Understanding Cervical Disc Herniation
Cervical Disc Herniation
Disc herniation is a common condition affecting the spine, causing pain and discomfort. It’s important to recognise the symptoms and seek appropriate treatment to improve quality of life.
What is Cervical Disc Herniation?
A disc herniation is when a fragment of the intervertebral disc is expelled from the disc. The expulsion of this fragment occurs through one or more fissures in the disc and cannot arise in perfectly healthy discs. A disc herniation differs from a disc protrusion, which corresponds to a progressive bulging of the disc as it collapses. Fissures, herniations, and disc protrusions are all consequences of discopathy or degenerative disc disease, a very common condition in the population, which explains the high number of people with disc herniations.
Evolution of Cervical Disc Herniation
Having a disc herniation is not necessarily serious or painful. Often, disc herniations are discovered in people who have no back pain complaints. A disc herniation becomes painful when it compresses a nerve root located just behind the disc in the spine. The evolution can lead to a decrease in symptoms, even if the herniation itself does not disappear. In other cases, there may be a worsening of pain or, in more severe situations, paralysis. For many patients, the evolution is cyclical, alternating between periods of pain and remission.
SYMPTOMS
Most of the time, symptoms start after a mundane effort, with pain in the cervical region, followed, after minutes or days, by the onset of pain in one of the arms. Sometimes, it manifests as a feeling of heaviness in the shoulders, which gradually settles and descends irregularly down the arms. This pain is related to the compression of a nerve root by the herniation, following a precise path in the arm, called cervicobrachial neuralgia. In more severe cases, tingling, numbness, loss of sensation, or even paralysis may occur, indicating severe nerve root injuries, which may become permanent if left untreated.
TESTS
Disc herniations are accurately diagnosed by means of computed tomography (CT scan) or magnetic resonance imaging (MRI). Performing one of these exams is essential before considering a surgical intervention.
Treatment Options
Treatment Options for Cervical Disc Herniation
In the absence of paralysis, surgery for disc herniation is never an emergency. Medical treatment consists of rest, analgesic and anti-inflammatory medications, and, in some cases, massages or infiltrations. The goal is to reduce inflammation around the compressed nerve root and wait for a possible spontaneous resolution of symptoms. After a few weeks, doctor and patient evaluate the effectiveness of the treatment and the likelihood of natural recovery.
Principles of Surgical Treatment
Criteria for Cervical Disc Herniation Surgery
If the evolution is not favourable, the surgeon will decide on the need for surgery based on the severity of symptoms, the duration of the condition, and the morphology of the herniation. The surgery aims to decompress the affected nerve root by removing the herniation.
Surgical Procedure
Cervical Surgery
Surgical removal of the disc herniation is performed by microsurgery, minimising the size of the incision and the retraction of tissues. Unlike lumbar disc herniations, in the cervical case, it is necessary to remove the entire disc to access the herniation located in the posterior part. In advanced situations of disc wear, the herniation may be calcified and associated with osteophytes (bone spurs), which must also be removed. At the end of the surgery, the disc is replaced by a fixed implant (arthrodesis) or a mobile one (disc prosthesis).
POST-OPERATIVE CARE
The patient is encouraged to get up a few hours after the surgery, using a simple cervical collar. A physiotherapist teaches the appropriate movements for daily life, such as getting up, lying down, picking up objects, and performing personal hygiene. Hospital discharge generally occurs on the morning after the surgery. The patient receives guidance on dressings, analgesic medication, and rest until the follow-up appointment.
CONVALESCENCE
At home, it is recommended to alternate rest in a comfortable position (semi-reclined, with legs slightly bent) with light walks on flat surfaces. Initially, walks should last 10 to 15 minutes, and can be gradually increased. Everyday activities, such as cleaning or driving, should only be resumed progressively from the 2nd or 3rd week, respecting the limits imposed by pain.
Physiotherapy begins after the 3rd week, with massages on the scar and painful areas, followed by exercises to stretch the body and strengthen the spine and limbs. Full recovery varies between 4 to 12 weeks, being generally faster after the placement of a disc prosthesis compared to an arthrodesis.
In the long term, there are no contraindications for a normal active and sports life.
Frequently Asked Questions
What is a cervical disc herniation?
It is a condition in which the nucleus pulposus of an intervertebral disc in the cervical region projects through a fissure in the annulus fibrosus, which can compress nerve roots or the spinal cord, causing pain and other neurological symptoms.
What are the main symptoms?
Symptoms include neck pain that may radiate to the shoulders, arms, or hands (brachialgia), tingling, numbness, muscle weakness in the upper limbs, and, in severe cases, coordination or balance difficulties.
What are the most common causes?
The most frequent causes are the natural ageing of the intervertebral discs, neck trauma, poor posture, repetitive movements, and genetic factors.
How is the diagnosis made?
The diagnosis is made through clinical evaluation of symptoms, physical examination, and imaging tests such as magnetic resonance imaging or computed tomography.
What are the treatment options?
Treatment may include physiotherapy, analgesic and anti-inflammatory medications, use of a cervical collar, and, in more severe cases, surgery for spinal cord decompression.
Is cervical disc herniation curable?
With appropriate treatment, many patients achieve symptom relief and return to normal activities. However, complete cure depends on the severity of the herniation and the response to treatment.
Who is most prone to developing this condition?
People over 40, workers who perform repetitive movements with their neck, smokers, and individuals with poor posture are at a higher risk of developing cervical disc herniation.
What activities should be avoided?
Activities that involve sudden neck movements, lifting excessive weights, and inadequate postures should be avoided so as not to aggravate the condition.
How to prevent cervical disc herniation?
Maintaining good posture, practising muscle strengthening exercises, avoiding smoking, and taking breaks during repetitive activities are effective preventive measures.
Can cervical disc herniation cause serious complications?
Yes. If not treated properly, it can lead to cervical myelopathy, a condition that affects the spinal cord and can result in loss of motor and sensory function.