CERVICAL HERNIATED DISC

Cervical Herniated Disc Information

Numerous cases of cervical herniated discs can indeed go undiagnosed. This often happens because symptoms can appear mild or mistaken for other common ailments. Diagnostic rates may also differ depending on the population being studied, leading to variations in estimates.

The estimated rate of cervical herniated discs in adults typically falls from 0.5% to 2%.

When it comes to the risk of developing a cervical herniated disc, the jury has been out for quite some time. Historically, men were believed more prone to this condition. However, recent research indicates that women might face a higher risk. This evolving understanding suggests that both genders must practice good cervical spine health, although the risk factors may differ.

Anatomical Components of a Cervical Disc

Understanding the anatomy of a cervical disc involves looking at its two primary components: the annulus fibrosus and the nucleus pulposus.

Annulus Fibrosus

The annulus fibrosus serves as the disc’s robust outer layer. Composed of concentric rings made of collagen fibers, this structure provides the necessary strength to protect the softer interior. Its key role includes managing the spine’s heavy loads and absorbing shocks from everyday activities. In summary, the annulus fibrosus gives the disc its durability and shock-absorbing capabilities, while the nucleus pulposus adds cushioning and flexibility. These two components work together to ensure the cervical disc can handle both stress and movement efficiently.

Nucleus Pulposus

Nestled within the annulus fibrosus is the nucleus pulposus, a gel-like core. This inner component consists of a network of fibers suspended in a mucoprotein gel, which allows it to act as a cushion. This cushioning effect provides both flexibility and support for spinal movements.

Understanding the Impact of Different Disc Levels on Motor Deficits, Reflex Changes, and Sensory Deficits

The alignment of your spinal discs plays a crucial role in maintaining overall nervous system function. When there’s a problem at specific disc levels, it can affect various areas of your body differently. Here’s a breakdown of how different disc levels can influence motor deficits, reflex changes, and sensory deficits:

C4-5 Disc Level

• Motor Deficits: You might experience weakness in your deltoid muscles, which are responsible for lifting and rotating your shoulder.
• Reflex Changes: Generally, there are no significant reflex changes noted at this level.
• Sensory Deficits: Sensation loss or numbness may appear on the lateral side of your shoulder.

C5-6 Disc Level

• Motor Deficits: Weakness in your biceps can occur, affecting your ability to bend your elbow and rotate your forearm.
• Reflex Changes: Changes in the bicep reflex are commonly observed.
• Sensory Deficits: You could notice sensory loss or numbness extending down the lateral part of your arm and forearm, including the thumb and index finger.

C6-7 Disc Level

• Motor Deficits: Weakness in your triceps and wrist extensors can occur causing challenges in extending your arm and wrist.
• Reflex Changes: Triceps reflex alterations are typically seen.
• Sensory Deficits: Sensation changes or numbness might affect your middle finger.

C7-T1 Disc Level

• Motor Deficits: You may face difficulties with hand grip and wrist flexion, impacting your ability to grasp objects and bend your wrist.
• Reflex Changes: Reflex changes are usually not noted at this level.
• Sensory Deficits: A sensory deficit might occur along the ring and small fingers, affecting tactile sensation.

Key Takeaways

• Motor Deficits: Different disc levels impact various muscle groups, such as deltoids (C4-5), biceps (C5-6), and triceps (C6-7).
• Reflex Changes: Not all disc levels result in reflex changes, but when they do, common areas include the biceps and triceps.
• Sensory Deficits: Sensory impairment is often localized to specific regions, like the lateral shoulder at C4-5 and fingers at C7-T1.

Understanding these correlations can help in diagnosing and managing the symptoms associated with spinal disc issues. If you experience any of these symptoms, consider consulting a healthcare professional for a thorough evaluation.

The Causes of a Herniated Disc:

• Age: As we get older, the discs in our spine lose water content, making them less flexible and more prone to injury.
• Repetitive stress: Repeated lifting, twisting, or bending can put stress on the discs and increase the risk of herniation.
• Poor posture: Sitting or standing in a slouched position can place undue pressure on the discs and increase the risk of injury.
• Obesity: Excess weight can put added stress on the spine and increase the risk of herniation.
• Genetics: Some people may get herniated discs because of genetic factors.
• Trauma: A sudden impact, such as a fall or car accident, can cause a herniated disc.
• Bulging disc in the neck

Symptoms of a Cervical Herniated Disc

To clarify, herniated disc symptoms can differ based on the location of the disc and the compression of any nerves.  In this case, symptoms often include:

• Pain in the neck that radiates down the arm towards the hands and fingers
• Numbness or tingling in the shoulders, arms, or hands
• Muscle weakness in hand and/or arms

In severe cases, a herniated disc may put pressure on the spinal cord. This will cause pain, tingling, numbness, or weakness in both arms and possibly even lower in the body.

