What Is Herniated Disc (Cervical)?
The cervical spine comprises seven vertebral bodies separated by compressible shock-absorbing discs.
In general, pain coming from the neck is divided into the pain originator, that is, ligaments or muscles, cervical disc or nerves, or from bone or facet joints.
Cervical Radiculitis (inflammation of the large nerves in the neck), or cervical radiculopathy (severe compression of the large nerves in the neck leading to functional changes), can originate commonly from a herniated cervical disc.
Our usual range of motion of flexion and extension and lateral rotation, as well as side-to-side bends, all cause gradual degeneration and take their toll on the disc.
Just as car tires will gradually lose their tread and show signs of wear, cervical discs are no exception.
When the center of the disc, the nucleus proposes, pushes outwards on the outer ring of the disc, called the annulus, it can cause inflammation and irritation of the adjacent nerve root.
The annular fibers may remain intact or degenerate and even rupture, allowing the internal nucleus pulposus to push outwards in the middle or side.
Because the back of the disc is the thinnest, the nucleus pulposus, the center of the disc, often herniated backward.
This is called central disc herniation.
In the cervical region, pressure backward on the spinal cord can result in severe symptoms and some cases, require immediate surgery.
More often, however, the herniation is to the left or the right side towards the foramen. In this opening, the nerve passes through, causing a chemical irritation and pressure on the nerve.
The patient’s symptoms are often directly related to which nerve is pinched.
For example, a herniation at the C4/C5 level can cause pain from the shoulder to the top of the upper arm and the front up to the elbow. Cervical herniated discs occur more commonly in the fourth and fifth decades of life.
Trauma from car accidents, a head strike against the dashboard or windshield, or habits such as chronic smoking, chronic obesity, and genetic factors may also cause weakening of the disc leading to herniation.
Often cervical herniated discs are incidental, meaning the patient does not have active pain.
Diagnoses involve a thorough history and physical as well as good imaging, including CAT scans, x-rays, MRI, electrodiagnostic studies, and bloodwork in some instances. Treatment options include analgesics for temporary pain relief, antiepileptic medications to help deaden sensitive nerves, low-dose antidepressants, which are helpful in both sleep and chronic pain, and opioid use for worsening chronic pain.
Physical therapy, including home exercises to help strengthen and improve the spine’s flexibility, is essential.
Epidural steroid injections, and trigger point injections into local muscles, may also be practical and augment the effects of oral medication and physical therapy.
If these fail, one can be evaluated for their candidacy for surgery.
