Cervical Disk Herniation

 

Cervical disk herniation is the protrusion of disk into the spinal canal in the neck. Disks are the cartilage between the vertebral bodies that allow for movement of the spine.

Presentation
Trauma is the most common identifiable cause of a cervical disk herniation; though most patients suffer the onset of a cervical disk herniation without any identifiable trauma, and simply “wake up with it”. Cervical disk herniation often presents with symptoms of neck pain. Painful limitation of neck motion is often seen. Pressure on the nerves in the spine can cause characteristic pain syndromes. Pain, numbness, tingling, burning, and weakness often are bundled together and radiate down from the neck to the arm. If the spinal cord is compressed, symptoms may involve the legs. Significant spinal canal compromise can result in spinal cord injury and paralysis (total or partial). 

Examination
Characteristic findings of nerve root compression (causing sensory, reflex and motor changes) can occur with a cervical disk herniation at different levels of the neck. At C3-4, symptoms involve the deltoid muscle; at C4-5, the bicep muscle; at C5-6, the brachioradialis muscle; at C6-7, the tricep muscle. Spinal cord compression can cause weakness in the hip flexors; as well as spasticity, abnormal Babinski reflexes, and hyperactive knee jerk responses. Lhermitte’s sign (an electric shock like sensation radiating down the spine) is an ominous sign of significant spinal cord compression. 

Diagnostic Testing
Magnetic resonance imaging (MRI) is the preferred study and should be a high quality cervical spine study. The quality of cervical MRI’s can vary between imaging centers and is usually less sharp with open MRI’s. Computed tomography (CT) with myelography can be done in special circumstances. Plain X-rays and bone scans are not useful in diagnosing a cervical disk herniation, but may be done as part of the workup of neck pain.

Treatment Options

Medical Therapy 
Most patients with a cervical disk herniation will improve with medical management, typically within the first 6 weeks after the onset of symptoms.

Step 1: Pain relievers, muscle relaxers, and possibly oral steroids (medrol dosepak) coupled with bed rest or reduced level of activity. 

Step 2: Physical therapy which includes stretching exercises, heat, massage, ultrasound, and traction. Patients need to determine the modality that works best for them. Each session provides short term benefit and ultimately should also be done at home.

Step 3: Pain management including epidural steroid injections (ESI). ESI is an injection of medication directly into the spinal canal. An ESI typically provides benefit lasting one month and can give lasting relief for those patients who are not surgical candidates.

Surgical Therapy 
Indicated for patients who do not respond to medical management, have large disk herniations, severe symptoms, are unlikely to respond to further non-surgical treatment, and/or have neurologic loss of function. Options include anterior and posterior approaches, fusion and non-fusion options. I prefer the anterior fusion approach. The disk herniation is removed freeing the nerve and the joint is fused to prevent bone spur formation.

Outcome of Surgery
The goal of surgery is to preserve neurologic function, and give the best chance for pain reduction and neural recovery. This is most likely if nerve root compression is not allowed to persist for very long. The overall chance of a complication is very small in a healthy patient. Patients must balance the risk of surgery with the risk of permanent injury from the disk herniation. Surgery is usually very well tolerated. Most patients are up walking shortly after the surgery and go home the next morning. Long term outcome from surgery is generally excellent with very high satisfaction rates.

 

If you have a cervical disk herniation, come see us for consultation.  We take an aggressive approach to the treatment of cervical disk herniation.  We have the clinical experience for great outcomes with a personal touch.