Symptoms of spinal cord compression may also include:

• Difficulty walking straight or unsteady gait
• A reduction in fine motor skills in the hands and arms
• Painful tingling or feelings like electric shocks in the torso or even into the legs.

Understanding Myelopathy: Causes and Symptoms

Myelopathy is a condition where the spinal cord is compressed, often due to issues such as cervical disc herniation. This compression can lead to a range of serious symptoms.

Symptoms of Myelopathy

• Difficulty Walking: Patients often experience challenges with mobility, and feeling unstable or uncoordinated.
• Spasticity: An increase in muscle stiffness and involuntary spasms.
• Bowel and Bladder Incontinence: Loss of control over bladder and bowel functions is a significant indicator.

These symptoms result from the pressure placed on the spinal cord, disrupting normal neurological functions. If you notice any of these signs, it’s crucial to seek medical attention promptly.

Herniated Disc Diagnosis

Your doctor will review your medical history.  Then he or she will perform a thorough physical exam, and look for any signs of limited mobility.  After that, the doctor will ask about any pain, check balance, muscle reflexes, loss of sensation, or muscle weakness.

If doctors suspect a cervical herniated disc, they will use an X-ray to confirm the diagnosis. Because X-rays can only show issues with the bones, the doctor may order a CT or MRI scan.

For imaging, we use a state-of-the-art digital low-dose X-ray system.  In less than a minute, this advanced unit takes high-quality patient images. Also, this system can take X-rays of patients in a standing or seated position.  Moreover, it’s located inside our Dallas office and you and your doctor can review the X-rays ASAP.

How is Sensory Loss Assessed in Patients with a Suspected Herniated Disc?

Assessing sensory loss in patients with a suspected herniated disc involves a multi-faceted approach. Here’s how medical professionals typically conduct these evaluations:

Muscle Strength Testing

Each muscle group is evaluated individually to identify any signs of weakness. This step is crucial, as weakened muscles can indicate nerve damage or compression.

Sensory Examination

Doctors use fine touch and light pinpricks to examine the entire body. These tests help detect any subtle losses in sensation. By comparing the results from different areas, practitioners can pinpoint regions affected by nerve issues.

Reflex Testing

Reflexes are tested at key points such as the elbows, hands, knees, and ankles. Abnormal reflexes in these areas can provide clues about the location of a herniated disc. For example, a diminished knee reflex might indicate an issue in the lumbar spine.

Muscle strength tests are crucial in diagnosing a herniated disc. By evaluating the strength of specific muscle groups, healthcare providers can identify areas of weakness that may indicate nerve impingement. This is essential in pinpointing which nerves are affected by the disc herniation.

In addition to muscle strength tests, physicians often use fine touch and light pin examination across the body. This helps to detect subtle sensory loss, which can indicate nerve damage. Reflex tests at various joints such as elbows, hands, knees, and ankles are also conducted. Abnormal reflexes in these areas can reveal the precise location of the herniated disc. Together, these tests provide a comprehensive view of how a herniated disc is impacting the nervous system, offering targeted insight for effective treatment strategies.

Using these methods, healthcare providers can accurately assess sensory loss and identify the underlying causes, ensuring appropriate treatment plans are devised.

Understanding Radiculopathy and Its Connection to Cervical Herniated Discs

Radiculopathy is a condition characterized by pain, numbness, or weakness that radiates along the path of a specific nerve. When it occurs in the neck region, it often stems from issues with the cervical discs. These discs serve as cushions between the vertebrae in the spine. When one of these discs becomes herniated, it can press against spinal nerves, leading to radiculopathy.

Symptoms of Radiculopathy

• Neck Pain: Begins in the neck and may extend down to the shoulder.
• Arm and Hand Pain: Radiates down the arm and into the hand, following the path of the affected nerve.
• Numbness and Weakness: Can affect the arm and hand, making everyday tasks challenging.

Link to Cervical Herniated Discs

Cervical herniated discs occur when the gel-like center of a disc bulges out through a tear in the tougher outer layer. This herniation can compress nearby nerves, causing the symptoms associated with radiculopathy.

