...in the cervical spine
When a disk herniates, parts of the jelly nucleus protrude into the spinal canal through fissures of the fibrous ring. It may then happen that the prolapsed tissue compresses the spinal cord or the efferent spinal nerves. In such cases the acute back pain comes along with neurological symptoms in the dermatome of the affected nerve root. This can lead to severe back or neck pain with radiation into the arm, the shoulder or also between the shoulder blades. Also pareses and fellings of numbness are possible. A very big herniation can even damage the spinal cord, making an immedient emergency surgery necessary.
Thorough diagnosis – prerequisite for successful treatment
For successful treatment your symptoms must be directly correlated to findings from diagnostic imaging techniques. A thorough clinical examination in combination with imaging methods like computed tomography or magnetic resonance imaging (CT and MRI) are hence essential for a successful therapy of your spine disease.
- Neck pain that can be felt in the head (headaches) and/or the shoulder
- Pain, numbness or weakness extending from the neck to the arms, back of your hands and/or to the fingers
- Pain in your shoulder with numbness in the region of the deltoid muscle and/or a feeling of weakness or paresis when lifting your arm sideways
The individual clinical picture mainly depends on what section of the cervical spine is affected and if and to what extent adjacent nerves are compressed by the herniated disk.
Intervertebral disks are elastic cartilaginous joints of about 5 mm thickness between adjacent vertebrae. Their main function is to dampen impacts of daily life activities – they work just like a shock absorber. In their centre is the nucleus pulposus – a gel-like tissue which is surrounded by a firm fibrous ring (the anulus fibrosus).
When a disk herniates, parts of the jelly nucleus protrude into the spinal canal through fissures of the fibrous ring. It may then happen that the prolapsed tissue compresses the spinal cord or the efferent spinal nerves. In such cases the acute back pain comes along with neurological symptoms in the dermatome of the affected nerve root.
What causes a disk herniation in the cervical spine?
Starting point is mostly a degenerative change leading to a loss of elasticity and stability of the affected disk tissue. Chronic poor posture or acute incidents at work or sports may exceed the natural compensation mechanisms of the intervertebral disk which will than succumb to the prevailing high hydrostatic pressures. This may already occur also in relatively young patients. It results in a protrusion or positively a prolapse of the nucleous pulposus through the fibrous ring. Patients will then suffer from local back or neck pain that may eventually radiate into the arm or hand.
In rare cases also a traumatic injury may lead to a disk prolapse in the cervical spine.
Only 8% of all herniated disks are in the cervical spine – it is hence a quite rare condition compared to disk prolapses of the lumbar spine (ca 90%).
- conservative treatment
A herniated cervical disk without paresis is usually treated conservatively with analgesic drugs and physical rest. Concomitant thermal or electrotherapy and physiotherapy can add to symptom relieve.
In persistent cases injections of local anesthetics and corticosteroids directly at the compressed nerve root (periradicular infiltration) or at the spinal cord (peridural infiltration) may help in the short-term. Severe neurological symptoms may render a hospitalization necessary where analgesic and anti-inflammatory infusions are given.
If after 6 to 8 weeks there is no significant relieve in symptoms, a surgical therapy should be considered
- Surgical treatment
One main focus of the APEX SPINE Center is the percutaneous nucleotomy (discectomy) of the cervical spine. This revolutionary surgical technique is practiced almost exclusively by Dr. Schubert.
As opposed to other common surgical procedures, where the entire disk is removed and replaced by a placeholder (cage or artificial disk replacement), with this special method only the herniated material is removed under local anesthesia. The natural mobility and stability of the cervical spine is maintained.
In fact, this surgical procedure is analogous to the discectomy of the lumbar spine where also only the herniated tissue is removed and not the entire disk replaced by an artificial placeholder.