Herniated Disc (Cervical)
Herniation of a disc is an anomalous spine condition characterized by leakage of the inner contents of the intervertebral disc, due to cracks in its outer wall. Herniated disc is commonly seen in the cervical or neck region, a condition called cervical herniated disc (CHD). CHD is followed by arm or neck pain that may arise due to compression of the spinal nerves by the protruding disc material. This condition is frequently reported in people between 30-40 years of age as well as elderly people. Treatment of CHD begins with conservative (non-surgical) methods, as reports show that around 90% of patients may return to normal activity by employing these interventions for at least 6 weeks. The patients which are not experiencing benefits from conservative interventions are recommended for surgery.
The cervical region consists of 7 cervical vertebrae (C1-C7), with intervertebral discs between each vertebra that function to provide flexibility to the back bone. Intervertebral discs are soft, compressible structures consisting of a hard outer ring called the annulus and a gel-like centre, called the nucleus.
The foremost causes and risk factors involved in the development of cervical herniated disc are advanced age, trauma or injury, abrupt neck movements, smoking and genetic factors. The usual symptoms associated with cervical herniated disc are pain and numbness in the neck, shoulders, chest, arms, and hands, followed by weakness in the associated region.
The diagnosis of a cervical herniated disc involves taking a medical history and performing a physical examination of the patient. Physical examination may also involve analysis of the neck movements to determine the source of pain and related injured tissues. Furthermore, various new advanced imaging techniques such as MRI scan, myelogram, CT scan, X-rays, electromyography (EMG) and nerve conduction velocity (NCV) tests, are widely used for accurate diagnosis, as confirmatory tests.
The well-established non-surgical interventions for CHD include adequate rest, massage of the neck, ice or heat compression, physical therapy, strengthening exercises, chiropractic care, and medications, including epidural steroid injections. In addition, widely accepted holistic therapies such as acupuncture, acupressure, and nutritional supplements are also extensively used.
Surgery is recommended for those patients who are not responding to non-surgical measures. Moreover, numerous other factors such as patient’s age, other medical conditions, previous neck surgeries, and duration of suffering are considered, before making the decision to have surgery. Highly advanced surgical techniques such as anterior cervical discectomy and fusion (ACDF), artificial disc replacement and posterior cervical discectomy, have shown tremendous results and explore a new era of cervical herniated disc treatment. Due to further advancement in technology, discectomy can be performed through minimally invasive techniques that employ a small incision for the operation. These advanced techniques have diminished recovery time, followed by an improved success rate.