What is Cervical Disc Herniation & How is it Treated?

The neck is made up of multiple bones called the vertebra. These extend from the base of the skull to the upper back. There are 6 cervical discs in the neck region that rests between the vertebrae and act as a shock absorber between the bones. The neck also houses a complex network of muscles and ligaments which support the bones and helps in neck movement.

Cervical disc herniation is a neck disorder caused by leakage of the jelly like fluid from the central portion of the disc through the cracks and tears in the outer or exterior portion. It is characterised by discomfort and pain in the neck with weakness, numbness and tingling in shoulder, arms and fingers based on the nerve root that has been impinged. The risk of developing cervical disc herniation increases with aging and lack of physical activities. It is more common in individuals involved in heavy lifting activities, driving for long hours, smokers etc. Neck injury, trauma and inappropriate neck postures also increases the risk of cervical disc herniation.

Herniated disk is defined as a condition characterised by abnormalities in the spinal disks between the individual vertebrae. Spinal disks have a soft centre with a jelly like consistency enclosed within a tough exterior. Disk herniation, also known as slipped disc, is a condition where the jelly like matter leaks out through a crack of opening in the exterior. This in turn can irritate the surrounding nerves and cause numbness and weakness in arms and legs.

The most common site of disc herniation is the neck (cervical) and lower back (lumbar). The cervical discs are not very large and there is limited space available for the nerve innervation in this area. Any small cervical disc herniation causes nerve impingement followed by significant pain in shoulders and arms.

Cervical disc herniation can occur at different levels and the symptoms depend of the particular nerve affected as follows:

• Symptoms of Cervical Disc Herniation at C4-C5 Level: It is characterised by weakness in the upper arm, shoulder and deltoid muscles caused by impingement of the C5 nerve root.
• Symptoms of Cervical Disc Herniation at C5-C6 Level: It is one of the most common areas for cervical disc herniation where there is impingement of C6 nerve root. There is weakness, numbness and tingling in the biceps, arms, wrist extensor muscles and side of the thumb.
• Symptoms of Cervical Disc Herniation at C6-C7 Level: Symptoms of C6-C7 disk herniation include weakness in triceps and extensor muscles of the fingers with tingling and numbness radiating from the triceps up to the middle finger due to impingement of C7 nerve root.
• Symptoms of Cervical Disc Herniation at C7-T1 Level: There is weakness while gripping with hands and also pain, weakness, numbness and tingling radiating down the arm and to the little finger of the hand.

The most common area of cervical disc herniation is at C5-C6 level followed by C4-C5 level and C6-C7 level. The risk of developing cervical disc herniation increases with aging and is most commonly seen at age of 40 years and above.

The prognosis of cervical disc herniation is good. It is easily diagnosed and treatment is suggested as per the extent of the condition. If diagnosed early, surgical intervention can be avoided. Right treatment at the right time can also help in preventing neurological complications.

Cervical disc herniation is caused by wear and tear of the cervical discs. The risk of cervical disc herniation increases with aging, as there is loss of cervical fluid with aging. It can also be caused by cervical injuries and trauma that may lead to cracks and tears in the outer layer of the disc, leading to leakage of fluids. The disc bulges as the jelly-like fluid from inside the disc is pushed out through the cracks and tears.

Studies that shown that the risk of developing cervical disc herniation increases with the following:

• Frequent lifting of heavy objects
• Driving for prolonged periods of time can lead to cervical disc herniation
• Inappropriate posture while sleeping and sitting at work place
• Increased usage of electronic gadgets such as mobile phones, laptops etc are a rosk factor for cervical disc herniation.
• Neck injury or trauma
• Cigarette smoking
• Aging.

Cervical disc herniation, if left untreated, can have serious neurological manifestations. It can lead to permanent numbness and weakness in the area intervened by the affected nerve root. It can limit mobility and can affect the ability to carry out daily functions and activities.

Cervical disc herniation is diagnosed by an experienced physician or orthopaedist. A thorough case history is obtained followed by a physical examination of the neck, shoulder and arms. Specialized studies may be done for further evaluation and management. These include:

• Imaging Studies to Diagnose Cervical Disc Herniation: Such as x-ray, CT scan and MRI to evaluate disc herniation.
• Electromyography or EMG to Diagnose Cervical Disc Herniation: It helps in measuring the health and activity levels of the muscles and nerve cells.
• Blood Work: It is done to rule out infectious disorders and inflammatory conditions such as Lyme titre, ANA antibody test, rheumatoid factor test etc. A negative report of these confirms cervical disc herniation as the cause of the symptoms.

