Cervical Herniated Disc

The name of cervical herniated disc in medicine is cervical disc herniation. The cervical region called neck is composed of 7 vertebrae and each vertebra receives a number from C1 to C7. Herniated cervical disc is most often caused by the discs between C5-C6 and C6-C7.  The causes of cervical disc herniation include posture problems such as lifting heavy objects, long-term use of computer and trauma.  As a result of some researches, it most commonly occurs the age of 40 and the ratio of female/male is 1/1.4.

The symptoms of cervical disc herniation are pain in the neck, numbness in the arms and arm pain radiating from the neck to the arm, loss of strength in the arms, and pain radiating from the neck to the back of the head. 80% of the first symptoms are the pain radiating from the nape to the head and the pain caused by spasm of the muscles around the spine which shows up with flat neck findings. This type of pain may be caused by many diseases including psychiatric diseases.  Therefore, surgery would be the wrong treatment option for such patients.  The correct treatment option is more follow-up for these types of patients.  Some studies have shown that the pain spontaneously disappears over time in 43% of such patients.

In the cervical vertebrae, nerve root compression of each level has specific findings, which are loss of strength, loss of sensory and loss of reflex.  The pain in the arm on the involved side, loss of strength in the region where the entrapped nerve functions, and absent or diminished response of deep tendon reflex are the typical findings.  Loss of strength depends on the severity and duration of the entrapment.  Also, sensory loss arises in the relevant part, which is usually seen with loss of strength at the same time.  Very advanced myelopathic findings such as gait (walking) abnormalities, spasticity, hyperactive reflexes and pathological reflexes can also occur.  Meanwhile, clumsy hands, getting tired quickly, muscle loss can be seen.

In order to make the diagnosis, a detailed anamnesis, a good neurological examination and radiological analyses should be evaluated correlatedly.  Direct x-rays should be the initial step in the examination.  Thus, the differential diagnosis of not only cervical herniated disc but also the diseases that may show similar findings such as spinal tumours can be made.  If a disease caused by bone structures is considered, cervical tomography should be preferred.  Magnetic resonance imaging (MRI) is preferred firstly as diagnostic technique for patients considered to have cervical myelopathy and/or herniated cervical disc and is considered to be sufficient in patients with neurological examination findings.

If the herniation is at the beginning stage and no neurological symptoms such as loss of strength, loss of sensory or reflexes have arisen yet, pain reliever, muscle relaxant, rest and exercise program are carried out in the treatment. However, if myelopathy develops or neurological symptoms progress, surgical treatment is necessary.

Sources

1- Turkish Neurosurgical Society Publications, Basic Neurosurgery Book