A common cause of neck, shoulder and arm pain is a herniated or ruptured
disc. Symptoms may include dull or sharp pain in the neck or between the
shoulder blades, pain that radiates down the arm to the hand or fingers, or
numbness or tingling in the shoulder or arm. Certain positions or
movements of the neck can intensify the pain.
The symptoms of a cervical herniated disc often resemble other disorders such as
carpal tunnel syndrome, problems with the rotator cuff and gout. In some
patients, cervical disc herniations can cause spinal cord compression where
disc material pushes on the spinal cord. This is a much more serious
condition and may require a more aggressive treatment plan. Spinal cord
compression symptoms include awkward or stumbling gait, difficulty with fine
motor skills in the hands and arms, and tingling or “shock” type feelings down
the torso or into the legs.
Anatomy – Normal Cervical Disc
In between each of the vertebrae (bones) in the spine is a disc, a tough fibrous
shock-absorbing pad. Endplates line the ends of each vertebra and help
hold individual discs in place. Each disc contains a tire-like outer band
(called the annulus fibrosus) that encases a gel-like substance (called the
nucleus pulposus).Nerve roots exit the spinal canal through small passageways
between the vertebrae and discs. Pain and other symptoms can develop when
the damaged disc pushes into the spinal canal or nerve roots.
Disc herniation occurs when the annulus fibrosus breaks open or cracks, allowing
the nucleus pulposus to escape. This is called a Herniated Nucleus
Pulposus (HNP) or herniated disc.
Progressive Steps Toward Herniation
Many factors increase the risk for disc herniation: (1) lifestyle choices such
as tobacco use, lack of regular exercise, and inadequate nutrition
substantially contribute to poor disc health. (2) As the body ages,
natural biochemical changes cause discs to gradually dry out affecting disc
strength and resiliency. (3) Poor posture combined with the habitual use
of incorrect body mechanics can place additional stress on the cervical spine.
Combine these factors with the effects from daily wear and tear, injury,
incorrect lifting, or twisting and it is easy to understand why a disc may
herniate. A herniation may develop suddenly or gradually over weeks or
months.
The four stages to a herniated disc include:
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Disc Degeneration: chemical changes associated with aging causes discs to
weaken, but without a herniation.
-
Prolapse: the form or position of the disc changes with some slight
impingement into the spinal canal. Also called a bulge or protrusion.
-
Extrusion: the gel-like nucleus pulposus breaks through the tire-like
wall (annulus fibrosus) but remains within the disc.
-
Sequestration or Sequestered Disc: the nucleus pulposus breaks through
the annulus fibrosus and lies outside the disc in the spinal canal (HNP).
Locating the Cause of Pain
Interestingly, not every herniated disc causes symptoms. Some people
discover they have a bulging or herniated disc after an x-ray for an unrelated
reason.
Most of the time the symptoms prompt the patient to seek medical care. The
visit with the doctor usually includes a physical and neurological exam; review
of medical history, symptom evaluation and the history of treatments and
medication the patient has tried.
An x-ray may be needed to rule out other causes of back pain such as
osteoarthritis. A CT or MRI scan verifies the extent and location of disc
damage. Sometimes a myelogram is necessary.
Treatment – Non-Surgical
Most patients do not need surgery! Initially, Dr. Cady may recommend cold
therapy. During the first 24 to 48 hours cold therapy helps to reduce
swelling, muscle spasm and pain by reducing blood flow. After the first
48 hours, heat therapy can be applied. Heat increases blood flow to warm
and relax soft tissues. Increased blood flow helps to flush away
irritating toxins that may accumulate in tissues as a result of muscle spasm
and disc injury. Never apply ice or heat directly to skin; instead, wrap
the cold or heat source in a thick towel for no longer than 15-20 minutes.
Medications may include an anti-inflammatory to reduce swelling, a muscle
relaxant to calm spasm, and a pain-killer (narcotic) to alleviate intense but
short-lived pain (acute pain). Mild to moderate pain may be treated with
non-steroidal anti-inflammatory drugs (NSAIDs). These work by relieving
both swelling and pain. Discuss NSAID use with your medical physician
first.
Dr. Cady may also recommend physical therapy. Physical therapy
includes a combination of non-surgical treatments to decrease pain and increase
flexibility. Ice, ultrasound, gentle massage, stretching, and neck
traction are some examples.
In four to six weeks, the majority of patients find their symptoms are relieved
without surgery! Be optimistic about your treatment plan and remember
that less than 5% of back problems require surgery!
Treatment – Surgical
Surgery is considered if non-surgical treatment does not relieve symptoms or if
spinal cord compression is suspected. If surgery is recommended, always
ask the purpose of the operation and what results you can expect. Never
be afraid to obtain a second opinion.
To relieve nerve pressure and neck pain, surgery usually involves a partial disc
removal or discectomy. This surgery is usually done from the front of the
neck (called an anterior discectomy). In addition, the surgeon may need
to access the herniated disc by removing a portion of the bone covering the
nerve. This procedure is called a laminotomy and is usually done from the
back of the neck (posterior laminotomy). Fortunately, these procedures
can often be done utilizing minimally invasive techniques. Minimally
invasive surgery does not require large incisions, but instead uses smaller
cuts and tiny specialized instruments and devices such as a microscope and
endoscope during the operation.
Prevention
Aging is inevitable, but lifestyle changes can help prevent cervical disc
disease. Risk factors include poor posture and body mechanics, weak neck
muscles, smoking and obesity. Start now to adopt habits that will help
preserve your spine for the future.