Cervical disc herniation is a common cause of neck and upper body pain. Pain may feel dull or sharp in the neck, between the shoulder blades, and may radiate (travel) downward into the arms, hands and fingers. Sensations of numbness and tingling are typical symptoms, and some patients report muscle spasms. Certain positions and movement can aggravate and intensify pain.
Combine these factors with the effects from daily wear and tear, injury, incorrect lifting, or twisting, and it is easy to understand why a disc may herniate. A disc herniation may develop suddenly or gradually over weeks or months.
The 4 stages to a cervical herniated disc are:
#1. Disc Degeneration: Chemical changes associated with aging cause intervertebral discs to weaken, but without a herniation. This is part of the aging process discussed above, and it can cause the disc to dry out, making it less able to absorb the shock from your movements. It can also become thinner in this stage.
#2. Prolapse: The form or position of the disc changes with some slight impingement into the spinal canal or spinal nerves. This stage is also called a bulging disc or protruding disc.
#3. Extrusion: The gel-like nucleus pulposus (inner part of the intervertebral disc) breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
#4. Sequestration or Sequestered Disc: The nucleus pulposus breaks through the annulus fibrosus and can move outside the interverterbral disc and into the spinal canal.
Interestingly, not every herniated disc causes symptoms. Some people discover they have a bulging or herniated disc after an x-ray for an unrelated reason. But it is often the symptoms that prompt the patient to seek their doctor's advice. The making of an accurate diagnosis includes reviewing the patient's medical history, physical and neurological examination, and imaging studies (eg, x-ray, CT scan).
Not all patients require neck surgery. Often, within 4 to 6 weeks most patients find non-surgical treatments relieve pain and symptoms. Be optimistic about your treatment plan and remember that less than 5% of back problems require surgery.
Cervical spine spine surgery may be recommended if pain and symptoms progressively worsen despite nonoperative therapies. If the herniated disc is compressing the spinal cord (ie, myelopathy), surgery may be necessary.
The purpose of spine surgery is to decompress nerves the herniated disc compresses. The most common procedure is a discectomy—either the partial or total removal of the damaged disc. This surgery is usually performed from the front of the neck (called an anterior discectomy). Sometimes it is necessary to access the herniated disc from behind by removing a portion of the lamina; a small bony plat covering the spinal canal. The name of the procedure is laminotomy (posterior laminotomy). Often, either procedure can be performed minimally invasively, and sometimes in an outpatient spine surgery center.
Aging is inevitable, but lifestyle changes can help prevent cervical disc disease. Practice good posture and body mechanics, maintain a healthy body weight, get regular exercise, and don't smoke.