Slipped disc / herniated disc in cervical spine
In case of a slipped disc, damages of a cartilage ring (anulus fibrosus) occur due to a weakness of the posterior part of the disc. That is, the posterior protective ring tears or protrudes and clamps or irritates nerves (see illustration A and B). Physicians then talk about slipped disc, disc herniation or disc prolapse.
Symptoms slipped disc / herniated disc cervical spine
A disc herniation in cervical spine can cause pain in the neck which can radiate into shoulders, arms or the back of the head. Often pain is accompanied by neurological deficits, e.g., formication, prickling and a decrease of sensation in arms and hands. A severe slipped disc / disc protrusion and pressure on the spinal cord can engender gait abnormality and complaints in the legs. The symptoms of a slipped disc in cervical spine in an overview:
- neck pain
- radiating pain, e.g., into shoulders, arms, hands, fingers
- sensation disturbances, formication, prickling in arms and hands
- gait abnormality and complaints in the legs
Causes slipped disc / herniated disc cervical spine
Not only heavy lifting and accidents but wrong body twisting and certain movements can cause a slipped disc if there is a genetic disposition. Risk factors comprise hereditary factors (’weakness of the connective tissue’), overweight and a lack of movement, permanent sitting, some occupational strains (trucker) and smoking. Furthermore, a bad muscle condition can enlarge the risk of a slipped disc.
Anatomical and biomechanical factors play a certain role in the prevalence of a slipped disc, especially in the lower third of the cervical and lumbar spine. Mainly the spinal segments L 4/5 and L5/S1 are affected. Wear processes rise owing to increasing desk and computer work but also due to damages of cervical spine. The causes of slipped disc in cervical spine in an overview:
- heavy lifting, accidents and certain movements
- hereditary factors ('weakness of the connective tissue')
- overweight
- lack of movement
- certain occupational strains
- bad muscle condition
- wear and tear
Diagnostics slipped disc / herniated disc cervical spine
To differentiate a slipped disc from other spinal diseases causing similar complaints, patients first get a neurological-orthopedic examination including a comprehensive talk about the history and treatment of illness. Often imaging examinations like MRI follow. Magnet resonance imaging enables us to examine and visualize a slipped disc and other spinal diseases very thoroughly. At Beta Klinik we use an open MRI systemto comfortly examine claustrophobic patients and those up to 250 kg (500 lbs).
Therapy slipped disc / herniated disc cervical spine
The causes of a slipped disc in cervical spine are similar to those in lumbar spine. Also comparable are conservative means and the microtherapy, but surgery is different.
Some slipped discs can be successfully treated by conservative means: use of painkilling and anti-inflammatory drugs and avoidance of heavy strains, especially bending over, lifting, pulling and quick turns. In such cases, the healing process of a slipped disc takes significantly longer. After acute pain treatment, a physiotherapy programme with specific exercises for the strengthening of the abdominal and back muscles should follow.
A revision of slipped disc therapy and surgery has to be discussed if conservative therapy does not improve the condition substantially; that means if pain is unbearable or neurological deficits occur. It is outdated that surgery in case of slipped disc is only indicated if neurological deficits exist or paraplegia seems to be imminent. In the face of minimally invasive surgery techniques, it is no longer recommendable to comply with the so-called stepwise phase model, which dictates 6 weeks of conservative measures.
Apart from classical indications (acute paralysis, imminent paraplegia), surgical removal of a slipped disc is even indicated after a few days due to heavy pain, decrease of sensation, imaging-proven symptomatic slipped discs, and with regard to the individual occupational and private life situation. Please click here to get comprehensive information about when surgery is medically indicated.
Therapy options of slipped disc in cervical spine encompass
- conservative treatment
- microtherapy
- percutaneous nucleotomy (endoscopic)
- microsurgery (with placement of a so-called cage)
- disc prosthesis surgery
The therapy of a slipped disc with microtherapy is comparable with microtherapy of vertebral joints. Under CT navigation, a thin needle is inserted into the osseous vertebral canal. Through this needle we inject swelling reducing and painkilling drugs around the nerve root. Like microtherapy of vertebral joints, microtherapy of a slipped disc has to be repeated two or three times in weekly intervals. The drugs can be applied epidurally in severe cases. This means that they are injected into the spinal canal right before the dural sack.
The percutaneous nucleotomy is a good alternative for treating a slipped disc in cervical spine if complaints cannot be cured due to rest, pain killers and physiotherapy; if the herniation is circumscribed and not too big; if there are no osseous stenoses. Percutaneous nucleotomy is a very gentle and at the same time efficient method. During this operation for the removal of a slipped disc, small tubes with increasing diameter are navigated to the disc. Disc herniations are visualized with the help of specific devices and removed by means of minute instruments, resulting in a decompression of the nerve. In special cases, the core of the disc (nucleus pulposus) is shrinked with the aid of a specific enzyme to reduce the volume and to decrease the intradiscal pressure for the purpose of recovery. Cick here to read more about percutaneous nucleotomy.
The safety and effectiveness of the microurgical removal of a disc herniation is similar to those of endoscopic surgery. But instead of using and endoscope, a special operation microscope is employed and a small skin cut is necessary. By means of the microscope, our phyiscians are able to operate very precisely. The damaged disc is removed from the anterior side of the neck. If there are osseous stenoses of the spinal or the nerve root canal, they can be eliminated this way. The substitute for a disc is a stable implant, the so-called cage. Read mor about microsurgery by clicking here.
In some cases of a slipped disc, a disc is replaced by a synthetic disc during disc prosthesis surgery / artificial disc replacement (ADR) surgery. The artificial disc preserves the spinal flexibility despite the removal of the natural disc. Click here to learn more about disc prosthesis / ADR surgery.