The cervical spine consists of 7 vertebrae. There is a flexible and cartilaginous structure called the intervertebral disc between these vertebrae. This structure provides mobility and shock absorption during neck activity. The arch-shaped structure located at the back of the vertebrae surrounds the spinal cord and has a protective feature.
At the level of each vertebra, a pair of nerves exiting the spinal cord symmetrically through the gaps between the vertebrae, called foramen, and distribute to the muscles, tissue and other body structures, providing movement and sensory transmission.
Traumas, strains, accidents or the loss of central water content of the disc as we get older, poor posture, smoking, and sedentary life may make the disc not perform its cushioning function as well as before. As the disc continues to deteriorate, its outer layer may rupture, and the center of the disc protrudes through a tear in the outer layer and spills into the space where the nerves and spinal cord are located, causing a cervical herniation. These types of cervical hernias generally have a more acute course (sudden onset, developing in a short time).
Herniations, which occur when the disc and ligament structures deteriorate and calcify due to degeneration at the nerve exit points in the neck and the formation of spondylotic bony protrusions and pressure on the nerve, have a more chronic course (developing over a long period of time and gradually increasing).
What are the findings in cervical disc herniation?
The patient’s complaints may vary, including neck pain, loss of strength and numbness in the arms and hands. There is usually a pain that starts from the neck and spreads to the shoulder blade, then to the arm, and sometimes to the chest. This pain may be accompanied by numbness and loss of strength. In very severe herniations, serious clinical conditions ranging from mild paralysis affecting the legs from the neck down may be observed. In addition to neck pain, the patient may also have headaches. Pain in the arms and fingers is relieved positionally by raising the patient’s arm above his head. Painkillers and rest provide little benefit. The patient has such limited mobility that he cannot continue his daily life. Especially at night, the patient has difficulty falling asleep due to pain. He has difficulty making his head and arms comfortable and struggles with the pillow. Insomnia and chronic pain reduce the quality of daily life. In advanced stages, he may have difficulty holding heavy objects and may drop them.
C4 – C5 (C5 nerve root) – May cause weakness in the shoulder epaulette (deltoid) muscle and upper arm. There is usually no numbness or tingling. It may cause shoulder pain.
C5 – C6 (C6 nerve root) – may cause weakness in the front of the biceps muscle in the upper arm and wrist extensor muscles. Along with numbness and pain, tingling may spread towards the thumb side of the hand. This is one of the most common cervical disc herniation distances.
C6 – C7 (C7 nerve root) – causes weakness in the back (triceps) muscles of the upper arm and hand-wrist extensor muscles. Numbness and pain may spread downwards from this area and tingling may be felt towards the middle finger. This is one of the most common cervical disc herniation distances.
C7 – T1 (C8 nerve root) – May cause weakness in hand muscles. Numbness and tingling and pain may radiate to the little finger of the hand.
Situations when you should see a doctor:
- After trauma such as falling, hitting or blows to the head
- Neck pain accompanied by fever and headache
- If the pain radiates down your arm
- If you have numbness, burning and weakness in your hands and arms
- If neck pain is accompanied by weakness in the arms and legs
- Does not respond to painkillers
- If it takes more than 1 week
Diagnosis of Cervical Disc Herniation
Strength, sensory loss and reflexes are measured and evaluated with a detailed history of the disease and physical examination.
Diagnostic tests: Neck x-ray and neck magnetic resonance examination are the most commonly used diagnostic methods. In addition, computed tomography, EMG and other diagnostic methods may be requested if necessary.
Cervical Disc Herniation Treatment
Medical Treatments of Cervical Disc Herniation
- Most cervical hernias do not require surgery.
- Relaxing and stretching exercises for neck muscles after a short-term rest (1-2 days)
- Hot-cold applications, light massage
- Drug treatments (Painkillers and muscle relaxants, non-steroidal anti-inflammatory drugs)
- Physiotheraphy
- Trigger point injections, foraminal or epidural injections
Surgical Treatment of Cervical Disc Herniation
Surgical treatment; It is necessary for patients with significant spinal cord and nerve root compression and significant loss of strength and sensation that does not resolve with medical treatment or physical therapy. There are surgical methods that are applied by approaching from the front or back of the neck.
Anterior Cervical Microdiscectomy
This surgery is performed to eliminate the pressure on the nerve roots or spinal cord in the neck. The cervical spine is reached by entering through a small half-necklace style incision of 2-3 centimeters from the front of the neck. Under the microscope, the herniated cervical disc is emptied and the compressive bone protrusions are cleaned. After the disc space is emptied, fusion (ossification, integration) is achieved between the two vertebrae by placing a bone graft and a cage filled with bone paste.
In selected cases, a cervical disc prosthesis can be applied to the vacated disc space in order to preserve neck movement and ensure function.
Posterior Microdiscectomy
This procedure is performed through a longitudinal incision at the nape of the neck. It is especially preferred in isolated side-protruding disc herniations. In this procedure, the disc space is not emptied, only the overflowing part causing pressure is removed.