Discs are round flat tire (or tyre) like bands that cushion the vertebrae which form the spinal cord. They act as shock absorbers and keep the spine flexible.
Herniated disk is also known as slipped disc, bulging disc, usually caused by wear and tear of the disc and also may result from some sort of trauma or injury to the spine. It can occur in any part of the spine, but they are most common in the neck (cervical) and lower back (lumbar) spine. Herniated disc may place pressure on nearby nerves or the spinal cord and result in pain, numbness or weakness in an arm neck, shoulder or leg.
The outer band of the disc breaks or cracks causing herniation. This leads to leakage of a gel like substance from inside the disc, thereby placing pressure on the spinal cord or the nerve roots. The surrounding nerves may also get inflamed due to the release of a chemical by the nucleus. Slipped disc or herniation is one and the same thing.
As one get older, the spinal disks lose some of their water content. That makes them less flexible and more prone to tearing or rupturing with even a minor strain or twist.
Stages of Cervical Herniated Disc:
- Disc Degeneration: With age the intervertebral discs weaken due to chemical changes. As part of the aging process, and it can cause the disc to dry out, making it less able to absorb the shock from the movements. Disc can also become thinner in this stage.
- Prolapse: A bulging or a protruding disc is known as a prolapsed disc. This happens when the position of the disc changes causing impingement into the spinal canal or spinal nerves.
- Extrusion: In this situation the inner part of the intervertebral disc called nucleus pulposus breaks the annulus fibrosus (tire like wall) but remains confined to the disc.
- Sequestration or Sequestered Disc: The nucleus pulposus breaks through the annulus fibrosus and can move outside the interverterbral disc and into the spinal canal.
- Numbness or tingling in the shoulder or arm.
- Pain that radiates down the arm to the hand or fingers.
- Impair ability to lift or hold items.
- Intense pain in the buttocks, thigh, calf, shoulder and arm
- Difficulty in standing or walking.
- Electromyography (EMG): To determine the exact nerve root that is involved.
- Myelogram: To determine the size and location of disk herniation.
- Physical Examination
- CT scan, MRI
- Spine X-Rays
Non Surgical Procedure:
- Physical therapy & Exercise: can be used to decrease the pain and increase flexibility. Therapy includes ice and heat therapy, gentle massage, stretching and neck traction.
- Cervical traction: Traction on the head can help reduce pressure over the nerve root.
- Bracing: In some instances a cervical collar or brace may be recommended to help provide some rest for the cervical spine.
- Anterior cervical discectomy and spine fusion: Nerve pressure is relieved by partial disc removal which is done through a small one inch incision. The incision is done in the front of the neck (hence Anterior). Removal of the disc results in space which is fused. To aid fusion and add stability a plate can be added in front of the graft.
- Leminectomy: It is performed on the cervical, thoracic or lumbar portion of the spine.
An incision is made in the back over the spinal column in the affected area. The size of incision depends on the type of procedure and the number of vertebrae affected. The broken pieces or the entire disc is removed and replaced it with prosthetic components. This procedure is done from back of the neck.
Now a days with technological advances – most procedure are done using minimally invasive techniques. This means smaller incisions and lesser recovery time. They use specialized instruments and devices thereby increasing success rate and reducing risk of failure and complications.
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