Displacement of Cervical Intervertebral Disc without Myelopathy

The spine or the spinal cord is the most important part of the body that is protected by vertebral column. The spinal cord is connected with the brain and brain is protected by skull. From the spinal cord, the major nerve roots are released that control the sensory, motor and multiple reflex functions of the entire body. However, these coordinated functions of the nerve roots with brain may be disrupted due to a number of reasons, of which the Displacement of Cervical Intervertebral Disc is a significant one that demands discussion.

As the name of the condition indicates, Displacement of Cervical Intervertebral Disc without Myelopathy means herniation or protrusion of the cervical intervertebral discs between the adjacent vertebrae. It must be mentioned here that there is no complete displacement of the disc as such, but only a protrusion or herniation. In fact, in the region where the spine meets the skull (C1 vertebrae) as well as between the C1 and C2 vertebrae, there are no discs. However, from C2 through C7, the condition of cervical intervertebral disc protruding through the adjacent vertebrae can occur due to a number of reasons. Myelopathy is a condition referring to neurological deficits with regards to the spinal cord. The neurological deficit following damage to sensory nerve fibres causes symptoms of tingling and numbness, and damage of motor nerve results in muscle weakness. Displacement of cervical intervertebral disc may or may not cause myelopathy depending on the extent of displacement. During the initial stages of mild to moderate displacement of cervical intervertebral disc, myelopathy is not observed because of lack of pinch or irritation of spinal cord or spinal nerve; however, if the condition is not treated in this stage, it might bring in severe problems.

From vertebrae C2 through C7, there are discs between each of the adjacent vertebrae. Disc contains soft jelly like substance in the middle of disc known as nucleus pulposus. Disc and nucleus pulposus act as a cushion and absorbs any shock associated with movement of neck and protect the spinal cord. The nucleus pulposus is protected by surrounding tough annulus fibrosis, which is made up of tough fibrous tissue. Thus, disc is formed by inner soft nucleus pulposus and outer tough annulus fibrosis.

When this annulus fibrosis becomes weak in certain areas of the cervical spine, the gel-like nucleus pulposus protrudes out and intrudes into spinal canal. This is known as the herniation or displacement of the cervical intervertebral disc. Based on the extent of the intrusion, either the spinal cord is compressed or the nerves are compressed or exited or both may happen.

The extent of the discomfort depends on the extent of the displacement or herniation of the cervical intervertebral disc. However, the common symptoms of cervical intervertebral disc without myelopathy would include –

• Tingling.
• Numbness.
• Pain in the back of neck, shoulder and arms.
• Weakness in neck, shoulders and arm muscles.

Herniation or protrusion of one of the disc in neck exerts pressure over the spinal cord or nerves within spinal canal or foramina. The irritation, pinch or pressure over spinal cord or nerve causes symptoms and the complication is known as myelopathy or neurological deficits. These include –

• Sensory Problems: Sensory changes or difficulty in the sensation of temperature, touch or even a sensation of pinprick can be experienced. The symptoms are tingling and numbness. During advanced stages one may find it difficult to understand position of hand, arms and neck while changing different position of the body.
• Motor Problems due to Displacement of Cervical Intervertebral Disc: As pressure is put on the motor nerves, it leads to weakness of muscular strength. The tone and power of muscles is weak, results in one unable to pick objects or lift upper arm and in few cases neck.
• Reflex Problems: This can be encountered especially in the upper limbs. The reflexes help to protect arm and neck by instant muscle contractions resulting in moving away from harmful effects during normal activities.

The conditions resulting in tingling, numbness and weakness of muscles is referred as radiculopathy. However, there can be displacement of the cervical discs without the signs of radiculopathy. If the cause of pinch, pressure or irritation is not removed, the numbness may persist as permanent complication and weakness may follow severe muscle wasting and atrophy. In fact, here it must also be mentioned that radiculopathy can be the signs and symptoms of many other conditions such as vertebral fracture, tumors in the vertebrae and even infection in the spinal canal.

The site between the fifth and sixth (C5-C6) cervical vertebrae and the site between the sixth and seventh (C6-C7) cervical vertebrae are the most common sites of the herniation or disc displacement. The reason behind this is the maximum movement or flexibility of these two cervical vertebras. However, the exact causative factors behind the Displacement of Cervical Intervertebral Disc without Myelopathy are not properly known. Case controlled studies have shown that usually this condition is associated with small to moderate disc bulge or herniation. The mild to moderate disc herniation resulting in only symptom of pain is rare, but may follow a automobile or work accident as well as in elderly following degenerative disc disease. With ageing, the bones are degenerated and the cervical disc too progresses towards degeneration. Osteoarthritis is the major cause of the disc degeneration.

If you experience any of the symptoms or discomforts in your neck, shoulder and arms, you must seek medical treatment before the condition worsens. With timely diagnosis and treatment, further damage of spinal cord and spinal nerve may be avoided. Once the doctor diagnoses your symptoms, he or she will run a thorough medical history. This will include if you have had a neck injury or injury in the upper limb in the past. Along with that, the history of other existing diseases like osteoarthritis, heart disease, diabetes, nervous system disorders, infections, atherosclerosis, obesity or malignancies are also taken into consideration. If these chronic diseases contributed to the condition, they need to be treated as well.

To determine the exact position of the displacement, an MRI is done. To support the diagnosis, CT scan is also done along with an X-ray of the spinal cord.

• Traction Therapy to Manage Symptoms of Displacement of Cervical Intervertebral Disc Without Myelopathy: Usually, conservative traction therapy is prescribed at home to treat the displacement or the protrusion of the vertebral disc. Traction is applied to neck either by using inverted traction table or mechanical device. The angle of slope of inverted traction table can be changed. The head lies on lower side. The angle is changed according to tolerance. One should lie on traction table for 3 to 4 times a day for maximum 10 to 15 minutes.
• Medicines to Manage Symptoms of Displacement of Cervical Intervertebral Disc Without Myelopathy: To reduce the pain as well as the inflammation of the area, NSAIDs are prescribed. In case of radicular arm pain of a severe intensity, cortisone or corticosteroids are prescribed. Sometimes, antidepressants, anticonvulsants or other narcotic drugs are prescribed in case the pain is severe. Opioids are avoided to prevent dependence and addiction
• Physical Therapy Treatment for Displacement of Cervical Intervertebral Disc: To reduce the pain, some other physical therapies are recommended. These include massage, heat and cold compress as well as ultrasound therapy.
• Discectomy for Displacement of Cervical Intervertebral Disc without Myelopathy: Usually it takes a long time for the condition to be treated or to be reduced to the extent of its protrusion. However, if none of the above mentioned techniques are found to be effective, discectomy or surgical intervention is the final resort. The surgeon removes the herniated disc from the spine to relieve the pressure and treat pain and other symptoms associated with the condition.

Even after successful treatment of the condition, patients suffering from Displacement of Cervical Intervertebral Disc without Myelopathy are advised not to lift heavy weight or avoid frequent rapid movement of neck.