The cervical discs are small cushions between the bones in the neck. The discs absorb the shock of trauma to the neck in addition to assisting the neck with movements. There are only 6 discs in the neck. There are no discs between the base of the skull and the first vertebrae or between the 1st and 2nd vertebrae.
Discs are composed of an outer strong layer and an inner gelatinous material. It is this jelly-like material that can herniate or protrude through the outer layer of the disc to cause a pinched nerve. Chemical irritation from the injured tissue may cause nerve pain.
Our age works against us in regard to discs. As we get older, the dehydration of the disc contributes to loss of flexibility and shock absorbing qualities. Disc herniations in the neck are most common between 30-50 years of age. Authors have reported on MRI studies, between 40-70% of disc herniations in adults over age 40 years of age are asymptomatic. Degenerative disc disease is a normal process that occurs as we age. It happens in spite of everything we do to control the process. However, there are actions that can accelerate this process. These may include:
- Trauma – injury to the muscles, tendons, ligaments and the disc
- Poor posture – including driving and working at the computer
- Disruption of blood supply – atherosclerosis or hardening of the arteries
- Mechanical onset – from occupational, recreational and repetitive activities of daily living
Degenerative Disc Disease
Degenerative disc disease can be a slow process that quietly progresses for years. It’s very likely produced from our normal day-to-day activities. One of the most common signs and symptoms include intermittent neck stiffness. As this condition progresses, other more significant and limiting symptoms may occur to include:
- Nearly constant neck stiffness
- Numbness into the arm, hand or fingers
- Tingling sensation into the arm, hand or fingers
- Weakness in the neck, shoulders and arms
- Fine motor skills and gait abnormalities may be present if it becomes severe
Disc Herniation or Rupture
The disc is susceptible to herniation from trauma to the neck. Herniation can also occur gradually (termed spontaneously) over time due to the degenerative changes to the outer disc. This weakens the disc fibers and the protrusion can occur during the course of normal activities of daily living.
The description of the disc herniation is confusing as it’s often called a rupture, protrusion, disc bulge, slipped disc or herniation. Each condition has a different meaning. For instance:
- Disc Rupture or Herniation – The disc material protrudes from the disc and compromises the nerve root or the spinal cord.
- Disc Bulge – The jelly-like material has not extruded through the outer fibers of the disc, but the fibers are weak and the disc is bulging like a bump on the side of a car tire. This can be a broad based bulge that includes over 50% of the back of the disc or a focal bulge that usually encompasses about 25% of the back of the disc.
- Disc Fragment – This is a free piece of the disc that has broken off and can move along the nerve root or adjacent to the spinal cord. It can be a real nemesis as it can act like an acute disc injury today and then move or migrate slightly from the nerve and no longer be symptomatic.
- Slipped Disc – This is a garbage “catch all” term. It’s best not to use this term when describing the condition.
Disc Herniation Signs and Symptoms
When the herniation, bulge or fragment presses on the nerve, the following symptoms may be present:
- Neck, shoulder and arm pain
- Numbness that follows a specific course or predictable pattern in the arm, hand and fingers. This helps the doctor determine which nerve root is causing the symptoms.
- Tingling or a “buzzing” feeling in the arm, hands or fingers
- Loss of strength on hand grasp, arm or shoulder movements
X-rays, CT Scan or MRI
Plain film x-rays of the neck may be the first recommended study to order. This gives the doctor information regarding the mechanics of the neck as well as to be able to rule out obvious bone pathology. The plain film x-rays can visualize the height of the disc as well as some bony encroachment of the openings where the nerves exit the neck. Computed tomography or CAT scans are useful for bone evaluation versus the Magnetic Resonance Imaging or MRI scan. The MRI is more helpful in viewing the soft tissue than plain film x-ray and CT scan are. Depending on the symptoms, history, findings or lack of response to care determines which studies your doctor will order.
Treatment of Cervical Disc Herniation
Conservative management of cervical disc herniation is well documented. Treatment includes but is not limited to the following:
- Cryotherapy – use of ice packs or a topical analgesic such as Biofreeze.
- Isometric and range of motion exercises
- Ultrasound and electrotherapy
- High velocity, low amplitude (HVLA) chiropractic adjustments
- Flexion-distraction adjustment
- Home, work and activities of daily living limitations and restrictions to prevent reoccurrence
Not all cases of cervical disc herniation respond to conservative care. Surgical consultations may be needed. Conservative management is a good first step in the management of cervical disc injury. Co-management may be necessary in some cases as anti-inflammatory medications or injections can be helpful. Surgery may be an option if conservative care does not provide relief.
Doctors at Coon Rapids Chiropractic Office work with imaging centers, neuroradiologists and surgeons in the north suburban area of Minneapolis and St. Paul for the care and treatment of cervical disc herniations.