The cervical spine is the most flexible part of the spinal column and is located between the thoracic spine and the skull. In between each vertebral bone lies an intervertebral disc which serves to cushion the forces of the vertebrae. Almost everybody has signs of wear and tear on their intervertebral discs with age. But in some people, these discs can develop pathology, which causes them to change their mechanical properties, resulting in herniation.
Dynamics of Herniation
A herniated or protruded cervical disc usually is a consequence of degenerative disc disease. The pathology leading to a herniated disc disease is not understood. The disc herniates when the fibrous outer layer tears or forms defects. Under pressure from the vertebral bones on each side, the softer inner disc material squeezes out through the defect. As the protruding material pushes onto the nearby nerve roots or the spinal cord, pain and other symptoms are elicited.
Who Is Afflicted
A herniated cervical disc resulting from degenerative disc disease is uncommon for people over 60 years old, says the Centra Care Health Library. The disease most commonly afflicts people who are 30 to 50 years old. Women and men are affected equally. Symptoms can appear slowly, over a period of years before they are recognized, or they can materialize suddenly. Environment and heredity can come together to impact the pathology. Also, people who smoke and those who perform repetitive activities are at higher risk of developing degenerative disc disease.
Symptoms
Symptoms of cervical disc herniation are variable and depend on the vertebral level, type of neural tissue affected and extent of the herniation. Symptoms may or may not occur and are different if the herniation pushes against the spinal roots or the spinal cord. Involvement of spinal roots produces radiculopathy, or pain and other symptoms characteristic of spinal root irritation. Myelopathy refers to functional disturbances such as sensory and motor problems when the spinal cord is irritated or damaged. Pain, weakness and sensory abnormalities can be felt from the neck to the hands and feet, usually on one side. More pronounced herniation can lead to weakness and paralysis on both sides of the body, as well as bladder and bowel dysfunction.
Conservative Treatments
The American Academy of Orthopaedic Surgeons states that conservative, or non-surgical treatments, relieve pain or other symptoms 90 percent of the time and are tried before surgery is recommended. Rest, physical therapy, cold compresses, muscle relaxants, analgesics, non-steroidal anti-inflammatory drugs and exercises can help alleviate the condition. Other treatments such as braces, electrotherapy, stress management and intra-spinal corticosteroid injections also may help.
Surgery
When conservative treatments fail, discectomy surgery is usually prescribed. Cervical discectomy is usually performed from the anterior neck. Either the entire disc or the herniated portion can be removed. Minimally invasive surgery also can be performed, which is usually approached from the posterior neck. In this case, smaller pieces of the disc are removed. Sometimes, multi-level discectomy might be required. If the entire disc is removed, the spinal column usually requires fusion. This means bone chips are grafted into the space left by the disc. Over time the graft encourages new bone to grow and eventually the two adjacent vertebrae fuse together. Permanent metal hardware may be required to hold the vertebrae together.
