Cervical Herniated Disc

Description

In between each of the seven cervical vertebral bodies (bones of the neck), lies a disc. This disc is composed of collagen fibers providing tensile strength, stiffness, and resistance to compression. The intervertebral disc connects each of the vertebral bodies, providing flexibility and distributing equally loads applied to the spinal column. The outer rubber-like band of the disc (called the annulus fibrosus) encases a jelly-like substance (called the nucleus pulposus). A herniation may develop suddenly or insidiously over weeks or months. In a normal, healthy disc, the nucleus distributes the load equally throughout the annulus. As the disc undergoes degeneration, either by genetic factors or changes in hydration, the nucleus loses some of its cushioning ability and transmits the load unequally throughout the annulus. In general, if a disc herniation is responsible for neck pain, the patient will be able to recall the exact time of injury and contributing factors.

Symptoms

Patients typically describe sharp pain radiating down one or both arms. This pain may be associated with numbness and tingling. Patients may also complain of burning and stabbing-like sensations. Weakness of the arms can be present.

Treatment

Approximately 90% of patients will have their symptoms resolve spontaneously within four to six weeks. While cervical disc herniations may cause a significant amount of neck and arm pain, the majority of patients experience resolution of symptoms regardless of treatment. Rest, anti-inflammatory medication, pain medication, and physical therapy are usually beneficial. If arm pain and weakness develop, epidural steroid injections may be warranted. Cervical epidural steroid injections are controversial. Surgery is reserved for those patients who fail to improve with conservative measures. To alleviate nerve pressure and arm pain, surgery involves removal of the herniation fragment compressing the nerve (discectomy). This can be done through a minimally invasive approach using a microscope.

Procedure

Improvements have been made in the tools available to the spinal surgeon for performing discectomy. Microdiscectomy involves using an operating microscope to locate and remove disc material that has ruptured into the spinal canal. This procedure is performed through a one-inch incision. Approximately 90-95 % of all patients will obtain significant relief of their symptoms after surgery. The indications for this procedure are similar to those for traditional discectomy.