OverviewA herniated disc occurs when the gel-like center of a spinal disc ruptures through a weak area in the tough outer wall, similar to the filling being squeezed out of a jelly doughnut. Neck or arm pain, numbness or tingling may result when the disc material touches or compresses a spinal nerve. Treatment with rest, pain medication, spinal injections, and physical therapy is the first step to recovery. Most people improve in 6 weeks and return to normal activity. If symptoms continue, surgery may be recommended. Show
Anatomy of the discsYour spine is made of 24 moveable bones called vertebrae. The cervical (neck) section of the spine supports the weight of your head (approximately 10 pounds) and allows you to bend your head forward and backward, from side to side, and rotate 180 degrees. There are 7 cervical vertebrae numbered C1 to C7. The vertebrae are separated by discs, which act as shock absorbers preventing the vertebrae from rubbing together. The outer ring of the disc is called the annulus. It has fibrous bands that attach between the bodies of each vertebra. Each disc has a gel-filled center called the nucleus. At each disc level, a pair of spinal nerves exit from the spinal cord and branch out to your body. Your spinal cord and the spinal nerves act as a "telephone," allowing messages, or impulses, to travel back and forth between your brain and body to relay sensation and control movement (see Anatomy of the Spine). What is a herniated cervical disc?A herniated disc occurs when the gel-like center of your disc ruptures out through a tear in the tough disc wall (annulus) (Fig. 1). The gel material is irritating to your spinal nerves, causing something like a chemical irritation. The pain is a result of spinal nerve inflammation and swelling caused by the pressure of the herniated disc. Over time, the herniation tends to shrink and you may experience partial or complete pain relief. In most cases, if neck and/or arm pain is going to resolve it will do so in about 6 weeks. Figure 1. Normal disc and herniated disc. The gel-filled nucleus material escapes through a tear in the disc annulus and compresses the spinal nerve.Different terms may be used to describe a herniated disc. A bulging disc (protrusion) occurs when the disc annulus remains intact, but forms an outpouching that can press against the nerves. A true herniated disc (also caimg-fluidd or slipped disc) occurs when the disc annulus cracks or ruptures, allowing the gel-filled center to squeeze out. Sometimes the herniation is so severe that a free fragment occurs, meaning a piece has broken completely free from the disc and is in the spinal canal. What are the symptoms?Symptoms of a herniated disc vary greatly depending on the location of the herniation and your own response to pain. If you have a herniated cervical disc, you may feel pain that radiates down your arm and possibly into your hand. You may also feel pain on or near your shoulder blade, and neck pain when turning your head or bending your neck. Sometimes you may have muscle spasms (meaning the muscles tighten uncontrollably). Sometimes the pain is accompanied by numbness and tingling in your arm. You may also have muscle weakness in your biceps, triceps, and handgrip. You may have first noticed pain when you woke up, without any traumatic event that might have caused injury. Some patients find relief by holding their arm in an elevated position behind their head because this position relieves pressure on the nerve. What are the causes?Discs can bulge or herniate because of injury and improper lifting or can occur spontaneously. Aging plays an important role. As you get older, your discs dry out and become harder. The tough fibrous outer wall of the disc may weaken. The gel-like nucleus may bulge or rupture through a tear in the disc wall, causing pain when it touches a nerve. Genetics, smoking, and a number of occupational and recreational activities lead to early disc degeneration. Who is affected?Herniated discs are most common in people in their 30s and 40s, although middle aged and older people are slightly more at risk if they're involved in strenuous physical activity. Only about 8% of herniated discs occur in the neck region. How is a diagnosis made?When you first experience pain, consult your family doctor. Your doctor will take a complete medical history to understand your symptoms, any prior injuries or conditions, and determine if any lifestyle habits are causing the pain. Next a physical exam is performed to determine the source of the pain and test for any muscle weakness or numbness. Your doctor may order one or more of the following imaging studies:
What treatments are available?Conservative nonsurgical treatment is the first step to recovery and may include medication, rest, massage, physical therapy, home exercises, hydrotherapy, chiropractic care, and pain management. Over 95% of people with arm pain due to a herniated disc improve in about six weeks and return to normal activity. If you don't respond to conservative treatment or your symptoms get worse, your doctor may recommend surgery. Nonsurgical treatments
Surgical treatmentsWhen symptoms progress or do not resolve with conservative treatment, surgery may be an option. Factors such as patient age, how long the problem has persisted, other medical problems, previous neck operations, and expected outcome are considered in planning surgery. The most common approach to cervical disc surgery is anterior (front of the neck). A posterior (from the back) approach may be performed if you require decompression for other conditions such as stenosis.
Clinical trialsClinical trials are research studies in which new treatments—drugs, diagnostics, procedures, and other therapies—are tested in people to see if they are safe and effective. Research is always being conducted to improve the standard of medical care. Information about current clinical trials, including eligibility, protocol, and locations, are found on the Web. Studies can be sponsored by the National Institutes of Health (see Clinicaltrials.gov) as well as private industry and pharmaceutical companies (see Centerwatch.com). Recovery & preventionBack pain affects 8 of 10 people at some time in their lives, and usually resolves within 6 weeks. A positive mental attitude, regular activity, and a prompt return to work are all very important elements of recovery. If your regular job cannot be done initially, it is in the patient's best interest to return to some kind of modified (light or restricted) duty. Your physician can give prescriptions for such activity for limited periods of time. The key to avoiding recurrence is prevention:
Sources & linksIf you have more questions, please contact Mayfield Brain & Spine at 800-325-7787 or 513-221-1100. Spine-health.com Glossaryannulus (annulus fibrosis): tough fibrous outer wall of an intervertebral disc. disc (intervertebral disc): a fiberous cushion that separates spinal vertebrae. Has two parts, a soft gel-like center called the nucleus and a tough fibrous outer wall called the annulus. discectomy: a type of surgery in which herniated disc material is removed so that it no longer irritates and compresses the nerve root. nucleus (nucleus pulposus): soft gel-like center of an intervertebral disc. radiculopathy: refers to any disease affecting the spinal nerve roots. Also used to describe pain along the sciatic nerve that radiates down the leg. vertebra: (plural vertebrae): one of 33 bones that form the spinal column, they are divided into 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal. Only the top 24 bones are moveable. Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. This information is not intended to replace the medical advice of your health care provider. What is the best treatment for cervical radiculopathy?Anterior Cervical Diskectomy and Fusion (ACDF) ACDF is the most commonly performed procedure to treat cervical radiculopathy. The procedure involves removing the problematic disk or bone spurs and then stabilizing the spine through spinal fusion.
How serious is a herniated disc in the neck?When a spinal disc becomes herniated in the neck, it can leak out into the spinal canal or nerve root tunnel and impinge on the exiting nerve root. This process can cause cervical radiculopathy with symptoms of pain, tingling, numbness, and/or weakness that can radiate down into the shoulder, arm, and/or hand.
How long does it take to heal from cervical radiculopathy?Over 85% of acute cervical radiculopathy resolves without any specific treatments within 8-12 weeks. Over 85% of acute cervical radiculopathy resolves without any specific treatments within 8-12 weeks.
Is cervical radiculopathy serious?In rare cases, cervical radiculopathy may continue to progress with numbness and/or weakness getting worse despite treatments. The longer that numbness and/or weakness lasts in the shoulder, arm, or hand, the more likely that these deficits will become permanent or lead to paralysis.
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