Cervical disc herniation and impingement is treated by pain management specialist, or an orthopaedist. In specialized cases, intervention by a neurologist may be required.

The treatment for cervical disc herniation includes:

• Oral Medications for Cervical Disc Herniation: Over-the-counter pain medications such as Aleve, Advil, and Tylenol etc. can be taken as needed to relieve pain.
• Topical Medications for Symptomatic Relief of Cervical Disc Herniation: A number of ointments, gels, creams and sprays are available over-the-counter. These can help in providing symptomatic relief.
• Physical Therapy for Cervical Disc Herniation: Physical manipulation of the neck by an experienced physiotherapist can help in reducing the pain and can also help in improving the flexibility.
• TENS (Transcutaneous Electrical Nerve Stimulation) for Cervical Disc Herniation: Electric impulses are delivered using electrodes for easing the pain.
• Traction to Treat Cervical Disc Herniation: Here the neck is stretched by an experienced professional using weights, pulleys and air bladders to increase the disc space.
• Immobilization: A soft collar may be worn as instructed by a physician to provide adequate rest and support to the neck.
• Steroid Injection: In advanced cases, corticosteroid injection in the facet joint can provide significant benefit to patients suffering from cervical disc herniation.
• Surgical Intervention for Cervical Disc Herniation: Surgery may be required for management of nerve compression in the neck. This includes cervical artificial disc replacement, posterior cervical disc discectomy, anterior cervical discectomy and spine fusion. Surgeries to treat cervical disc herniation are carried out by orthopaedic surgeons and involves placement of artificial discs and plates. A neck brace is often given, to be worn post operatively to limit mobility and maintenance of neutral neck position to accelerate healing.
• Home Care: Alternate application of heat compresses and ice application over the affected area provides symptomatic relief. Warm showers in the morning can help in improvement of neck stiffness.
• Alternative Medicine for Cervical Disc Herniation: Alternative medicine such as acupuncture, chiropractic therapy and massages can also be considered for relieving symptoms of cervical disc herniation.

It is advised to stay physically active and exercise on a regular basis to avoid disc herniation. Physical activities help in maintaining the flexibility of the neck. A number of home exercises are recommended for improving the condition. These include simple stretching followed by neck rolls and shoulder rolls. Gently rotate the neck, laterally, forward and backward. It is advised to take warm showers or do heat compresses prior to the exercises for better results. Special exercises may be recommended by the physician or physiotherapist based on the condition and requirement.

The following is recommended to prevent disc herniation and neck pain:

• Maintain Appropriate Posture for Avoiding Cervical Disc Herniation: It is advised to maintain the back and shoulder in right posture while standing and sitting. Slouching and hunching over increases the risk of neck pain. Maintaining correct posture while sleeping is also important.
• Take Frequent Breaks It is advised to avoid activities such as watching television, working on computers, driving long distances and using mobile phones and tablets for prolonged periods of time. It is advised to take frequent breaks to provide adequate rest to the neck and prevent conditions like cervical or lumbar disc herniations.
• Ensuring Proper Ergonomics Can Help Prevent Cervical Disc Herniation: Computers and other electronic gadgets should be used keeping in mind the correct ergonomics. It is recommended to maintain the monitor at eye level, use a chair with good back support and maintain knees below the hip level with feet flat on the ground.
• Use Headsets: It is advised to uses headsets and earphone while talking on phone for long hours to prevent neck strain.
• Quit Smoking: Smoking increases the risk of neck pain so one must avoid it.
• Avoid Heavy Back Packs to Prevent Cervical Disc Herniation: It is advised to avoid heavy back packs while going to school. One can consider trolley bags instead.

Cervical disc herniation is a very common condition in today’s world due to lack of physical activities and over indulgence towards sedentary lifestyle. Although it can be managed with proper care and treatment; if not treated in time or neglected, it can cause debilitating changes and can be very painful. In advances cases surgery is suggested by an experienced physician. It is also advised to do exercises as recommended by a physical therapist for faster recovery. If proper treatment is done and followed, one can overcome the condition and life a pain free life.