured disc treatment approaches is through targeted exercise. By strengthening the muscles that support the neck, it may be possible to relieve some of the strain placed on the ruptured disc and help with painful symptoms. Exercise is also helpful because it helps patients lose excess weight, further reducing stress on the spine.

Many patients also turn to complementary and alternative medicine to assist in their recovery. The use of chiropractic therapy, acupuncture and other similar options are often attempted. However, these ruptured disc treatment approaches are somewhat controversial in the medical community because their overall effectiveness hasn’t been fully established. It just remains extremely important that you inform your physician before beginning any new treatment — alternative or otherwise — to make sure that you are giving yourself the best possible chance to overcome your disc pain.

Furthermore, conservative treatment of any kind can be a slow process. Finding the right combination of treatments can require a certain degree of trial and error and as a result, it’s very important to remain patient and tell your doctor if any particular approach is helping or not. If you ever experience additional pain from a treatment, stop it immediately and speak with your doctor before proceeding.

Prevention steps to increase spine health

The best way to prevent a ruptured disc is to live a healthy lifestyle.

by staying in relatively good shape, maintaining good posture and properly stretching, the chances of ruptured discs are reduced — although never fully eradicated. Some additional preventative methods you can take include:

• Stop smoking
• Stay active
• Maintain a healthy body weight
• Drink plenty of water throughout the day
• Stretch daily