Cervical Herniated disc - information, diagnosis, and treatment

The cervical herniated disc (cervix = neck) cannot only cause acute pain, but also numbness and even paralysis in the arms. In most cases, it is sufficient to treat the symptoms conservatively. Only if more pronounced symptoms like paralysis occur, surgery is needed to prevent permanent nerve damage.

What are cervical discs?

The cervical intervertebral discs are found between the seven cervical vertebrae. Like all discs of the body, they have two functions. First, they stabilize the movements of two adjacent vertebral bodies to each other and protect thereby the spinal cord in the vertebral canal located behind the cervical disks. Performed is this task is by the fibrous ring that seals the cervical disk to the outside. This extraordinary structure is designed so that with every imaginable movement always one part of tense part of the connective tissue fibers relaxes, so that the movement does not cause any harm.

The second function is to absorb and redistribute stress and weight on the spine. This task is performed by the gelatinous nucleus of the disc, which contains a high concentration of water-binding protein molecules. Thus, the disc acts as a water-filled cushions and reliably absorbs the shock loads of everyday life.

What are the symptoms of a cervical herniated disc?

In case of a cervical herniated disk, part of the gelatinous core of the intervertebral disc has been leaked through the fibrous ring and pressed into the spinal canal. There, the herniated disc can press on one of the nerve roots exiting on both sides of the spinal canal. This results in pain that radiates into the nerve root area of skin supplied by the respective nerve root. Together with the arm pain, numbness and tingling can be present in this area, and in the worst case, the arm muscles may be weakened or paralyzed. If a very large herniated disc enters into the center of the spinal canal, it can also cause pressure damage to the spinal cord. This can create a disturbance of temperature perception, the fine tactile perception (somatic senses), but also an unsteady gait.

How is a cervical herniated disc diagnosed?

The experienced spine specialist can usually reliably determine the height and location of the suspected disc herniation based on the patient's complaints and his neuro-orthopedic examination. To ensure the clinical diagnosis but is necessarily a current magnetic resonance imaging of the cervical spine is needed. Here, the physician can assess the herniated disc and its topographic proximity to the individual nerve roots and the spinal cord and excellent image quality. Exposure to X-rays as in computed tomography does not occur there.

Cervical herniated disc – What treatments are available?

Similar to the lumbar disc herniation, cervical herniated discs are first treated conservatively. Physiotherapy and physical therapy in combination with anti-inflammatory and analgesic medications accompany the symptomatic infiltration therapy. In the so-called “periradicular therapy" (PRT) a combination of an analgesic and an anti-inflammatory drug is injected directly into the affected nerve root under CT guidance. Usually three to four injections at weekly intervals are required to control the pain permanently.

However, if a paralysis is present, surgery is usually indicated as soon as possible to free the nerve root from the pressure of the herniated disc. The probability that an existing paralysis is formed back depends on the duration of nerve root compression. It is therefore important not to wait too long with the surgery.

An indication for surgery is also given if a conservative treatment is performed six to eight weeks without noticeable success and the pain and numbness are unacceptable for the patient in everyday life.

What are the surgical procedures for a cervical herniated disk?

The operation of a cervical herniated disc is generally performed from the front of the neck, with a small transverse incision of about 3 to 4 centimeters in length.

In contrast to the lumbar disc surgery, the entire disc will be removed in a cervical discectomy. Under the microscope, the herniated disc is removed from the spinal canal. Now the spine surgeon must decide what will be inserted between the adjacent vertebral bodies. Basically, there are two options:

1. The adjacent vertebrae are stabilized by inserting a placeholder made of plastic in the former intervertebral disc space.
2. If the motion segments still have no distinct signs of wear, the implantation of a disc prosthesis may be considered. This procedure allows for retaining the mobility of the segment concerned.

The hospital stay after surgery of a cervical herniated disc is about three days. After a cervical disc surgery, the cervical spine should be immobilized for two weeks by wearing a soft cervical collar. After the two weeks, cervical spine can be moved again. Sports like swimming and loose jogging can be resumed. All other sports should be paused for at least three months. If intervertebral disc prosthesis was implanted, the immobilization with a cervical collar is, however, not necessary.