Other Possible Complications

• Spinal Cord Compression: In severe cases, a herniated disc may also compress the spinal cord, leading to myelopathy. This condition can cause significant issues with walking, muscle stiffness (spasticity), and even control over bladder and bowel functions.

Understanding this relationship is crucial for accurate diagnosis and treatment. If symptoms of radiculopathy are present, addressing the underlying cervical disc issue often provides relief and prevents further complications.

Treatment for a Cervical Herniated Disc

As a result, treatment options range from physical therapy and medicines to surgery.  At our offices, our doctors always start with a conservative approach to treatment before thinking about surgery.  In addition, our Doctors always take the time to discuss all options with our patients. So we talk with the patient about our options and how treatment depends on age, health, and severity of the problem.

Non-surgical Treatment

Most patients see rapid improvement with medicines that reduce pain, inflammation, and muscle stiffness that accompany a herniated disc. Medicines manage the pain while any numbness or tingling sensations tend to improve with time and rest.

The initial treatment for a herniated cervical disc is usually conservative. This often involves non-steroidal anti-inflammatory medication such as ibuprofen, Aleve or Mortin, along with rest. Approximately 80% of herniated discs can be managed conservatively, highlighting the effectiveness of this approach. By combining these methods, many patients experience significant relief and a return to normal activities without the need for more invasive procedures.

Non-surgical treatments for a Cervical Herniation Disc include:

• Physical therapy and/or exercises to relieve the pressure on the nerves
• Medications to reduce swelling and pain, such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, Aleve, and Motrin
• Epidural steroid injections and nerve root injections reduce swelling around the affected disc and nerves, as well as relieve acute pain radiating to the hips or down the legs.

Approximately 80% of herniated discs can be managed conservatively with these methods. Physical therapy often employs techniques such as traction, ultrasound, and electrical muscle stimulation to relax muscles that are in spasm and secondarily inflamed from the compressed spinal nerve. In some cases, an epidural steroid injection may be performed using a spinal needle under x-ray guidance to ensure the medication is directed precisely to the level of the disc herniation. This procedure is typically carried out by a neurosurgeon or a pain specialist.

Epidural steroid injection

An epidural steroid injection utilizes a spinal needle under x-ray guidance to direct the medication to the exact level of the disc herniation. This precise targeting helps ensure the medication effectively reduces inflammation and pain. The procedure is typically carried out by a neurosurgeon or a pain specialist, ensuring that it is done safely and accurately.  

Cervical Herniated Disc Surgery

If the pain, numbness, and other symptoms persist for more than 6-12 weeks, or if evidence suggests a severe spinal cord compression, your doctor may recommend surgery.

Surgical Treatment Includes:

Anterior Cervical Discectomy and Spinal Fusion involves removing the bad disc through the front of the neck. This will relieve the pressure on the nerves and/or spinal cord. Because most (if not all) of the disc gets removed, a fusion procedure will then stabilize the spine. A fusion procedure involves a small bone graft, screws, and rods to ensure that the bones fuse properly.

This procedure, known as Anterior Cervical Discectomy and Fusion (ACDF), begins with an incision in the neck to expose the front of the spine. The damaged disc is then carefully removed to alleviate pressure on the spinal cord and nerve roots. Following the removal, a bone graft is placed in the space left by the disc. The graft can come either from a bone bank or the patient’s hip. To further support the spine, a metal plate bridges the area, ensuring stability during the healing process.

It’s also worth noting that multiple-level ACDFs can occur if more than one disc is affected. This adaptability makes ACDF a versatile solution for various degrees of cervical spine issues.

Posterior access

Posterior Cervical Decompression (Microdiscectomy). In cases where the herniation of the disc appears minor, your doctor may use a minimally invasive technique. The Doctor removes the portion of the disc pressing on the nerve and makes a small incision on the back of the neck. Because only the small herniated portion of the disc gets removed, this surgery does not usually need to add a spinal fusion procedure.

Posterior Cervical Discectomy. During this operation, bone is removed from the back of the spine to expose the compressed nerve root. The disc is then removed, creating space for the nerve root to pass through. This procedure is designed to alleviate pressure on the nerve, providing relief from pain and other symptoms.

By combining these techniques, surgeons can tailor the approach to the specific needs of the patient, ensuring the best possible outcome with the least invasive methods.

