Herniated Disc in Neck

by Dr. David Kramer

Do You Have a Herniated Disc in Your Neck?

Over 85% of patients with cervical disc herniation (herniated disc in neck) see substantial improvement with conservative treatment.  Get a second opinion to ensure you don’t undergo surgery that’s more invasive than you need.

 

A common cause of neck, shoulder and arm pain is a ruptured or herniated cervical disc in the neck.  As common as the condition is, it’s important to keep in mind that it can often be addressed with non-surgical treatment.  And, when surgery is necessary, it can usually be kept to a minimum.

We’ve never met a patient who wants “more” surgery than they need, so keeping things to a minimum is in everyone’s best interest!  This is precisely why we offer second opinions: to ensure you never undergo more surgery than is absolutely necessary for your condition.

Overview

Cervical disc herniation occurs as a result of a tear in the outer layer of the disc (annulus) allowing the gelatinous material (nucleus pulposus) to escape.

cervical herniated discA cervical disc herniated – also known as cervical radiculopathy – can develop when an existing nerve root becomes irritated or compressed as a result of a cervical disc herniation. Most often a herniated disc in your neck develops as a result of progressive degenerative changes of the cervical spine including a loss of disc space height and associated peripheral bulging of the disc itself.

Symptoms of Cervical Disc Herniation

The classic presentation of a cervical disc herniation includes neck and radiating arm pain, though symptoms can include any of the following:

  • Neck pain
  • Radiating shoulder or arm pain that may extend into the hand
  • Tingling or numbness (paresthesia) of the shoulder or arm
  • Muscle weakness in the shoulder or arm

Sometimes the patient describes pain which travels in a specific nerve root pattern, but often the complaint is of diffuse pain which originates in the region of the neck and radiates down the arm and into the hand. A patient may, on occasion, identify the onset of symptoms with an inciting trauma or injury, but more often than not, no specific event is identified.

Non-Surgical Treatment of Herniated Disc

In more than 85% of patients, the symptoms of a herniated disc will improve with conservative treatment.  

On physical exam we look for loss of reflexes, muscle weakness or atrophy, and pain or paresthesia which follows a specific nerve root distribution. There are eight cervical nerve roots. The nerve roots most commonly affected are C5, C6 and C7.  It is the pressure on the spinal cord or the nerve roots which produces pain.

The body has the ability to shrink or resorb a soft disc herniation thereby allowing the secondary inflammation of the compressed nerve root to resolve.

When evaluating neck pain plain, radiographs (x-rays) may be used to assess overall spinal alignment and to guide in initiating conservative care. An MRI may be obtained to confirm the diagnosis of a disc herniation and to help direct more aggressive treatment.

All of these methods help lead your doctor to an effective assessment of your condition and the treatment that may be best for you–either surgical and non-surgical.

In the following section, as we discuss pain management, we’ll also explore non-surgical treatments.

Managing the Pain of a Herniated Disc

First things first: the management of neck pain and cervical radiculopathy should begin with conservative, non-surgical treatment.  These options may include any of the following and should be extensively explored before surgery is considered:

  • Physical therapy
  • Activity modification
  • Pain and anti-inflammatory medications
  • Time

cervical spinePhysical therapy typically emphasizes isometric techniques, increasing range of motion and traction.

Non-steroidal anti-inflammatory medications like ibuprofen and naproxen can often alleviate acute pain and, on occasion, oral steroids (prednisone) may be prescribed for a significant exacerbation of symptoms. Narcotics, when prescribed, are used on a limited basis for pain. Epidural steroid injections and selective nerve root blocks may be used on both a diagnostic and therapeutic basis.

Finally, as simple as it may sound, allowing for the passage of time is also useful.  It allows you and your practitioner to identify the effects of your treatment and provides more opportunity to analyze your condition to ensure you receive the best care.

Herniated Disc Surgery

While no one wants to undergo surgery, the good news is that cervical radiculopathy responds well to a variety of surgical treatments with a greater than 90% success rate.  Once all non-surgical treatment has been exhausted, it may be time to consider this option.

Surgery is often recommended if a patient fails to respond to conservative care on a sustained basis or has a progressive neurologic deficit. A decision must be made whether to approach the disc from the front (anteriorly) or back (posteriorly) of the spine. Options include a posterior cervical foraminotomy, anterior cervical disc excision and fusion, and cervical artificial disc replacement.  The procedure is determined by the location and extent of cervical pathology.

Second Opinions

Given the extensive, alternative surgical treatments and approaches available to treat cervical disc herniation, patients should obtain a second opinion before proceeding with any proposed procedure.  Simply put, it is the most effective way to ensure you receive the right treatment for your specific condition.

If you are considering surgery for cervical disc herniation and want a second opinion,fill out the brief online form found on the right side of this page or call us today toll free at:

855-377-4767

Dr. David Kramer

About Dr. David Kramer

Director of the Western Connecticut Health Network Spine Center since 2005, and with over 16 years in practice as a specialist in complex spinal surgery, Dr. Kramer conducts his spine practice at Connecticut Neck and Back Specialists in Danbury, Connecticut. He has been certified by the American Board of Orthopedic Surgeons since 1998. After earning his bachelors... Read More »