Cervical Disc Herniation
What is Cervical Disc Herniation?
The spinal column is made up of individual vertebra that are separated by discs. The discs are the spongy, soft material that provide cushioning, shock absorption, and movement/ flexibility of the spine. Sometimes, a disc will herniate, meaning the soft inner material ruptures out into the spinal canal. This can put pressure on the spinal cord and/or the nerves of the spine.
A disc herniation can happen all at once, in which the soft, squishy material (nucleus pulposis) of the disc pushes out backwards, causing severe pain. Other times, a disc can slowly degenerate over time; these are called hard disc herniations (as opposed to soft). A hard disc herniation happens when the neck goes through a wear-and-tear process, the disc of the spine gets worn out. As the disc wears out, it loses some of its pliability and can collapse on itself. As it collapses, the disc can slowly widen, putting pressure on the nerves as they leave the spine.
Herniated disks will sometimes be referred to as pinched nerves because this is exactly what they are doing – they are pinching the nerves the spine as the nerves are exiting the spine and going to the neck and arm.
What symptoms does cervical disc herniation cause?
Regardless of why the disc has degenerated or herniated, the symptoms produced are similar. Cervical disc herniation can be excruciatingly painful. Cervical disc herniation can cause neck pain, because the biomechanics of the neck have changed. It can also present with arm pain, weakness, and/or numbness. Arm pain or shoulder blade pain is often a result of the disc putting pressure on the nerves that are exiting the spine. Depending on which disc in the neck herniates, the symptoms in the arm may be felt in a different distribution. For example, when someone has a disc herniation at C6-7, meaning the disc between the C6 bone and the C7 bone has herniated, it will put pressure on the C7 nerve. Classically with a C6-7 disc herniation, patients will experience symptoms along the side of the neck down the inside of their shoulder blade radiating down the back of the arm and elbow, and sometimes all the way down into the hand. Although symptoms can follow very predictable patterns depending on the level of the spine that is affected, symptoms can vary from patient to patient. Based on the pattern of pain that is felt, it may provide an idea about which disc is herniated before it is seen on an MRI.
How is cervical disc herniation diagnosed?
Cervical disc herniations can be made as a clinical diagnosis. This means, based on what the patient reports in combination with the physical exam, a diagnosis can be made. X-rays will not show the disc herniation itself, but it will show if someone has some degenerative changes in the neck that could predispose them to neck problems. The only way to absolutely confirm a cervical disc herniation is with advanced imaging, usually in the form of a MRI of the neck (cervical spine). The MRI allows visualization of the individual discs, the spinal contents, the nerves, and if something is putting pressure on a nerve.
How is cervical disc herniation treated?
I generally divide treatment into a couple different tiers. I individualize my treatment plan based on the patient’s duration of symptoms, severity of symptoms, and on the patient’s overall goals.
The first tier of treatment is conservative and can include observation alone if symptoms are overall pretty mild. The second tier of treatment involves anti-inflammatory medication, physical therapy, rest, and rehabilitation. The third tier of treatment is to consider pain management injections. In this situation, we will often use the MRI and symptoms like a map to identify exactly which nerve is being irritated by which disc. The pain management specialist can perform nerve root blocks or epidural steroid injections to coat the offending nerve in medicine to hopefully help with the pain. In general, the pain is usually due to an inflamed nerve, so if we can calm down the inflammation in the nerve, things should get better. The fourth tier of treatment is operative.
Cervical disc herniations most the time do not require any surgery. However if everything else has failed, or if the patient has severe symptoms that do not respond to conservative management, or if the patient has red flag symptoms, sometimes operative intervention is warranted. The most common surgery performed for cervical disc herniations is an anterior cervical discectomy and fusion or a cervical disc arthroplasty.
Both are excellent options, however not all cervical disc herniations are the same and individualized surgical decision making is needed for each patient.
Regardless of your symptom severity, the good news is that cervical disc herniation can be treated. Most patients are able to return to their prior level of functioning after a cervical disc herniation.