One question that is often asked of me is “What is a disc herniation and how do I as a doctor go about diagnosing it?” In today’s short FB Live I discuss a recent disc herniation case that came into my office, how I diagnosed, what imaging options were used and what next steps entail for this patient.
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.
In some patients, a cervical herniated disc can cause spinal cord compression where disc material pushes on the spinal cord. This is a much more serious condition and may require a more aggressive treatment plan. Spinal cord compression symptoms include awkward or stumbling gait, difficulty with fine motor skills in the hands and arms, and tingling or “shock” type feelings down the torso or into the legs.
Several factors increase the risk for disc herniation:
- Lifestyle choices such as tobacco use, lack of regular exercise, and inadequate nutrition substantially contribute to poor disc health.
- As the body ages, natural biochemical changes cause intervertebral discs to gradually dry out, affecting disc strength and resiliency.
- Poor posture combined with the habitual use of incorrect body mechanics can place additional stress on the cervical spine.
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.
Stages of a Cervical Herniated Disc
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.
Making an Accurate Diagnosis
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).
Nonsurgical Treatment Options
Not all patients require neck surgery. Often, within 4 to 6 weeks most patients find nonsurgical treatments relieve pain and symptoms. Be optimistic about your treatment plan and remember that less than 5% of back problems require surgery.
- Medications may include a nonsteroidal anti-inflammatory drug to reduce swelling, muscle relaxant to ease spasms, and/or a pain reliever.
- Physical therapy may include cold and heat treatment, gentle massage, and stretching.
Surgical Treatment Options
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.
Can a cervical herniated disc be prevented?
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.
source: Spine Universe