According to "Harrison's Principles of Internal Medicine," herniation or protrusion of a cervical disk commonly causes pain in the neck, shoulder, arm or hand. C-3, C-4, and C-5 designate the third, fourth and fifth cervical disks, counting from the top of the neck down. In young people, trauma often causes a ruptured neck disk. "Davidson's Principles and Practice of Medicine" states that degenerative changes occur in a neck disk in the same manner as in the lumbar spine.
Conservative Treatment
The most common levels for disk problems in descending order include: C6-C7, C5-C6, C7-T1, C4-C5 and rarely C3-C4, according to the Chicago Institute of Neurosurgery and Neuroresearch. Herniation may affect one disk, usually between C-6 and C-7, or several disks. Disk herniation affects people of all ages. Conservative treatment helps the majority of patients with cervical disk herniation. The Chicago Institute of Neurosurgery and Neuroresearch states that conservative treatment reduces pressure on the cervical nerve. Treatment includes immobilizing the patient with the neck flexed forward; use of anti-inflammatory medications such as aspirin, ibuprofen or Vioxx; physical therapy consisting of traction, stretching, heat, massage and ultrasound; and finally, home cervical traction.
Surgical Treatment
Patients who require urgent decompression, those who do not have time for conservative approaches and patients who have failed conservative management after six to eight weeks need surgical treatment, according to The Chicago Institute of Neurosurgery and Neuroresearch. The two surgical approaches to repair cervical disk herniation include anterior, from the front, and posterior, from the back. The anterior approach affords the surgeon easier access to the disk located in front of the spinal cord. According to Universityspine.com, an anterior spine diskectomy usually accompanies an anterior cervical fusion or a cervical artificial disc replacement. A minimally invasive cervical foraminotomy using tube retractors and a microscope uses the posterior approach; this offers an alternative to the anterior approach when indicated.
Cervical Endoscopic Diskectomy
According to DrSchiffer.com, cervical endoscopic diskectomy, or CED, offers an alternative treatment for repair of cervical disk herniation. CED differs from open cervical disk surgery in that no damage occurs to the neck muscles, no bones are removed and no large skin incision is required. The surgeon performs this minimally invasive surgery on an outpatient basis.
References
- "Harrison's Principles of Internal Medicine"; Dennis Kasper, M.D.; 2005
- Chicago Institute of Neurosurgery and Neuroresearch: Cervical Disc Herniation
- "Davidson's Principles and Practice of Medicine"; John Macleod; 1977
- DrSchiffer.com: Cervical Endoscopic Discectomy
- University Spine: Conditions
