Cervical Disc Herniation

The spine consists of bones (vertebrae) that are stacked upon one another. Each vertebra is connected to the other by an intervertebral disc. The intervertebral discs help increase the flexibility of the spine and function as shock absorbers. Each individual intervertebral disc consists of a tough outer fibrous layer surrounding a gelatinous inner layer. 

Cervical disc herniation usually occurs when one of the discs in the neck's spinal column becomes damaged and starts to protrude. This can result from factors such as ageing, wear and tear, poor posture, a specific injury, or sudden trauma. As we age, our intervertebral discs become stiffer and are more at risk of rupturing.

A cervical disc herniation, or slipped disc in the neck, can describe a tear of the outer fibrous layer of the intervertebral disc, with or without protrusion of some of the inner jelly-like layer. In a cervical disc herniation, a tear of the outer fibrous layer can cause significant pain that is usually localised to the neck. 

If there is also bulging of the inner gelatinous layer that irritates or compresses one of the nerves around the spine, this can result in significant pain, numbness, weakness or tingling that extends into one or both arms.

Symptoms of cervical disc herniation

When it comes to cervical disc herniation, the symptoms can be quite noticeable. People often experience:

• Neck pain: this might radiate down into the shoulders, arms, or even the hands.
• Numbness or tingling sensations: this can occur in the shoulders, arms or hands. 
• Weakness in the arm muscles: you might experience difficulty with coordination or gripping objects
• Pain that worsens when sneezing or coughing: you might notice a sudden pain when the neck jolts with sneezing, coughing or laughing. 

If you're facing any of these issues, it's a good idea to reach out to a medical professional. They can guide you on the best steps to take for relief.

In most instances, the pain from a disc herniation gets better on its own and does not require any treatment. 9 out of 10 people with a disc herniation will improve within six weeks.

Very occasionally, if a disc herniation is very large or in certain locations, it can cause compression of the spinal cord or certain important nerves. This can cause the pain to persist for longer periods. In these rare instances, more urgent investigation and treatment may be required.

If the pain continues, this can be managed with painkillers. If the pain persists beyond the six-week timeframe or if it's causing significant disruption to your daily life, it's important to consult a healthcare professional.

Treatment options for a cervical herniated disc

There are various treatments available for cervical disc herniation. Here are a few options:

• Conservative measures: rest in moderation, avoiding activities that worsen the pain, and using over-the-counter pain relievers or anti-inflammatory medications can help manage symptoms. Physical therapy can also be beneficial, focusing on exercises to strengthen neck and shoulder muscles, improve posture, and increase flexibility.

• Medications: your healthcare provider might prescribe stronger pain medications or muscle relaxants to help alleviate discomfort. In some cases, steroid injections directly into the affected area can provide relief by reducing inflammation.

• Surgery: if conservative methods don't provide relief and the pain is severe or worsening, surgery might be considered. Procedures like discectomy (removal of the herniated disc material) or cervical fusion (joining two vertebrae together) might be recommended.

• Chiropractic care: some individuals find relief through chiropractic adjustments, which involve manual manipulation of the spine to help alleviate pressure on the affected nerve.

• Acupuncture: this alternative therapy involves inserting thin needles into specific points on the body to help manage pain and promote healing. Some people find it helpful for cervical disc herniation pain.

• Lifestyle changes: maintaining good posture, practising gentle neck stretches, and avoiding activities that strain the neck can aid in managing symptoms and preventing further issues.

Remember, the most suitable treatment depends on the severity of your condition, your overall health, and your preferences. Consulting a healthcare professional is crucial for getting an accurate diagnosis and personalised treatment recommendations.

If you develop severe neck pain following an injury, you should seek urgent medical attention. If your symptoms have any of the following associated features, you should seek urgent medical attention;

• Numbness or weakness that extends down both arms or both legs.
• Numbness around your genitals or bottom.
• Loss of control of your bowels or bladder.
• Fevers or feeling generally unwell.

If you do not have any of the above features, you should see your doctor if your symptoms have failed to improve after six weeks or if they are associated with swelling, pain worse at night or recent unintentional weight loss.

The doctor will ask you about your symptoms and examine you. In the absence of any concerning features, you may be given advice regarding exercises to help relieve your symptoms in addition to simple pain medications. You may be referred to a physiotherapist in the first instance, depending upon the local services available. On occasions, depending upon your symptoms and your examination, you may be sent for further investigations which can include blood tests, X-Ray or MRI scans. If you have any concerning symptoms or features on examination, your doctor may send you to the hospital for further investigation and treatment.

9 out of 10 people with a disc herniation will get better without requiring treatment. If your symptoms do not improve you may be referred to a spinal surgeon. Further treatments available for disc herniation include injections to relieve your pain or surgery to assess the prolapsed disc.

Do I need surgery for a cervical herniated disc?

Surgery is generally considered when conservative treatments haven't provided sufficient relief or when neurological symptoms are severe and worsening. Let's break it down:

When surgery may be required

• Persistent and severe symptoms: if your pain, numbness, weakness, or other symptoms are persistent and seriously impacting your quality of life despite trying conservative treatments, surgery might be considered.

• Progressive neurological deficits: if you're experiencing progressive neurological deficits such as muscle weakness, loss of coordination, or changes in bladder or bowel function, surgery might be necessary to prevent further damage.

• Unbearable pain: if your pain is intense and unmanageable, hindering your ability to perform everyday activities, surgery could be an option to relieve your suffering.

• Failed conservative treatment: when several months of conservative treatments like rest, physical therapy, and medications have not led to significant improvement, surgery might be recommended.

When surgery might not be required

• Mild symptoms: if your symptoms are relatively mild and manageable with conservative treatments, surgery might not be immediately necessary. Many people find relief through non-surgical methods.

• Improvement with conservative measures: if you're noticing gradual improvement with conservative treatments, surgery might not be needed. It's common for symptoms to get better over time with proper care.

• No neurological deficits: if you're not experiencing any neurological deficits such as weakness or loss of function, your doctor might suggest continuing with non-surgical approaches.

• Patient preference: ultimately, the decision to undergo surgery is a personal one. If your symptoms are not severe, and you prefer to exhaust non-surgical options first, your healthcare provider can work with you to develop a suitable treatment plan.

Remember, the decision to undergo surgery should be made in consultation with a qualified healthcare professional. They can thoroughly assess your condition, discuss the pros and cons of surgical intervention, and help you make an informed choice that aligns with your health goals and preferences.