Cervical disc herniation

What is a cervical disc herniation?

A cervical disc herniation is a pathology of the spine that occurs when the nucleus pulposus of the intervertebral disc displaces and compresses the cervical nerve root. This condition can cause pain, weakness and numbness in the neck, shoulders, arms and hands.

Depending on the degree of migration of the nucleus pulposus, hernias can be classified as follows:

• Protruded: when the fragment of the nucleus is still contained by the annulus fibrosus, with or without compression of neurological structures (medulla or nerve root). In most cases they tend to be resorbed.
• Extruded: when the nucleus passes through the annulus fibrosus and the posterior common vertebral ligament. This herniation may compress a nerve root or the spinal cord.
• Sequestrated: occurs when the extruded segment ruptures, occasionally with displacement of the free fragment into the spinal canal.
• Hard: this is the name given to a hernia consisting of osteophytes secondary to unciform spondylosis and articular apophyses.

On the other hand, depending on their location, cervical hernias may be central, lateral or foraminal.

What are the causes of cervical disc herniation?

The cervical spine is made up of 7 vertebrae and between each vertebra is an intervertebral disc that acts as a shock absorber. Cervical disc herniation occurs when the nucleus pulposus bulges through a fissure/tear in the annulus fibrosus and can compress the nerve roots.

The main causes of cervical disc herniation are:

• Ageing: natural ageing can weaken the intervertebral discs and make them more prone to cervical disc herniation.
• Injury: Injuries to the neck can cause a herniated cervical disc.
• Repetitive movements: Repetitive movements of the neck can wear down the intervertebral discs and cause a herniated cervical disc.

What are the symptoms of cervical disc herniation?

Symptoms can vary from person to person, but the most common symptoms are:

• Pain in the neck, shoulders, arms and hands.
• Numbness and tingling in the arms and hands.
• Weakness in the arms and hands, paresis and, in more severe cases, insecurity when walking and/or loss of walking ability and urinary sphincter control.
• Difficulty in moving the neck.

How is cervical disc herniation diagnosed?

Diagnosis of cervical disc herniation is made through a combination of clinical evaluation and diagnostic testing. Your spine surgeon will perform a physical examination to assess strength, sensation and reflexes in the arms and hands.

In addition, the imaging tests usually performed to diagnose cervical disc herniation are X-rays and, most importantly, MRI, which will allow correlation with the physical examination.

In the final diagnosis of a herniated cervical disc, anamnesis and physical examination are essential, as they allow differentiation between pain of radicular and non-neurological origin.

What is the treatment for cervical disc herniation?

Conservative treatment may include physiotherapy, medication for pain and inflammation, and lifestyle changes (exercise, diet, …).

If pain persists, minimally invasive methods (foraminal infiltrations, ultrasound-guided infiltrations, platelet-rich plasma infiltrations, etc.) may also be used.

It is important to thoroughly analyse the need for conservative treatment as long as there are no clear indications that contribute to consider surgery as an option.

Surgery may be necessary if conservative treatment does not relieve symptoms or with increasing pain or if there is a progressive or severe neurological lesion.

The most common technique is microdiscectomy and anterior arthrodesis, in any of its forms, or microdiscectomy and disc prosthesis if the requirements to preserve the mobility of the segment are met.

Recovery after surgery may vary depending on the type of surgery and the severity of the cervical disc herniation. In general, a period of rest and physiotherapy is recommended to help regain strength and mobility in the neck and arms.

Can a herniated cervical disc be prevented?

Although it is not always possible to prevent cervical disc herniation, adopting healthy lifestyle habits and following a few tips can significantly reduce the risk: maintain a healthy diet, keep a healthy weight, and good posture, avoid repetitive movements neck and strengthen the neck muscles are habits that can help prevent cervical disc herniation.

Cervical disc herniation can be a painful and debilitating condition, but there are many treatment options available. At BSI we help our patients understand the symptoms and their causes and indicate the most appropriate treatment for each case.