Cervical disc herniation is the protrusion of one or more of the intervertebral discs of the neck toward the spinal canal and/or a nerve root.
Overview
The condition arises most often in the lower part of the cervical spine.
Symptoms
Cervical disc herniation gives rise to two distinct clinical pictures according to where the pressure is exerted.
- Radiculopathy — compression of a nerve root
- Pain, numbness, tingling, burning and weakness are felt in the neck, shoulder and arm. The pain radiates along the course of the compressed nerve root in the arm.
- Myelopathy — compression of the spinal cord
- Where a cervical disc compresses the spinal cord, serious problems may arise: disturbance of gait, spasticity, and disturbance of bowel and bladder function.
Diagnosis
Diagnosis rests on a detailed neurological examination, imaging studies and neurophysiological tests. At examination the muscle groups are assessed individually and any weakness is sought. Accompanying sensory loss and the presence of abnormal reflexes are also examined.
Magnetic resonance (MR) imaging is the best means of demonstrating the anatomy and the soft tissues around the spine and spinal cord. Herniated discs are identified on MRI; computed tomography (CT) and plain radiographs are used where required.
Where MRI is contraindicated — in the presence of a pacemaker or an implant not compatible with MRI, for instance — computed tomography may be performed instead.
Treatment
The first step is generally conservative: analgesic and muscle relaxant medication together with rest. Approximately 80% of patients can be treated by conservative means.
- Physiotherapy
- Traction, ultrasound therapy and electrical muscle stimulation are used.
- Epidural Injection
- Under imaging guidance, a steroid and a local anesthetic are delivered together to the level of the herniation through a spinal needle. The procedure is carried out by neurosurgeons or by pain specialists.
Surgery is required where the patient has a neurological deficit, where the symptoms do not respond to conservative treatment, or where there is myelopathy.
Surgical Procedures
- Anterior Cervical Microdiscectomy and Fusion
- The operation performed most often worldwide for cervical disc herniation. The front of the spine is reached through an incision in the front of the neck. The level of the herniation is confirmed by imaging during the operation; the herniation is removed and the pressure on the spinal cord and nerve roots is relieved. A cage or a bone graft is placed where the disc has been removed.
- Artificial Disc (Prosthesis)
- Introduced in recent years for the treatment of cervical disc disease. A prosthesis is placed in the operated disc space in order to preserve normal movement of the neck and to reduce the risk of adjacent segment disease at the other levels of the spine.
- Posterior Cervical Discectomy
- An approach through the back of the neck, used in selected cases. Where the herniation lies within the canal (the foramen) through which the nerve root leaves the spinal canal, a posterior approach may be recommended.