Cervical Disc Herniation
Cervical disc herniation can arise due to aberrations of the intervertebral disc such as bulging, rupture and slipped or extruded disc. It results in neck, shoulder and arm pain. In some cases, disc herniation may occur due to injury, repetitive movements or degenerative disc disease (DDD). In DDD the disc strength, resiliency and structural integrity is affected due to advancing age, trauma, injury, smoking, poor diet, improper posture or poor body mechanics.
Each disc is composed of an inflexible ring-like annulus fibrosis enclosing a gelatinous inner structure called the nucleus pulposus. Each disc is kept in position with the help of endplates present between two vertebral bodies. The cervical intervertebral disc acts as a shock absorber. Any cracks or breaks in the annulus fibrosis, which act as a protecting band for the nucleus pulposus, results in oozing of the gelatinous material outside the disc. In a bulged intervertebral disc the nucleus pulposus remains within the disc and acts as a forerunner to herniation. The protruding disc matter causes nerve root and spinal cord compression.
Cervical disc herniation is associated with pain. The degenerative changes in the disc can result in a reduction in disc height which can cause compression of the spinal cord and the spinal nerves. In addition, the exuding disc matter causes pain and inflammation of the nerve due to chemical irritation.
Patients may experience neck pain which may radiate to the shoulder, upper back, hands and fingers; this condition is known as radiculopathy. The other common symptoms associated with cervical disc herniation include:
- Increased pain with movement
- Burning, tingling or numbness
- Stiffness in hand or arm
- Improper balance and gait
- In rare cases, bowel and bladder dysfunction
- An accurate diagnosis is essential for effective and successful treatment.
- The diagnosis of cervical disc herniation comprises of the following steps:
- Medical and family history of the patient
- Physical and neurological examinations
- Testing of reflexes to evaluate muscle weakness, sensitivity, and other signs of neurological injury.
- Diagnostic imaging techniques such as X-rays, CT scan, and MRI scans are employed to confirm the location of the damaged cervical disc.
- The simple X-ray helps in identifying the collapsed disc space, while CT and MRI scan helps to visualize the bone, disc, nerve and soft tissues.
Both surgical and non-surgical methods can be considered in the management of cervical disc herniation. Initially, Dr. Stilwell may advise non-surgical methods or a combination of two or more therapies to relieve pain and other symptoms.
The common non-surgical treatment options include:
- Activity modification
- Medications such as narcotics and muscle relaxants
- Spinal injections
- Use of neck braces to support the cervical spine and relieve pain
- Physical Therapy
Surgical treatment is recommended for patients who fail to respond to non-surgical treatment and in patients with associated spinal instability and neurological dysfunction.
Lumbar Disc Herniation
Lumbar disc herniation is the most common cause of low back pain and leg pain (sciatica). The lumbar intervertebral discs are flat and round, present between the lumbar vertebrae and act as shock absorbers when you walk or run. There is a soft, gelatinous material in the center (nucleus pulposus) which is encased in strong elastic tissue forming a ring around it called annulus fibrosus.
Ageing, injury or trauma may cause the annulus fibrosus to tear resulting in protrusion of the nucleus pulposus. This may compress the spinal nerves and/or spinal canal. The bulging disc may even break open releasing the gelatinous material, which is a chemical irritant, causing inflammation of the spinal nerves.
Obesity, sedentary lifestyle and smoking increase the risk of lumbar disc herniation.
The symptoms of lumbar disc herniation include:
- Mild to intense back pain, making it difficult to bend
- Numbness and weakness in the leg or foot leading to the sensation of tingling (pins and needles)
- Leg and/or feet pain making it difficult to walk or stand
- In rare cases, loss of bowel and bladder function (cauda equine syndrome) may occur. This condition requires immediate medical attention.
Diagnosis includes medical history coupled with physical and neurological examination. Neurological examination is done to indicate any neurological injury and involves evaluation of reflexes and muscle weakness by various tests. To confirm the diagnosis Dr. Stilwell may order a MRI to evaluate changes in the disc and spinal nerves.
Non-surgical treatment is preferred over surgery and includes rest, activity modification, and pain medication which include non-steroidal anti-inflammatory drugs, muscle relaxants and epidural analgesic injections. Back braces are recommended for a few days to keep the lower back still and reduce mechanical pain due to movement. Physical therapy or acupuncture may be helpful in some cases.
Surgery is considered in cases with significant leg pain, muscle weakness and numbness that is unresolved after conservative treatment measures.