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Cervical Disc Hernia

The cervical disc hernia is the protrusion of the gel-like structure found in the disc following the weakening or rupture of the strong connective tissue fibers surrounding the external part of the vertebral joints.

The neck pain ranked number two after the lumbar pain among the chronic pains. Contrary to the general belief, cervical disc hernia is not the most common cause of neck pain. The incidence of neck pain caused by several other factors between 20-46 years of age is relatively higher.

THE CAUSES of CERVICAL DISC HERNIA

The neck is the most mobile part of the spine and can move in any direction. It consists of seven cervical vertebras. There are small gel-like cushions between the vertebras. These discs are responsible for the balanced transfer of the load to the lower parts of the body. Spinal cord and nerves extending to the arms pass through the canal of the cervical spine.

 

The hernia is defined as the protrusion of the gel-like structure found inside the disc to the surrounding tissues. This protrusion may compress on the nerves. This compression causes a sharp and knifelike pain, which spreads from the neck to the arms. The pain is more severe in the involved arm than the neck itself. The neck pain may be accompanied by a pain spreading from the scapula to the medial side. The patient cannot turn his/her head to the opposite side and cannot bend down on the same side. The most common levels of cervical disc hernia are between C5-C6 and C6-C7.

 

Prominent bulging may compress the fibers of the spinal cord, which may cause paresis and weakness along with the pain in the neck and arm. In severe cases, the patient may complain from gait difficulties, urinary incontinence and weakness in legs in addition to the clinical condition described above. Depending on the compressed nerve, sensorial changes like paresis, tingling, electric-like sensation, loss of sensation may occur.


If the nerve root C5 is compressed, the pain spreads from the neck to the top of the shoulder. The sensation impairs on the lateral side of the shoulder and restriction of the sidewise movement of the shoulder can be observed. Shoulder pain on both sides may emerge.


If the nerve root C6 is compressed, the pain spreads from the neck to the shoulder area and downwards to the thumb and index finger. Paresis may develop in these fingers and the patient experiences difficulty during the extension of the hand wrist.


If C7 is compressed, the pain spreads from the neck to the middle finger and paresis may emerge in this finger along with the difficulty in the extension of the elbow.


The compression on the C8 nerve root causes a pain spreading to the inner side of the arm and paresis in the fourth and fifth fingers in addition to the loss in the grasping strength.

 

 

All these findings should be checked and defined by the physiatrist for a correct diagnosis. MRI is the most useful technique for the diagnosis of patients with consistent symptoms. If there is a suspicion of nerve injury, EMG examination may be useful.

The Non-Surgical Treatment Options

 

Most of the cervical disc herniae can be treated with physiotherapy methods so that surgical intervention can be avoided.

 

Medical treatment: Several muscle relaxants and analgesics can be used for the treatment of spasms, edema, and pain.

 

Conventional physiotherapy methods: Heat and cold applications, electric current, vacuum interference, ultrasound, laser and magnetic field.

 

Dry Needle Treatment: Muscle spasm is one of the most important causes of the pain in the cervical disc hernia. The spasm can compress the intervertebral discs and worsens the protrusion and the pain in the spine. It can also compress the vessels so that the patients complain from the coldness, paresis, and edema in arms and legs. The dry needle treatment is an important and effective treatment method for the pain related to the muscle spasms.

 

Regenerative methods

Injection methods like prolotherapy, PRP, proloPRP, neuraltherapy increase the blood flow at the application site and support the repair process. These methods activate the natural repair process of the organism. The injections are done usually in intervals of several weeks according to the size of the hernia and the severity of the accompanying spasm.

 

Spinal Injections (Needle treatment on the spine)

The spinal injections are used to reduce the pain in patients with lumbar and cervical disc hernia and spinal stenosis. This method enables a non-surgical treatment for the cervical disc hernia. The drug mixture is administered through the vertebras and the shrinkage of a hernia is achieved without any surgical intervention. The spinal injection can be done without hospitalization. The patient should rest for 1-3 hours after the intervention. Depending on the disease; facet, caudal spinal, foraminal spinal, sacroiliac needling methods can be used.