Cervical disc herniation
Spread of pain in arm in case of cervical disc herniation (also known as brachialgia)
What is a disk hernia in the cervical spine?
The cervical spine consists of vertebrae and intervertebral discs spaced between them. The intervertebral discs consist of a dense outer ring and a thick gel-like core or nucleus. The discs provide “cushioning” of the spine and permit the range of motion required to facilitate movement.
If the disc is deformed or the nucleus herniates the spinal cord or any adjacent nerves can become compressed. This type of deformation can be caused by loading or trauma. It can also occur as a process of natural wear and tear that the disc suffers throughout its lifetime.
Intact intervertebral disc in the cervical spine
Herniated disc with compressed outbound nerve
How does a disc herniation of the cervical spine manifest?
Each nerve that comes out of the cervical spine has its own specific area that it innervates (these areas are called dermatomes).
When a disc herniates and compresses a nerve it can cause pain in the corresponding dermatome (see picture).The pain is often described as pulling, sometimes burning, radiating from the neck along the path of the nerve. When it affects the arm, it is referred to as brachialgia.
How is the intervertebral disc herniation in the cervical spine diagnosed?
If the patient has relevant complaints and symptoms, a magnetic resonance imaging of the cervical spine should be performed to confirm the diagnosis.
How is the disc herniation in cervical spine treated?
In the case of a cervical spine disc herniation, treatment is started with pain-relieving medication, as well as specific therapeutic exercises to strengthen the cervical spine. Exercises strengthen the musculature of the cervical spine and relieve the pressure excreted on the intervertebral disks, the decreasing pressure promotes healing and resorption of herniated tissue in turn decreasing the pressure on the affected nerve. About 70-80% of patients recover within 6-8 weeks of starting proper treatment. If non-operative methods are ineffective, surgery may be considered.
When an operation is required?
Spinal disc hernia surgery (ACDF surgery) is recommended only after all non-surgical treatment options have been exhausted. If drug therapy fails to alleviate pain, or pain is very severe from the outset of disease, as well as if there is loss of muscle strength and/or control – surgery should be considered immediately.
What does surgery mean to me as a patient?
With modern tools and equipment, cervical disc herniation surgery is patient-friendly and easily tolerated.
The operation involves a small incision on the skin on the anterior surface of the neck. The surgeon then creates access to the damaged vertebral disc of the spine, gradually detaching the surrounding tissue. An x-ray machine is used to verify that the correct vertebral space is being accessed. The damaged disc tissue is removed under microscope guidance and a titanium implant is inserted in its place. The operation wound is closed.
When the patient wakes up, the pain in the arm is usually gone and the patient may stand up just hours after operation and go home the next day after surgery.
How effective is the operation?
Cervical disc herniation surgery surgery is highly effective – about 90% of patients are able to completely get rid of their hand pain.
Does surgery carries high risks?
In general, anterior cervical discectomy and fusion (ACDF) surgery is considered as safe, but as with any surgical procedure, there are some minor risks that your doctor will discuss with you if surgery will be needed.