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SPINAL DISORDERS CERVICAL HERNIA

Aging Spine

Cervical Hernia

What is cervical disc hernia?

Boyun Fıtığı Due to traumas, overforcing, accidents, or loss of the water content in the central disc caused by aging, the disc can not perform its cushioning as is used to do. As the disc continues to detoriate the outer layer may be torn and the center of the disc may extrude through a tear in the outer layer, eventually flooding to the space that harbors the nerves and the spinal cord and causing a cervical disc hernia.

Our neck is composed of 7 vertebrae, with discs interposed in between them to provide movement. The disc is the most significant structure that connects one vertebra to the other. It is composed of strong connective tissue and acts as a cushion or impact absorber between the vertebrae. (figure 1)

The discs and the facet joints allow movement of the vertebra so that it becomes possible for you to bend or rotate your neck or back. The disc is composed of an outer and sturdy layer named “annulus fibrosus”, and an inner layer named “nucleus pulposus” which is a jelly like structure.

What are the signs of cervical disc hernia?

Rarely the herniated disc may compress the spinal cord and cause problems in the legs.

How is a cervical disc hernia daignosed?

In addition to a clinical examination directed toward finding the type and location of the pain, a careful examination of the weakness, loss of sensation and abnormal reflex is generally adequate for diagnosing the disc hernia and determine its location.

Your doctor’s diagnosis will be verified with X rays, computer tomography, and magnetic resonance imaging. X rays can show the bone prominences resulting from wear and detoriation of the spine or show the narrowing in the disc spaces, however it cannot show the disc herniation or the nerves going out from the spinal cord. CT and MRI (golden standart) scan provides detailed images of all spine components (vertebrae, discs, spinal cord, and nerves) and detects most disc herniations.

In addition to all of the above, electrodiagnostic studies may be performed to search for the findings of nerve injury that may result from disc herniation.

What are the nonsurgical treatment methods in cervical disc hernia?

Most patients with cervical disc hernia improve without any treatment. There are various options for patients with persistent pain. There are numerous drugs that can decrease pain related to cervical disc hernia.

Most patients will improve with nonsurgical medical treatment or conservative management.

If necessary, your doctor may recommend treatments including rest, collar, antiinflammatory drugs for decreasing nerve injury, painkillers for pain control, physical treatment, exercise or epidural steroid injections.

The aim of nonsurgical treatment in cervical disc hernia is to decrease the nerve injury resulting from the herniated disc, decrease the pain, and to improve the general condition of the patient. You need to ask your doctor if you can go to work during the treatment process.

A short period of rest (1-2 days) after the onset pain from cervical disc hernia may be useful. Reinitiation of movements after this brief rest period is important for the prevention of joint stiffness and muscle weakness. With the help of a nurse or physiotherapist, your doctor may inform you by teaching the special exercises directed toward strengthening your neck. You can perform these exercises home, or you may need to visit a physiotherapist to carry out a specialized program that suits your needs and capacity.

Traction and stretching method in cervical disc hernia

Your doctor or physiotherapist may decrease the pain of cervical disc hernia, inflammation (injury), and muscle spasm by applying treatments such as traction (pulling, stretching), hot or cold pack applications, manual massage.

Drug therapy in cervical disc hernia

Drugs used for the control of pain are named painkillers (analgesics). In most conditions the pain responds to commonly used (nonprescription over the counter) analgesics such as aspirin, ibuprofen, naproxen or acetaminophen. If you have severe and persistent pain, your doctor may add narcotic analgesics for a short period. Muscle relaxants can be added to the treatment in some cases. Taking higher doses of the drugs will not accelerate your healing, besides these drugs have side effects such as nausea, constipation, lightheadedness, dizziness, and addiction. All drugs should be taken the way and amount they are described. Report to your doctor all the drugs you are using (including nonprescription drugs you used) and tell your doctor if you tried any of them before, tell if you had gotten any benefit or not. You should be under the follow up of your doctor with respect to the problems (stomach problems or bleeding) that may arise from the long term use of prescribed or nonprescribed painkillers and NSAIDs.

Corticosteroid drugs (tablet or injection forms) may be occasionally prescirbed for very intense arm and leg pain for their potent antiinflammatory properties. Corticosteroids may have side effects like NSAIDs. You should obtain information from your doctor regarding the benefits and risks of these drugs.

Spinal injection method in the management of cervical disc hernia

Spinal injections or “blocks” may be used to relieve very intense arm pain caused by the cervical disc hernia. These are cortisone (corticosteroid) injections performed into the epidural space (the space around the spinal nerves) by a doctor trained for the technique. The first injection may be supplemented with one or two more injections later. These are generally performed as a part of a rehabilitation and treatment program.

Injections made on the trigger points are local anesthetic (sometimes corticosteroids may be added also) injections made directly into the painful soft tissues and muscles located along the spine. Although they are useful in some conditions for the control of pan, injections made into the trigger points do not restore the herniated disc.

Cervical disc hernia operation

Boyun Fıtığı Surgery in may be necessary in patients with cervical hernias who did not benefit from nonsurgical treatment methods.

The purpose of cervical hernia surgery is removal of the segment of the disc that compresses the nerve. This is done by a procedure named discectomy. In order to reach the spine the surgeon performs an incision on the neck, which is either on the front (anterior) (figure 2) or back (posterior) (figure 3) of the neck depending on the location of the herniated disc. The technical decision whether the operation will be performed from the front or the back depends on numerous factors including the exact location of the disc herniation, experience of the surgeon, and his or her preferences. In both approaches, the part of the disc compressing the nerve is generally removed with good results. In the approach from the front, a great portion of the disc will be removed to access the herniated disc part, therefore a fusion procedure will be often necessary in the same session.

Spinal fusion surgery in cervical hernia

Boyun Fıtığı The most important disadvantage of spinal fusion surgery is the elimination of any movement in the fused area. This does not constitute a significant disadvantage for neck movements when discectomy is applied at a single level. This is because the lost movement of this segment is compensated and tolerated by the remaining intact segments. However the increased burden of movement and loads impacted on the upper and lower segments cause this areas to be worn out in the following years, and may result in neck hernia or pain. Today thanks to the developing technology, instead of fusion mobile prostheses are being inserted to replace the removed disc.

However the insertion of prosthesis may not be appropriate for all patients. Suitable patients are those who are young, who do not have detoriation in the facet joints and have relative preservation of the disc space. The best decision regarding the appropriateness of a prosthesis will be made by your doctor.

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