Cervical Disc Herniation

Cervical (or neck) disc herniation can be a common cause of neck and radiating arm pain. Often cervical disc herniations can be confused for a problem of the shoulder, elbow, wrist or hand. The problem usually starts with a neck ache or strain and then is soon followed with a tooth-ache type pain in the shoulder or arm. Listening carefully and conducting a proper exam of the patient will lead the doctor to determine if your neck or arm pain is related to a cervical disc herniation. Although a disc herniation of the neck can sound concerning, more than 80% of patients can be treated without the need for surgery and obtain satisfactory results!

Cervical Disc Herniation: What is it?

First it is important to understand some simple anatomy of the cervical spine. The cervical spine is comprised of 7 vertebral (bone) segments. In between the cervical bones are intervertebral discs. The discs act as shock absorbers and allow motion to occur between the bones. The disc is made of a tough outer later called the annulus (because it goes all away around the perimeter of the disc). The annulus is made of a tough type of collagen (which also comprises tendons and ligaments). The center of the disc is made of the nucleus. The nucleus is a jelly-like material and is composed mostly of water. A disc herniation occurs when there is an injury or tear to the annulus, allowing the nucleus or jelly out of the center of the disc space. Very near to the disc lies the spinal cord and spinal nerves. When a disc herniation is large enough it can put pressure on the spinal cord or an exiting nerve. This can cause pain and many other types of symptoms.

Symptoms: What does Cervical Disc Herniation feel like?

Disc herniations of the cervical spine can occur for unknown reasons or after a fall, heavy lifting/pushing/pulling or an accident. Generally, disc herniations in the neck start with a neck-ache. Initially an injury to the outer layer of the disc occurs. Sometimes the ligament on the back side of the bone will also be injured. This usually causes neck pain and muscles spasms. Inflammation begins and contributes significantly to the symptoms. Due to the injury of the disc and ligament the jelly-like material can then squeeze out and begin pushing on the spinal cord or nerve roots. This in turn can then create pain that radiates into the shoulder blades, shoulders, arms and hands. Loss of muscle strength can also occur because the message from the brain to the muscle is getting obstructed or blocked by the disc herniation in the neck. The location of the disc herniation in the neck will determine what part of the shoulder, arm or hand will be most affected. For instance, a disc herniation between C4-C5 would create neck and shoulder pain (deltoid muscle) or weakness. A disc herniation at C6-C7 would cause neck pain, and arm pain that would travel down the back of the arm to the back of the forearm and back of the index and middle finger. At the C6-C7 level the tricep muscle may be weak due to pinching of the C7 nerve.

Causes

Disc herniations in the neck can occur due to many different things or events. Sometimes the cause is never determined. Occasionally a patient will wake up from sleep with the symptoms. In other cases the patient was lifting something heavy above their head or pulling something at work. Any event that causes tension or change of position of the neck can lead to a cervical disc herniation. A common cause is a car accident. When a person traveling in the car gets hit from the front or back of their vehicle this can cause the head and neck to change position rapidly, leading to disc injury and possibly disc herniation.

Evaluation: How is Cervical Disc Herniation diagnosed?

As mentioned above, a cervical disc herniation can masquerade as some other injury to the arm. Often times patients are initially treated for a shoulder strain or rotator cuff tear. Other times they are treated for carpal tunnel syndrome. All of these conditions share symptoms that can be caused by a cervical disc herniation. The most important part of obtaining the diagnosis is a thorough history (patient’s story) and proper physical examination. If the doctor is able to rule out other causes of neck, shoulder and arm pain the initial tool to help them confirm the neck as the cause is a simple X-ray. The X-ray can reveal abnormalities of alignment or signs of arthritis. To truly diagnose a cervical disc herniation the imaging study of choice is an MRI. The MRI will show soft tissue structures such as the disc, spinal cord, nerves, muscles, tendons and ligaments.

Treatment

Non-operative treatment

The mainstays of treatment of a herniated disc include physical therapy, chiropractic treatment, non-steroidal anti-inflammatories (i.e. ibuprofen), acetaminophen (Tylenol), traction and injections. No treatment has been proven to physically remove or dissolve the disc herniation. Treatment is geared towards improving symptoms while the body attempts to heal itself. MRI studies have shown that disc herniations in the majority of cases will slowly dissipate in size over time. We believe this is related to the body’s immune system using enzymes to degrade or dissolve the disc through a complex process. As mentioned above, >80% of disc herniations heal spontaneously over 6-12 weeks.

Surgery

The unfortunate individuals who continue to be symptomatic after 6-12 weeks of non-surgical treatment may find themselves discussing surgical options with their physician. Surgical options fall into 3 main categories, all aimed at removing the offending disc and relieving the pinched nerve or spinal cord. The most common surgical treatment for a herniated disc in the cervical spine is call an ACDF. Anterior cervical discectomy and fusion (ACDF) is a highly successful procedure where the surgeon removes the herniated disc from the anterior (front) part of the neck and then replaces the disc with a spacer (cage) and secures the two bones on either side of the disc with a plate and screws. This procedure has been used for several decades successfully improving arm and neck pain in patients with herniated discs.

