To understand the mechanism of cervical disc herniation, it is first necessary to consider the structure of the cervical bones. The neck consists of 7 vertebrae from the base of the skull. In the middle of each vertebral body is the spinal cord, which is an extension of the brain. The signals going back to the brain from different parts of the body or the orders sent from the brain to the body pass through the spinal cord. In the cervical region, nerves that exit from the level of each vertebral body spread to the arm and the back, providing sensation and movement to these areas.
The disc tissue, which we call the intervertebral shock absorber, has an outer part (annulus fibrosus) as well as an inner part (nucleus pulposus). A cervical disc herniation occurs as a result of the gelatinous inner portion tearing the outer portion, which consists of stronger connective tissue and compresses the spinal cord and nerves. The main difference from a lumbar herniation is that partial or complete weakness is felt throughout the body, which is caused not only by the nerves but also by the spinal cord itself. Since the spinal cord ends on the level of the first lumbar vertebra, only nerves continue to the lower region.
The pain increases with head movement and the location of the pain in the cervical region or around the spine makes us think of pathological changes related to the neck area. Cervical disc herniation is one of the most common pathologies in this region.
Complaints of patients with cervical disc herniation can be severe pain, pain that extends to the arm, headache, neck stiffness, numbness, imbalance, decreased movements, tingling, tinnitus, dizziness, and weakness.
The most common symptom is PAIN. It is felt in the area that is stimulated by a pinched nerve. Neck movements, especially turning the head back, can increase the pain. It may or may not be affected by pain medication. The pain in cervical disc herniation can also be sharp and it can start suddenly. Additionally, this pain may start out mild and increase with time.
Other conditions that can be confused with cervical disc herniation include multiple sclerosis (MS), spinal stenosis, tumour formations, vitamin B12 deficiency, inflammation of the spine, heart diseases.
Risky occupations and causes that increase the likelihood of cervical disc herniation:
- road accidents, injuries, sudden braking, sudden manoeuvres, and impacts
- strain in everyday activities
- wrong movements and incorrect neck posture
- emotional tension, weakness in the neck muscles
- degenerative changes in the bone structure due to aging, calcification
- certain common inflammatory rheumatoid diseases (ankylosing spondylitis, rheumatoid arthritis)
- fibromyalgia
- incorrect posture and disease conditions associated with incorrect posture, stress, exposure to cold, fatigue
- occupations in which workers sit for long periods of time in front of a computer, housewives, secretaries, teachers, drivers are considered to have the greatest impact on the neck
All this leads to wear and tear of the spine, discs, joints and connective tissue.
Listening to the patient's complaints and careful neurological examination are the most important elements in making a diagnosis. In the diagnosis of cervical disc herniation, direct radiography of the neck, magnetic resonance imaging (MRI) and computed tomography (CT) are performed, and if necessary, an EMG and nerve conduction test are also performed. MRI is a sensitive and popular method for the treatment of cervical disc herniation. It allows obtaining accurate results in 85-90% of cervical disc herniations. Usually, it is also sufficient for its diagnosis. It shows both the soft tissues and the nerves.
Nowadays, there is more than one method of treatment of lumbar and cervical disc herniation in the world. This sometimes poses a problem not only for patients but also for doctors.
90-95% of cervical disc herniations are treated without the need for surgical treatment.
Treatment of cervical disc herniation
Three methods are used in the treatment of cervical disc herniation:
- Medication treatment: nowadays it is possible to treat and counteract the pain with the help of creams, tablets, or injections, which can be purchased from any pharmacy. In fact, 96% of cervical disc herniations can easily pass with such treatment, without the need for surgical intervention.
- Physical exercises and physiotherapy: within the scope of physiotherapy there are additional methods related to relaxation treatment, such as all types of massage, physical exercises, acupuncture, transcutaneous electrical nerve stimulation (TENS), ultraviolet treatment, magnetic therapy. Special exercises and treatments that improve the patient's quality of life are added to these methods, along with medical treatment.
- Surgical treatment: Our patients who undergo the microdiscectomy method (the gold standard) can be discharged the same day after 5-6 hours. This method removes significant pressure from the spinal cord by penetrating 1-1.5 cm into the skin using a microscope. In our hospital, we perform this type of surgical treatment, and the patient can continue with their normal lifestyle in about a week afterwards.
Recommendations to prevent/reduce the occurrence of cervical disc herniation:
- Practicing water sports.
- Our patients with lumbar and cervical disc herniation are treated by swimming before and after surgery.
- Since heaviness is the main enemy of the spinal cord, we primarily recommend a diet, stress-free lifestyle.
Very few patients need surgical treatment.
Conditions requiring surgical treatment of cervical disc herniation:
Although severe pain in the neck and arms is the main thing that requires surgical intervention, the disappearance of pain does not mean that the threat to the spinal cord has disappeared. Therefore, apart from numbness of the arms, weakness and restricted movements, instability of the whole body, curving of one side while walking, stumbling, and dragging of the feet indicate that cervical disc herniation is in an advanced stage.
Patients who complain of feeling no relief despite treatment, and those whose neurological status worsens during treatment, are candidates for surgical treatment. During surgical treatment, it is important for the nerve to be relaxed. Currently, the standard method is anterior microdiscectomy (with an anterior approach). The surgery is performed under general anesthesia. The patient is discharged one day after. This operation, in which the disc herniation material is enlarged 20 times, and in which the spinal cord and nerves are relaxed, is performed successfully in almost all hospitals today.
In cervical disc herniation patients, fusion with a prosthesis or cage is performed to prevent narrowing or angulation between the vertebrae that may develop after surgery.
Microdiscectomy using a microsurgical technique is very successful in well-selected cases, especially in patients with persistent pain. The success rate is 97-98%.
To prevent cervical disc herniation: correct your posture and alignment by keeping your neck straight and in the correct position, not leaning forward. Neck bending and lifting occurs frequently when tidying your desk and in work environment. When using a computer, it is absolutely necessary to adjust your desk, computer screen, keyboard, and posture. You cannot cure neck pain or mechanical pain with the help of analgesics. Exercises for posture correction and aerobics are very important in treating and preventing neck pain. They help correct the curvature of the neck.