Everything you ever wanted to know about Cervical Herniated Disc Disease
Anterior Cervical Discectomy and Fusion Surgery
To best understand herniated discs in the neck you have to learn some basic human anatomy. As you probably know, the entire spine runs from the base of your neck down to the buttocks. The spine spanning this region is divided into four parts. Starting at the top, from your head and working down, the four parts are called:
- Cervical Spine
- Thoracic Spine
- Lumbar Spine
What we call "cervical" is commonly called the neck. The "Thoracic Spine" is your upper back and the "lumbar spine" is your lower back. The sacrum is the back part of your pelvis, just beneath the buttocks.
Even though the spine is made of bone it is still quite flexible. The movement occurs because the spine is made up of 24 separate bones, called vertebrae. There are 7 vertebral bones in the cervical spine, 12 in the thoracic spine and 5 in the lumbar spine. The sacrum is all one solid bone and doesn't have any separate vertebral components.
Each individual spinal bone is connected to the next one in line by a rubber-like cushion called a "disc." The disc is wonderful because it allows flexibility while at the same time acts as a strong connector of the spinal bone above and below. The disc has a tough outer ring and on the inside has a core of soft jelly-like material.
What Happens When A Cervical Disc Herniates?
Sometimes the inner jelly in the core of the cervical disc comes out (herniates out) and causes trouble. The word "herniation" in the dictionary is defined as, "to protrude abnormally from an enclosed cavity." This is trouble because there are spinal nerves surrounding the spinal bones and when the jelly protrudes it can push against one of those nerves.
This pressure on the nerve produces pain. Because the nerves in this area of the cervical spine are the ones going down into the arm, the patient will end up with symptoms into the arm. If you have a herniated disc in your neck you may feel pain, numbness and tingling all the way to the fingers. Severe pressure can even cause arm weakness.
What Are the Symptoms of a Cervical Herniated Disc?
If the disc is herniated on the left side you will have symptoms into the left arm. Likewise, if the disc is herniated on the right side it will be your right arm with symptoms. It's less common for the disc to protrude centrally. If that happens then there may be pressure on the spinal cord and more complex neurologic symptoms may present. Severe spinal cord compression can lead to arm and leg weakness, loss of bowel and bladder function and even paralysis. As mentioned, this is less common however it's more important to seek emergency care and go to the Emergency Department of your nearest hospital if any of those spinal cord symptoms develop.
A herniated disc in the neck can also cause neck pain. Most often though it's the radiating arm pain towards the shoulder associated with numbness or tingling in the arm or hand that brings people to the doctor. The quality and type of pain can vary from sharp, aching, and localized to dull, burning, and pinpoint.
Symptoms such as numbness, tingling, and especially weakness in the muscles of your arms, are warning signs that your problem may be more serious. Weakness in your arms is a definite sign that you should see a doctor about your neck pain "Myelopathy" is a term that you may come across while doing your internet research so it's worth mentioning when talking about big herniated discs. A herniated disc in the neck which is large in size may cause such severe compression on the spinal cord that it leads to actual injury of the spinal cord. This injury produces signs and symptoms which is a condition called "myelopathy." Patients with myelopathy may experience symptoms such as loss of bowel or bladder control, spasticity while walking, as well as weakness and other deficits of coordination. Myelopathy requires urgent care.
Herniated Cervical Disc, Ruptured Cervical Disc, Slipped Cervical Disc or Extruded Cervical Disc with Fragment. What's the difference?
Many patients are confused about the difference between a herniated disc and a bulging disc and I want to take this time to clarify those terms. The least severe condition is the bulging disc and most doctors consider a bulging disc to be a normal condition.
Studies have shown that over 30% of MRIs on people who have no pain at all in the neck or back will have one or several bulging discs. From a surgeon's standpoint, most often we view a bulging disc as a problem which is non-surgical and may or may not be even associated with pain in the neck or arms.
The condition that is more significant is that of the herniated disc. There are several terms that also describe herniated discs and those include slipped disc, ruptured disc, and extruded disc. These all are pretty much the same thing and these terms are used interchangeably.
The term "extruded disc" implies that the herniated piece, the fragment, has separated from the disc itself.
It's easier to understand if you think of the disc as a jelly donut, like the kind you would get at Dunkin Donuts. When you squeeze the donut some of the jelly will protrude out. It's similar to what happens when a disc herniates.
Causes of a Herniated Disc in the Neck. Why Me?!
Bad luck is the short answer. Herniated discs occur commonly in people ages 20-40 but can occur at any age. Frequently there is a family history of back problems or there may have been a recent strain on the neck from some sort of trauma but it's not uncommon for a disc to herniate without any good reason. Most often, it's one of those things that "just happens" so don't waste a lot of time wondering what you did wrong to end up like this.
Certainly as we get older the discs lose water content and get brittle, losing some of their flexibility. This may allow the ligamentous annulus surrounding the outer ring of the disc to tear more easily, leading to a herniated disc.
Diagnosis: Yes, I Have Neck Pain Going Into My Arm. What Test Can Be Done To Confirm That I Have A Herniated Disc?
Simple answer: MRI
The MRI is a simple non-invasive test that shows all the discs, nerves and bones in the neck. It will confirm whether or not you have a herniated disc, tell if that disc is pressing on a spinal nerve and reveal if there is spinal cord compression.
In order to get an MRI you will need to see a doctor and get a prescription.
Don't be alarmed if your doctor doesn't order the MRI right away, even though you have pain in the neck going down the arm. Because most herniated discs get better on their own within six weeks, it's good medical practice to wait and be sure the patient isn't getting better on his own before ordering the MRI.
Natural History: What Happens to People With Herniated Discs? Am I Going to Get Better?
Yes, you are going to get better. One way or another.
The good news is that most herniated discs get better on their own. 90% of herniated get better without the need for surgery.
About 50% of people are better by four weeks and 90% by eight weeks. In most cases, the disc fragment that herniates and presses against the spinal nerve loses water content and shrinks in size over several weeks. When it shrinks it pulls away from the nerve and the pain goes away.
If you are in the 10% group that continues with pain for several weeks you will need microsurgery and then you will be better. The procedure is safe and effective when performed by a spine specialist. It's a good idea to try some non-surgical treatments first and save surgery as the last treatment.
Read the "Treatment" section of this web site to get information on what you can do to help yourself heal from a herniated disc.
Am I Going to Get Paralyzed? Am I Going to Die?
No and No.
Nothing is guaranteed so don't hold me to it but in most every case the symptoms from a herniated disc are safely and effectively resolved without paralysis. It is extremely rare for paralysis to occur and for most routine herniated discs without spinal cord compression it is not even something to worry about.
90% of people get better on their own without the need for surgery. The 10% that require microsurgery, as a group, do very well and have excellent relief of pain.
The more common serious complications from a herniated disc in the neck are persistent chronic arm numbness or weakness, despite treatment. Myelopathy (see above) is also a more serious condition and it is not uncommon for permanent nerve damage to persist even after surgical treatment.
Cervical herniated discs are considered a benign condition. In and of themselves they are not fatal.