CERVICAL DISC HERNIATION

Definition of Cervical Disc Herniation – The disc between the bones that make up the spine weakens over time, causing the disc content (nucleus pulposus) to protrude outward. As a result of herniation, pressure may occur on the nerve root or the spinal cord. The cause of this pathology is the rupture of the disc’s fibrous ring due to dystrophic changes in the cartilage tissue of intervertebral formations (osteochondrosis), injuries, or irregular loads on the spine.

DISC ANATOMY

Your spine consists of 24 movable bones called vertebrae. The cervical spine supports the weight of your head and allows you to bend your head forward and backward, side to side, and rotate it 180 degrees. There are 7 cervical vertebrae, numbered from C1 to C7. The vertebrae are separated by discs that act as shock absorbers to prevent friction between the vertebrae. The outer ring of the disc is called the annulus fibrosus. There are fibrous bands attached between the bodies of each vertebra. Each disc has a gel-filled center called the nucleus pulposus. At each disc level, a pair of spinal nerves exit the spine and branch out to the body. The spinal cord and spinal nerves act as a “telephone line” that allows messages or impulses to be transmitted.

WHAT IS A CERVICAL HERNIA?

A herniated disc occurs when the gel-like center of the disc ruptures through a tear in the tough outer wall (annulus) of the disc (Fig. 1). The gel material irritates the spinal nerves, causing chemical irritation. Pain is a result of spinal nerve inflammation and swelling caused by intervertebral disc pressure from the hernia.

Fig. 1 Normal disc and herniated intervertebral disc. The nucleus pulposus protrudes into the spinal canal and compresses the spinal nerve.

Various terms can be used to describe a cervical herniated disc. A bulging disc (protrusion) occurs when the disc wall remains intact but creates a bulge that can press on nerves. A true herniated disc (also known as a ruptured or slipped disc) occurs when the annulus of the disc cracks, allowing the gel center to squeeze out. Banish or free fragments occur when a piece is completely broken off from the disc and lies within the spinal canal.

WHAT ARE THE SYMPTOMS OF A CERVICAL HERNIA?

The symptoms of a herniated disc vary widely depending on the location of the hernia and your own pain tolerance. When the hernia reaches critical dimensions, compression of the structures in the spinal canal occurs, and significant pain and neurological symptoms develop: spontaneous severe neck pain and/or pain radiating to the upper extremities;

• Restriction of head and hand movements;
• Tingling in fingers; headache;
• High blood pressure;
• Muscle weakness in the upper shoulder girdle;
• Muscle cramps (muscles become uncontrollable);
• Weakness in the biceps and triceps muscles;
• In people with heart disease, it may exacerbate chest pain.

LOCALIZATION OF DISC HERNATION

• C2-C3 Localization: If the herniated disc in the neck occurs in the disc between the 2nd and 3rd vertebrae, the patient experiences headache, numbness and impaired mobility of the tongue, a feeling of a “lump in the throat”, and difficulty moving the head. In addition, various eye problems may occur.
• C3-C4 Localization: Symptoms of a hernia between the 3rd and 4th cervical vertebrae include neck pain, pain in the clavicle, limitation of head movements, and severe pain when trying to raise the shoulders.
• C4-C5 Localization: If a hernia occurs here, the patient experiences pain and weakness in the shoulders, especially in the deltoid muscle and scapular region. Numbness or tingling may also occur in these areas. Symptoms increase when trying to lift the arm up.
• C5-C6 Localization: A hernia at this level is characterized by pain and tingling on the lateral aspect of the arms in the elbow region. The patient experiences pain and numbness in the biceps, and swelling and tingling in the thumb and index finger.
• C6-C7 Localization: In people with a herniated disc between the 6th and 7th cervical vertebrae, the back of the shoulder, parts of the forearm, the back of the hands, and the middle and ring fingers hurt and become numb. It is difficult for the patient to clench their hand into a fist or perform extension movements.

WHAT ARE THE CAUSES OF CERVICAL HERNIA?

Discs can bulge, herniate due to injury, incorrect weightlifting, or develop spontaneously. Aging plays an important role. As you age, your discs dry out and become harder. The tough fibrous outer wall of the disc can weaken. The nucleus pulposus can bulge through tears in the disc wall, crack, and cause pain when it touches the nerve. Genetics, smoking, and a number of professional and recreational activities lead to premature disc degeneration.

HOW IS THE DIAGNOSIS MADE?

If you have a hernia in your neck, you can consult us. Professor Dr. Erol YALNIZ guarantees you a proper diagnosis and treatment at our Private Ekol Hospital. The Professor takes a complete medical history (anamnesis) to understand your symptoms, previous injuries or conditions, and to determine if any lifestyle habits are causing the pain. A physical examination is then performed to identify the source of the pain and test for muscle weakness or numbness. The diagnosis is confirmed by MRI. Magnetic resonance imaging (MRI) is a non-invasive test that uses magnetic fields and radio frequency waves to give a detailed view of the soft tissues of your spine. MRI can determine which disc is damaged and if there is any nerve compression. It can also detect bone growths, spinal cord tumors, or abscesses.

WHAT KIND OF TREATMENT AWAITS YOU?

Most people with a herniated disc do not need surgery. Rest and other conservative treatments should start to improve symptoms within 4-6 weeks. However, if your pain does not improve, a surgical option is required.

Indications for surgery: * No result from painkillers and physical therapy. * Your symptoms continue to worsen. * You have problems sitting, standing, or walking. * You lose bowel or bladder control.

Surgical Methods

The most common approach for cervical disc surgery is anterior (from the front of the neck). If decompression is required for other conditions such as stenosis, a posterior approach can be performed.

Anterior Cervical Discectomy and Fusion (ACDF): The surgeon makes a small incision in the front of the neck. The neck muscles, blood vessels, and nerves are moved to the side to expose the bony vertebrae and discs. The part of the ruptured disc pressing on the nerve is removed. After removing the herniated material, the disc space can be filled with a bone graft or cage to create fusion. Fusion is the process of joining two or more bones together. Over time, the graft will fuse with the upper and lower vertebrae to form a single solid bone. Metal plates and screws may be used to provide stability and perhaps a better fusion rate during recovery.

Artificial Disc Replacement: During an anterior discectomy, a movable device that mimics natural motion is placed in the damaged joint area of the disc. While fusion eliminates motion, the artificial disc preserves motion. They look like implants of hip and knee joints made of metal and plastic. Compared to ACDF, results for artificial disc replacement are similar, but cervical disc replacement preserves motion and may avoid adjacent segment disease, although this remains a hypothesis and is not yet proven.

Minimally Invasive Microendoscopic Discectomy: The surgeon makes a small incision in the back of the neck. Small tubes called dilators are used with increasing diameters to expand the tunnel towards the vertebra. A portion of the bone is removed to expose the nerve root and disc. The surgeon uses an endoscope or microscope to remove the ruptured disc. This method causes less muscle damage than traditional discectomy.

Posterior Cervical Discectomy: The surgeon makes a 1-2 inch incision in the back of the neck. To reach the damaged disc, the vertebral muscles are cut and moved to the side to expose the bony spine. A portion of the bone arch (lamina) is removed to reach the nerve root and disc area. The part of the ruptured disc compressing the spinal nerve is gently removed. The areas where nerve roots exit the spine are often widened to prevent future compression. The surgery can last between 60-90 minutes. Following surgical treatment, the patient is transferred to the ward. The Professor arranges the necessary treatment to relieve your pain. Your hospital stay is 3-4 days.