What it is
A herniated disc in the neck is a result of the rupture of a gel like centre through the tough disc wall in your spine known as the annulus.
As the gel causes a chemical irritation to the spinal nerves, swelling occurs as the gel touches or compresses a spinal nerve.
This results in pain in certain parts of the body depending on where the rupture occurred. When this occurrence takes place in the neck, one will suffer intense pain in the shoulders and arm, along with the possibility of numbness, tingling and weakness.
Herniated discs tend to subside within 6 weeks through rest, pain medication, special injections and physical therapy. However, surgery may be required if symptoms persist.
Disc anatomy and relation to herniated disc
Looking at the spine, it should be noted that there are 24 bones in the spine called vertebrae which can be divided into different sections.
The cervical or neck section supports the weight of your head, allowing for you to bend and rotate your head. In the spine there are seven cervical vertebrae that are numbered from C1 to C7, each of which are separated by disks that stop the vertebrae from rubbing against one-another.
The outer ring of these discs is called the annulus and the gel-filled centre of these disc is known as the nucleus. The annulus can be torn as a result of aging as the spine and neck bear most of a person’s weight, so they can easily degenerate. This process can start when people reach the age of 30.
As the discs degrade, they are more prone to tears caused by repetitive motion due to a weakened annulus along with traumatic injuries.
Such tears allow the nucleus to seep out and irritate the spinal nerves which results in the symptoms that characterise a herniated disc.
Symptoms of a herniated disc
A herniated disc in the neck (cervical) is characterised by a severe pain that radiates your limbs or the shoulder blades.
Pain may also occur when turning your head or bending your neck, and may be accompanied by a numbness and a tingling sensation in your arm.
Muscles can tighten uncontrollably which results in muscle spasms. It is possible to experience these symptoms without any traumatic injury, and they can occur suddenly when you wake up.
There is also a possibility that you may experience no pain at all, and the occurrence of a herniated disc would only be noticed on spinal images.
Individuals Affected by a herniated disc
It is common for people in their 30s and 40s to be affected by a herniated disc. However, middle aged and older people are slightly at risk, especially if they are involved in strenuous activities.
It should be noted that only 8 % of herniated discs occur in the neck. There are a number of other factors that may increase the risk of getting a herniated disc and these include your weight, occupation and certain elements of your genetics.
Excess weight can increase stress on the discs in your back, increasing the risk of a tear in the annulus.
Working in physically demanding jobs and performing actions such as repetitive lifting, pulling, pushing, bending and twisting can put stress on the discs and increase your risk of getting a herniated disc. Certain people can inherit predispositions that affect their chances of getting a herniated disc.
Concern and when to get treatment
Generally, there is no reason to be worried about a herniated disc as the pain should subside within six weeks with relaxation. However, it should be noted that your spinal cord does not extend into the lower portion of your spinal canal, but rather, it separates into a set of nerve roots. In rare occasions, a herniated disc can cause the roots to be compressed and emergency surgery must be performed in order to prevent permanent weakness or paralysis.
It is advised that you seek medical attention if you suffer from the following problems. Your symptoms continue to worsen to the point where they affect your daily activities. Compression of the nerve roots results in difficulty urinating, even with a full bladder. You begin to lose sensation in the inner thighs, back of the legs and the area around the rectum.
Diagnosis and Treatment
When you contact your doctor regarding your symptoms, they will look through your medical history in order to get an understanding of your symptoms and to determine if certain elements of your lifestyle are the main cause. Afterwards, a physical exam will be performed for weakness in the muscles and to determine the source of the pain. Doctors would then perform an imaging study. There are numerous types of studies that are performed. A Magnetic Resonance Imaging scan (MRI) is performed to get a three dimensional view of the spine in slices and may or may not be performed with a dye injected into the bloodstream. It can detect the damaged disc along with nerve compression, bony overgrowths, spinal cord tumours or abscesses. A specialised X-ray known as a myelogram is performed with a dye injected into the spinal canal through a spinal tap before an X-ray fluoroscope records images that have been formed by the dye. This technique shows the nerve that has been pinched by the herniated disc, along with other problems such as overgrowths, tumours and spinal abscesses. A Computed Tomography (CT) Scan may then follow. It uses an x-ray beam and a computer to make 2 dimensional images of the spine, giving the doctor a view of the spine in slices much like the MRI scan. This is useful for finding the damaged disc. Electromyography is useful for detecting nerve damage and muscle weakness. It is often done alongside a NCV study, measuring the response of nerve and muscle response to electrical stimulation induced by small needles or electrodes placed into the muscles. A machine would then record the response which would be irregular as a herniated disc would put pressure on the nerve root. Finally, an X-ray would be used to look at the bony vertebrae in the spine to see if any are too close together or if any arthritic changes, bone spurs or fractures have occurred. This is an ineffective method as it does not detect herniated discs.
Available treatment consists of anti-inflammatory drugs such as aspirin or naproxen to relieve the pain symptoms. Analgesics like acetaminophen relieves pain, but they are ineffective in terms of acting as anti-inflammatories, and using them long-term can risk stomach ulcers along with kidney and liver problems. Muscle relaxants may be used to reduce muscle spasms. Steroids would reduce swelling along with the inflammation of the nerves. Steroid injections would also be used on the area of the herniated disc if the pain is too severe. Other treatments may include physical and holistic therapies. However, if the symptoms do not subside, then surgical treatments such as an Anterior Cervical discectomy or artificial disc replacement, may need to be performed.