Understanding Artificial Discs in Cervical Disc Disease Treatment

Artificial discs are advanced medical implants designed to replace damaged or degenerated cervical discs in the spine. These prosthetic devices mimic the natural structure and function of a healthy spinal disc, providing an innovative solution for patients suffering from cervical disc disease.

How Are Artificial Discs Used?

When treating cervical disc disease, a surgeon removes the problematic disc and inserts the artificial disc into the disc space. Here’s a breakdown of the key benefits and aspects of this procedure:

• No Bone Graft Required: Unlike traditional spinal fusion, the installation of an artificial disc doesn’t necessitate a bone graft. This simplifies the surgical procedure and reduces the recovery time.
• Maintains Mobility: A significant advantage of artificial discs is their ability to preserve the natural motion of the neck. This contrasts with fusion surgery, which can limit flexibility and movement.
• Prevents Adjacent Disc Disease: By retaining normal neck function, artificial discs may help prevent the premature degeneration of adjacent discs. This is a common issue in patients who undergo traditional spinal fusion, where the added stress on nearby discs accelerates wear and tear.

Why Choose Artificial Discs?

Patients with cervical disc disease often experience chronic pain and mobility issues that can severely impact their quality of life. Artificial disc replacement provides a promising alternative to fusion surgery, offering benefits such as:

• Quicker Recovery: Reduced need for post-operative immobilization and potentially shorter rehabilitation periods.
• Enhanced Quality of Life: Maintaining natural spine movement can significantly improve daily activities and overall well-being.
• Potential for Reduced Future Interventions: By minimizing the risk of adjacent disc disease, patients may face fewer additional surgeries or treatments down the line.

In conclusion, artificial discs represent a significant advancement in the treatment of cervical disc disease, providing patients with an option that supports both recovery and long-term spinal health.

Understanding Corpectomy and Fusion vs. ACDF

When it comes to treating herniated cervical discs, two common surgical options are available: Anterior Cervical Discectomy and Fusion (ACDF) and Corpectomy and Fusion. Both procedures aim to alleviate pain and restore spinal stability, but they differ in terms of their approach and scope.

Anterior Cervical Discectomy and Fusion (ACDF)

Procedure:

• ACDF involves a small incision at the front of the neck to access the spine.
• The damaged disc is carefully removed, which helps relieve pressure on the spinal cord and adjacent nerve roots.

Bone Graft and Stabilization:

• After disc removal, a bone graft is inserted into the space, and a metal plate is added to ensure stability.
• The bone graft come from either a donor bank or the patient’s hip.

Multiple Levels:

• Surgeons can use this technique to treat multiple levels of the spine if several discs are problematic.

Corpectomy and Fusion

• In contrast to ACDF, a corpectomy involves not just removing the damaged disc but also part or all of the affected vertebral body.

Procedure:

• A larger section of the bone is excised, which provides more extensive decompression of the spinal cord and nerves.

Bone Graft and Metal Plate:

• Similar to ACDF, a bone graft and metal plate are used to bridge the gap and stabilize the spine.

Key Differences

Extent of Removal:

• ACDF focuses on removing only the herniated disc, while corpectomy goes a step further by removing a section of the vertebral bone.

Indications:

• ACDF is typically performed when one or a few discs are involved, whereas corpectomy is reserved for more severe cases requiring broader decompression.

Surgical Impact:

• Corpectomy may involve a longer recovery due to the more extensive nature of the surgery.

Understanding these differences helps in making informed decisions about which surgical option aligns to the patients condition. Always consult with a specialized spine surgeon to explore which procedure aligns with your medical needs.

Why Choose the Southwest Scoliosis and Spine Institute

There are many reasons why you should choose the Southwest Scoliosis and Spine Institute doctors to treat your lumbar spinal scoliosis. Here are a few:

• They have a team of experienced and board-certified surgeons who specialize in treating spinal conditions, including scoliosis.
• They offer a variety of treatment options, including non-surgical and surgical treatments.
• They have a state-of-the-art facility that is equipped with the latest technology for diagnosing and treating spinal conditions.
• They have a reputation throughout the Nation for providing the very best spinal care for their patients.
• They are conveniently located in three locations in Dallas, Plano, and Frisco, Texas.

If you are considering treatment for lumbar spinal scoliosis, we encourage you to schedule a consultation with the Southwest Scoliosis and Spine Institute. They can help you to understand your condition and develop a treatment plan that is right for you.

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National Institute of Health: Cervical Herniated Disc
Medtronic: Cervical Herniated Disc