Cervical Disc Herniation
A cervical disc herniation can be a cause of pain that radiates down the arm, sometimes accompanied by numbness and tingling down into the fingertips, and sometimes muscle weakness as well. It usually develops in men and women between 30 and 50 years old. This is one of the most common cervical spine conditions treated by spine specialists. The herniated disc may occur from an injury or trauma to the spine, but it most commonly is a spontaneous development.
The arm pain occurs as a result of a disc in the cervical spine (the neck) pinching or pressing on a nerve, which causes pain to radiate down that nerve. Most cervical disc herniations extrude out to the side of the spinal canal and pinch the exiting nerve root at the next lower level of the spine.
Symptoms: cervical disc herniation
Depending on which part of the cervical spine is affected, any of the following may be symptoms of a cervical disc herniation:
- Weakness in the deltoid muscle in the upper arm
- Weakness in the biceps (muscles in the front of the upper arms) and wrist extensor muscles
- Weakness in the triceps (muscles in the back of the upper arm and extending to the forearm) and the finger extensor muscles
- Weakness with handgrip
- Numbness and tingling along with pain can radiate to the thumb side of the hand, down the triceps into the middle finger, or down the arm to the little finger side of the hand
- Shoulder pain
This list covers some of the typical symptoms, but others may also occur. It is possible to have a cervical disc herniation with symptoms completely different from these.
Discs in the cervical spine are usually not very large. However, even a small disc herniation can pinch the nerve and cause pain. The pain is usually greatest when the nerve is first pinched.
Since the symptoms vary widely, often, the best way to correctly diagnose a cervical disc herniation is with a diagnostic imaging test such as the following:
- The best test to use is an MRI (Magnetic Resonance Imaging) scan. An MRI scan can usually see any nerve root pinching caused by a herniated cervical disc.
CT Scan with Myelogram
- A CT (computed tomography) scan with myelogram may also be ordered, because it is more sensitive than the MRI and can see subtle pinching that might be hard to see on an MRI. This test is not usually the first one ordered because an injection is required to place an imaging dye into the patient. Therefore, it is best to try an MRI first in order to see if that will be enough. CT scans without myelogram will not do much good for diagnosing this condition so are not used.
- Occasionally, an EMG (Electromyography) may also be used. This is an electrical test that stimulates specific nerves to see if certain muscles may have been affected from a pinched nerve, which could indicate cervical disc herniation.
The pain from a cervical herniated disc can usually be controlled with medication, and conservative (non-surgical) treatments alone are often enough to resolve the condition.
Treatment is designed to resolve the pain initially, and the weakness, numbness and tingling will go away over time. Once the pain starts to improve it doesn’t usually return. It may be a little while before the other symptoms go away, but if the pain is under control there is no reason to move to a more aggressive (surgical) treatment, as there is no evidence that surgery helps the nerve root heal any faster. However, for patients with profound weakness due to a disc herniation, it may be reasonable to consider surgery earlier to give the nerve the best healing position (e.g. to relieve the pinching).
Generally, treatment will begin very simply with rest and medication. Anti-inflammatory medications such as ibuprofen (e.g. Advil, Nuprin or Motrin) or COX-2 inhibitors (e.g. Bextra or Celebrex) can help reduce the inflammation of the disc material, which will help reduce the amount of pain. If pain is severe, or continues for more than two weeks, stronger medication such as oral steroids may be considered.
While the medications diminish the amount of pain, if the condition doesn’t resolve on its own, there are several options that can be considered:
- Physical therapy for exercises to help relieve the pressure on the nerve root.
- Chiropracticor osteopathic treatments for gentle, low velocity manual manipulation to help relieve the pressure on the nerve root. However caution should be used with manipulation if the patient is experiencing any neurological problems.
- Manual traction to help open up the cervical foramen where the nerve root exits the spinal canal. If this therapy helps relieve the pain, a home traction unit can be prescribed. Traction should be initiated under a physical therapist’s supervision.
- Epidural injections may be considered if the pain doesn’t get better with medication and physical treatments. Epidural injections effectively relieve pain approximately 50% of the time, and if they do work they may be repeated every two weeks up to a total of three times within one year.
Surgical treatments: cervical disc herniation
Most episodes of pain from cervical disc herniation will be taken care of with 6 to 12 weeks of conservative treatment. However, if it doesn’t get better in that time or if the pain is very severe, surgery may be considered. The success rate for using surgery to relieve arm pain from a cervical disc herniation is about 95 to 98%. Risk of complication is low with an experienced spine surgeon.
The disc may be removed from the back of the neck (posterior approach) or from the front (anterior approach). Generally, surgeons prefer the anterior approach for most cervical disc herniations.
- Anterior approach-This approach may be favored if there is any disc space collapse, as the approach allows the surgeon to open up the disc space and place a bone graft to keep it open. This procedure opens up the foramen, which gives the exiting nerve root more room.
- Posterior approach-This approach may be favored for a large soft disc that is lateral (to the side of) the canal. This approach is technically more difficult than the anterior approach, and also requires more manipulation to the spinal cord.
Both surgeries can usually be done with an overnight stay in the hospital.