Cervical Herniated Disc
A cervical herniated disc is diagnosed when the inner core of a disc in the neck herniates, or leaks out of the disc, and presses on an adjacent nerve root. It usually develops in the 30-to-50-year-old age group. While a cervical herniated disc may originate from some sort of trauma or neck injury, the symptoms commonly start spontaneously.
The arm pain from a cervical herniated disc results because the herniated disc material “pinches” or presses on a cervical nerve, causing pain to radiate along the nerve pathway down the arm. Along with the arm pain, numbness and tingling can be present down the arm and into the fingertips. Muscle weakness may also be present.
The discs in the cervical spine are not very large; however, there is also not a lot of space available for the nerves. This means that even a small cervical disc herniation may impinge on the nerve and cause significant pain. The arm pain is usually most severe as the nerve first becomes pinched.
Symptoms of a Cervical Herniated Disc
A herniated disc in the neck can cause a variety of symptoms in the neck, arm, hand, and fingers, as well as parts of the shoulder. The pain patterns and neurological deficits are largely determined by the location of the herniated disc.
The cervical spine is constructed around the vertebrae, or the 7 stacked bony building blocks in the spine. They are numbered top to bottom C1 through C7. The nerve that is affected by the cervical disc herniation is the one exiting the spine at that level, so at the C5-C6 level it is the C6 nerve root that is affected.
- C4-C5 (C5 nerve root): A herniation at this level can cause shoulder pain and weakness in the deltoid muscle at the top of the upper arm, and does not usually cause numbness or tingling.
- C5-C6 (C6 nerve root): A C5-C6 disc herniation can cause weakness in the biceps (muscles in the front of the upper arms) and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand. This is one of the most common levels for a cervical disc herniation to occur.
- C6-C7 (C7 nerve root): A herniated disc in this area can cause weakness in the triceps (muscles in the back of the upper arm and extending to the forearm) and the finger extensor muscles. Numbness and tingling along with pain can radiate down the triceps and into the middle finger. This level is also one of the most common areas for a cervical disc herniation.
- C7-T1 (C8 nerve root): This level is located at the very bottom of the neck, where the cervical spine meets the thoracic, or upper, back. A herniation here can cause weakness with handgrip, along with numbness and tingling and pain that radiates down the arm to the little finger side of hand.
These are typical pain patterns associated with a cervical disc herniation, but they are not absolute. Some people are simply wired up differently than others, and therefore their arm pain and other symptoms will be different.
Surgical Treatment Options
Most episodes of arm pain due to a cervical herniated disc will resolve over a period of weeks to a couple of months. However, if the pain lasts longer than 6 to 12 weeks, or if the pain and disability are severe, spine surgery may be a reasonable option.
Spine surgery for a cervical herniated disc is generally reliable. The success rate is about 95 to 98% in terms of providing relief of arm pain.
With an experienced spine surgeon, the surgery should carry a low risk of failure or complication, and can be done with a minimal amount of postoperative pain and morbidity (unwanted aftereffects).
The surgery for a cervical herniated disc can be done a number of different ways:
- Anterior cervical discectomy and spine fusion (ACDF). This is the most common method among spine surgeons for most cervical herniated discs. In this surgery, the disc is removed through a small one-inch incision in the front of the neck. After removing the disc, the disc space itself is fused. A plate can be added in front of the graft for added stability and possibly a better fusion rate.
- Posterior cervical discectomy. This is similar to a posterior (from the back) lumbar discectomy, and for discs that occur laterally out in the neural foramen (the “tunnel” that the nerve travels through to exit the spinal canal) it may be a reasonable approach. However, it is technically more difficult than an anterior approach because there are a lot of veins in this area that can result in a lot of bleeding, and the bleeding limits visualization during the surgery. This approach also necessitates more manipulation to the spinal cord.
- Cervical artificial disc replacement. Like an ACDF, an artificial disc surgery involves removing the affected disc through a small incision in the front of the neck. However, instead of a fusion in the disc space, an artificial disc is placed in the disc space. The goal of the artificial disc is to mimic the form and function of the original disc.
Although any major surgery has possible risks and complications, with an experienced spine surgeon serious complications from cervical disc surgery should be rare. The two most common surgeries, ACDF and artificial disc, are both considered reliable surgeries with favorable outcomes in terms of reducing the patients pain.
**Information above is for educational purposes and is used with permission from https://www.spine-health.com.
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