Anatomy
– Normal Cervical Disc:
In between each of the vertebrae (bones) in the spine is
a disc, a tough fibrous shock-absorbing pad. Endplates line
the ends of each vertebra and help hold individual discs
in place. Each disc contains a tire-like outer band (called
the annulus fibrosis) that encases a gel-like substance
(called the nucleus pulposus).Nerve roots exit the spinal
canal through small passageways between the vertebrae and
discs. Pain and other symptoms can develop when the damaged
disc pushes into the spinal canal or nerve roots.
Disc
herniation occurs when the annulus fibrosis breaks open
or cracks, allowing the nucleus pulposus to escape. This
is called a Herniated Nucleus Pulposus (HNP) or herniated
disc.
Progressive
Steps Toward Herniation:
Many factors increase the risk for disc herniation: (1)
lifestyle choices such as tobacco use, lack of regular exercise,
and inadequate nutrition substantially contribute to poor
disc health. (2) As the body ages, natural biochemical changes
cause discs to gradually dry out affecting disc strength
and resiliency. (3) 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 herniation
may develop suddenly or gradually over weeks or months.
The
four stages to a herniated disc include:
Disc
Degeneration: chemical changes associated with
aging causes discs to weaken, but without a herniation.
Prolapse:
the form or position of the disc changes with some slight
impingement into the spinal canal. This is also called a
bulge or protrusion.
Extrusion:
the gel-like nucleus pulposus breaks through the tire-like
wall (annulus fibrosis) but remains within the disc.
Sequestration
or Sequestered Disc: the nucleus pulposus breaks
through the annulus fibrosis and lies outside the disc in
the spinal canal (HNP).
Locating
the Cause of Pain:
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.
Most of the time the symptoms prompt the patient to seek
medical care. The visit with the doctor usually includes
a physical and neurological exam; review of medical history,
symptom evaluation and the history of treatments and medication
the patient has tried.
An x-ray may be needed to rule out other causes of back
pain such as osteoarthritis. A CT or MRI scan verifies the
extent and location of disc damage. Sometimes a myelogram
is necessary.
Treatment
– Non-Surgical:
Most patients do not need surgery! Initially, Dr. Cady
may recommend cold therapy. During the first 24 to 48 hours
cold therapy helps to reduce swelling, muscle spasm and
pain by reducing blood flow. After the first 48 hours, heat
therapy can be applied. Heat increases blood flow to warm
and relax soft tissues. Increased blood flow helps to flush
away irritating toxins that may accumulate in tissues as
a result of muscle spasm and disc injury. Never apply ice
or heat directly to skin; instead, wrap the cold or heat
source in a thick towel for no longer than 15-20 minutes.
Medications may include an anti-inflammatory to reduce
swelling, a muscle relaxant to calm spasm, and a pain-killer
(narcotic) to alleviate intense but short-lived pain (acute
pain). Mild to moderate pain may be treated with non-steroidal
anti-inflammatory drugs (NSAIDs). These work by relieving
both swelling and pain. Discuss NSAID use with your medical
physician first.
Dr. Cady may also recommend physical therapy. Physical
therapy includes a combination of non-surgical treatments
to decrease pain and increase flexibility. Ice, ultrasound,
gentle massage, stretching, and neck traction are some examples.
In four to six weeks, the majority of patients find their
symptoms are relieved without surgery! Be optimistic about
your treatment plan and remember that less than 5% of back
problems require surgery!
Treatment
– Surgical:
Surgery is considered if non-surgical treatment does not
relieve symptoms or if spinal cord compression is suspected.
If surgery is recommended, always ask the purpose of the
operation and what results you can expect. Never be afraid
to obtain a second opinion.
To relieve nerve pressure and neck pain, surgery usually
involves a partial disc removal or discectomy. This surgery
is usually done from the front of the neck (called an anterior
discectomy). In addition, the surgeon may need to access
the herniated disc by removing a portion of the bone covering
the nerve. This procedure is called a laminectomy and is
usually done from the back of the neck (posterior laminectomy).
Fortunately, these procedures can often be done utilizing
minimally invasive techniques. Minimally invasive surgery
does not require large incisions, but instead uses smaller
cuts and tiny specialized instruments and devices such as
a microscope and endoscope during the operation.
Prevention:
Aging is inevitable, but lifestyle changes can help prevent
cervical disc disease. Risk factors include poor posture
and body mechanics, weak neck muscles, smoking and obesity.
Start now to adopt habits that will help preserve your spine
for the future.
