Cervical Disc Herniation
Neck pain, shoulder, arm or hand pain, weakness in the upper or lower extremities, lack of coordination, imbalance when walking, bowel or bladder incontinence.
A cervical disc herniation (herniated disc) is a rupture and/or bulge of an interverterbral disc in the neck. The intervertebral disc is a complex spongy structure which consists of a central sticky gelatinous portion, the nucleus, and an outer fibrous ring of tissue, the annulus. These discs are found along the entire spine from the neck all the way down to the lowest part of the back. The function of this disc is to permit motion of the spine while also acting as a shock absorber and connecting link between each vertebral body. The outer layer, the annulus, may actually tear and result in extrusion or bulge of the inner part of the disc, the nucleus. This is called a disc herniation.
The nerve may become irritated either as a result of chemical reaction to an injured disc and/or to compression from the herniated disc itself. The space in which nerves normally sit is quite small and there is minimal free space. The symptoms from this irritation can range from numbness, tingling and pain to bladder dysfunction, weakness and even partial paralysis. The particular area of the body which is affected depends upon which nerve is being irritated by the herniated disc.The four stages to a herniated disc include:
1. Disc Degeneration - chemical changes associated with aging causes discs to weaken, but without a herniation.
2. Prolapse- the form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion.
3. Extrusion - the gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
4. Sequestration or Sequestered Disc - the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal.
Cervical Disc Herniation Case Study
45 year old active woman with 3 years of neck and right arm pain. MRI scan shows disc abnormalities at C3-4 and C6-7 (Image A). The C6-7 level shows (Images A & B) a right sided disc herniation impinging upon the exiting nerve root. This finding corresponds to the patient’s pain in her middle finger and the weakness of her wrist flexion and triceps.
The patient had a significant amount of mechanical neck pain, at times worse than the arm pain. A discogram was therefore performed to rule out other causes of her neck pain.
This procedure involved placing a needle inside the disc and injecting dye. If the familiar pain is reproduced, the discogram is noted as positive at that disc. A positive discogram indicates that there is a high chance that the disc is the cause of the patient’s pain.
This patients discogram revealed dye extravasation at C3-4 (Image C), but no reproduction of familiar neck pain.
At C5-6 (Image D), she had reproduction of familiar neck pain. The C4-5 disc was negative for reproduction of pain or extravasation of dye.
A two-level anterior decompression, fusion, and instrumentation was performed resulting in immediate improvement of arm symptoms and gradual improvement of neck pain (Image E).