A second surgical procedure used to treat disc herniations is cervical disc arthroplasty (disc replacement). Again, the surgeon accesses the disc from the front of the neck and removes the disc entirely. Instead of a spacer, plate and screws, the surgeon implants a device that maintains motion of the bones above and below the disc. The device is made out of the same materials that are used in knee and hip replacements; titanium, cobalt-chrome alloy and a very hard plastic bearing (polyethylene). Cervical disc replacements have the advantage of maintaining normal or near-normal flexibility. This has been shown to help decrease the forces or stress on other parts of the spine and may even prevent or slow the development of arthritis in nearby joints or discs. This surgery has been performed in the US since 2007 (Prestige, Medtronic). Cervical disc replacements are typically used in younger patients with disc herniations and without severe arthritis.

Lastly, an option that is far less common than ACDF or disc replacement is a posterior surgery named laminotomy and foraminotomy. This is a procedure where a small “key-hole” piece of bone on the back of the neck is removed allowing access to the pinched nerve and below in the herniated disc. The surgeon may able to safely remove the disc without injuring the nerve or spinal cord. However, in some cases merely removing the bone and ligament on the back of the spine will successfully unpinch the nerve without the need to remove the disc. In this surgery there is no need to fuse the spine. This procedure is more technically demanding and in some cases not as successful at treating all the neck and arm pain.

Recovery: What Can Be Expected?

In most cases cervical disc herniations improve with time and symptomatic treatment. This can take 6-12 weeks. Improvement is usually seen within 2-3 weeks and full recovery in the ensuing 2-3 months.

Those patients requiring surgery can expect a full recovery 3-6 months after surgery. Recovery from surgery may include the use of a cervical collar (brace) for 6-12 weeks to allow the tissue and bone to heal. Return to work for those with light duty or desk jobs can be within 2-4 weeks whereas heavy laborers generally cannot return to heavy lifting for 3 or more months. Typically you will see your surgeon several times over 4-6 months to make sure symptoms have improved and that healing has occurred. Long-term follow-up depends on symptoms whereas most patients will not need any further neck surgery

Frequently asked questions about Cervical Disc Herniation

How long does it take for a herniated disc to heal?

6-12 weeks

Does a herniated disc hurt when you push on it?

Generally not. Pain may increase from a disc herniation when lifting heavy objects or turning your neck in a certain position. Jarring your neck while riding in a car or on a bike can also increase symptoms.

How painful is a herniated disc?

Pain intensity varies from a mild dull ache to severe shooting arm pain. This all depends on the size of the disc herniation, amount of nerve pinching and the timing of the injury.

Can I work with a herniated disc?

This depends on the severity of your pain and job expectations. If pain is mild and you do not have a physically demanding job you may be able to continue work. Others with physically demanding jobs or those with severe pain may need to take several days or weeks off of work.

Is exercise good for a herniated disc?

Yes. In most cases being physically active is good for herniated discs. Bedrest and inactivity will generally lead to worse symptoms. Walking is a great exercise to increase blood flow, increase heart rate, expand your lungs and help with pain.

Physicians

The following physicians specialize in the treatment of Cervical Disc Herniation:

Matthew K. Wingate, MD

Gregory F. Alvine, MD

K. C. Chang, MD

James T. Brunz, MD

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Testimonials

I first saw Dr. Chang 14 years ago …I had nerve conduction studies, followed by 8 acupuncture treatments, and was pain-free after years of chronic sciatica back pain. I then joined a local fitness center to continue the healing, as I was actually able to exercise again! I have never even had to go back for any more treatments for that health problem! His gifts of healing, experience, and expertise have changed my life forever for the better! He is compassionate, caring, kind, thorough, and so intelligent.

I returned to him years later for a very painful neck and shoulder, with the same successful results. I am now seeing him for the third time … once again for acupuncture for pain relief of a new problem area. All of my 3 treatment periods over the past 14 years have been consistent of the highest quality.

We are blessed to have Dr. Chang here in Sioux Falls. I tell others about him all the time, and try to help promote acupuncture as a viable option for pain relief. I had a “needle phobia” most of my life, so it took ALOT for me to decide to try this. If you are worried about the needles, don’t be! You will be fine!

My pain is so much better; I owe that to Dr. Baumgartner professional knowledge. He was most courteous, so was the entire staff. Even the X-ray nurse. Now my PT will get me back on track to more strength in my arms. Taking my shower, wiping off with a towel was so much easier, the very next day. I have better strength to do my daily walks, n chores, get dressed easier too. My immune system is not overwhelmed like it was when I had so much pain & inflammation in my arms, shoulders, & neck. I sleep better too.

I’ve only seen Dr. Wingate once. He was extremely thorough in studying my history with neck and back problems and the treatments I’d had over the years. While there are very few procedures available to me surgically, he offered me the possibility of some alleviation that had not been attempted previously. We are in the process of checking this out.

OI has outstanding staff and Dr’s. They are with you every step of the way-before and after surgery. It has been YEARS since I felt this good- Thanks to TEAM WINGATE (including the Spine Therapy dept) performing a successful ACDF C6/7. I definitely recommend. And… thank you Dr. Windgate!

Kelly Trapp

The staff at OI are very professional and helpful and the surgeons are the best at what they do. Had foot surgery a few years ago and have also been seen for my spine and my daughter was seen for a knee injury. They’re not knife-happy, they treat conservatively and do surgery when necessary. I appreciate the time they and their PAs take to answer questions and make sure the patient knows the plan of action. The PT staff is awesome too. Very thorough and they all know what they’re doing.

Liz Hansen

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Cervical Disc Herniation