Author: Dr. Zaki Ibrahim

Millions of people suffer from neck, shoulder, and arm pain. While there are numerous conditions that can result in this type of pain, a common cause is a herniated disc. Discs, which act as shock absorbers for the spine, are located in between each of the vertebrae in the spine. Each disc contains a tire-like outer band (called the annulus fibrosus) that surrounds a gel-like substance (called the nucleus pulposus).

A herniation occurs when the outer band of the disc breaks or cracks and the gel-like substance from the inside of the disc leaks out, placing pressure on the spinal canal or nerve roots. In addition, the nucleus releases a chemical that can cause irritation to the surrounding nerves causing inflammation and pain.

Cervical spine MRI showing herniated disc

Symptoms of a cervical disc herniation may include the following:

• Dull or sharp pain in the neck or between the shoulder blades, which can intensify in certain positions or after certain movements.
• Pain that radiates down the arm to the hand or fingers (this is called radiculopathy).
• Numbness or tingling in the shoulder or arm.

How Do Discs Herniate?

Most cervical disc herniations occur as a result of sudden stress, such as from a fall. Sometimes they occur gradually, over weeks or months.

 

Stages of Disc Herniation 1. Disc Degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation. 2. Prolapse: the form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion. 3. Extrusion: the gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc. 4. Sequestration or Sequestered Disc: the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP).

However, there are risk factors that can contribute to the chances of a disc herniation, including:  

• Aging. As we get older, discs gradually dry out, affecting their strength and resiliency.
• History of major or minor trauma to the cervical spine.
• Lifestyle choices. Lack of regular exercise, not eating a well-balanced diet, and tobacco use substantially contribute to poor disc health.
• Poor posture, incorrect and/or repetitive lifting or twisting can place additional stress on the cervical spine.

Treatment for Cervical Disc Herniation

The good news is that most cases of cervical disc herniation do not require surgery! There are a number of non-surgical treatments that can help relieve symptoms. These include the following:

• Pain medications such as anti-inflammatories to reduce swelling and pain, muscle relaxants to calm spasm, and narcotic painkillers to alleviate acute pain.
• Heat/cold therapy, especially during the first 24-48 hours.
• Physical therapy exercises such as gentle massage, stretching, and neck bracing or traction to decrease pain and increase flexibility.

In conjunction with these treatments, the medical professionals at CCSI educate patients about risk factors to avoid, healthy posture, good body mechanics, and suitable exercises. Quality education can lead to a healthier spine in the long run.

Surgical Options

If non-surgical measures do not work, we may recommend surgery to treat your disc herniation.

An anterior (from the front) cervical discectomy is the most common surgical procedure to treat damaged cervical discs. The goal of this procedure is to relieve pressure on the nerve roots or on the spinal cord by removing all or part of the damaged disc.

During the surgery, the soft tissues of the neck are separated and the offending disc is removed, so to take pressure of the spinal cord. If necessary, the space left by the removed disc will be filled with a bone graft – a small piece of bone usually taken from the patient's hip. The bone graft is used to join or fuse the vertebrae together. This is called fusion. In some cases, some instrumentation (such as plates or screws) may be used to help promote fusion and to add stability to the spine.

Cervical Spine Model with Cervical Plate

In addition, a portion of the bone covering the nerve may also need to be removed. This procedure is called a laminotomy.

Fortunately, these procedures can often be done utilizing minimally invasive techniques. Minimally invasive surgery uses smaller incisions and tiny specialized instruments such as microscopes and endoscopes.

Recovery

At CCSI, most patients can begin getting out of bed on the same day surgery is performed! Activity is gradually increased and patients are typically able to go home within 1 - 2 days after their procedure, depending on the extent of the surgery. As with most surgeries, there will be some pain after the procedure. However, the staff at CCSI is very attentive to patients' pain levels, and we have considerable expertise at minimizing pain and discomfort. We have pain medications available that will keep you comfortable.

At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a week or two after surgery. Other techniques for reducing pain and increasing flexibility will be discussed with you before you leave CCSI. When you can return to work and other activities such as sports and driving will also be discussed with you before you leave.

Your health is our primary concern

Like you, we are eager to see you return to a healthy, pain-free and active life. You can be assured that at CCSI we will offer you a combination of appropriate treatment and in-depth education to help you overcome your current condition and to minimize the chances of recurrence.