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Sunday, November 3, 2013

Patient Information on Cervical (Neck) Disc Herniations - Part I

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1.      Cervical Disc Herniaton (Herniated Disc in the Neck)
 
 a. What is a Cervical Disc Herniation?

Disc herniations are also called “slipped discs” or “ruptured discs”. When a patient has a disc herniation, the outer ring of the disc (annulus fibrosus) ruptures and allows some of the softer inner core material (nucleus pulposus) to escape. An analogy would be a tube of toothpaste which was stepped on where the cap comes off and some of the toothpaste leaks out.

b. What is the difference between a Disc Bulge, a Disc Protrusion, a Disc Herniation and a Disc Fragment?

It is often thought that any change in the disc beyond a normal and healthy appearance is a disc herniation. In reality there are several different changes in the shape of the disc which can occur, each with their own name and description.
                                                                  
                                                                             

This illustration shows a Normal Disc of the neck (cervical spine) as a slice cut across. The back of the spine is at the top, the front at the bottom. The Spinal Cord is shown in yellow in the center of the spine. The spinal nerves can be seen leaving the spinal cord through a nerve channel. The inner core of the disc is seen in dark red, while the outer shell is shown in orange.
                                                                       



 
 

1. Disc Bulge
                                                                             

This illustration shows a bulging disc. The arrows indicate the direction of the bulge. The disc has changed shape in the direction of the arrows.

A “disc bulge” is a change in the shape of the disc where the outer shell (annulus fibrosus) is weakened and allows a change in the shape to happen. The outer shell of the disc is only weakened to the point where it allows the pressure from the inner core to change its shape, but will not allow material to actually push all the way through and herniate. To qualify as a “bulged disc”, the change in the disc or bulging has to consist of more than 50% of the circumference of the disc when looking at it from the top down (cross-section). An analogy would be a hamburger which is too big for its bun and bulges over the sides of the bun. Disc bulges are often part of the normal aging process of the spine and may not be part of a specific spine disease.

2. Disc Protrusion
                                                                                  

 
This is an illustration of a cross section (cut across the spine) of the spine. A portion of the core of the disc is seen protruding outward against the outer shell which has thinned and weakened.

A “disc protrusion” is a change in the shape of the disc where the outer shell is weak in a smaller, more confined area. This weakness is more profound than that seen in a “disc bulge” and allows that part of the disc to push out significantly more. In a “disc protrusion”, some of the core material (nucleus) will push very hard against the weakened area and its material will be part of the protrusion, but it does not leak out through the outer shell (annulus) of the disc. The outer shell, though weakened is still intact.
3. Disc Herniation
                                                               

This is an illustration of a cross section (cut across the spine) of the spine. A portion of the inner core of the disc is seen breaking through the outer shell. This is called a herniation. The herniated disc material is irritating the spinal nerve which can cause arm pain, numbness and weakness.


A “disc herniation” goes beyond what happens in a “disc bulge” or a “disc protrusion”. To qualify as a true herniation, core material (nucleus pulposus) of the disc must have escaped from the main part of the core. Sometimes, a small amount of the disc’s outer shell (annulus fibrosus) still remains, coating this material, while at other times the core material is completely outside the outer shell.

c. Who is most likely to get a Cervical Disc Herniation?

A true disc herniation is most common in younger adults aged 35-45, but can occur at any age. The rarest cases occur in children. Studies have found that cervical disc herniations are present in 5% of the population under the age of 40 who have no symptoms. Over the age of 40 this number doubles to 10%. This shows that only a small percentage of the public actually has symptoms from a disc herniation. It is not known why only some patients get symptoms while many do not.

d. Which discs in the neck are most likely to herniate?

The most common spinal levels for discs to herniate are at the C5/6 and C6/7 disc levels in the neck.

e. Which part of the disc is most likely to herniate?


This illustration is a cross-section of a vertebra (slice cut across the spine). The front of the spine is at the top, the back at the bottom. A piece of the core of the disc (nucleus) shown in blue can be seen pushing through the outer shell (annulus) shown in blue. This disc herniation (red) can be seen pushing on a spinal nerve which is getting inflamed (red).


The most common area for a herniation is on the sides of the back of the disc (posterior-lateral), where the disc’s outer shell (annulus fibrosus) is thinnest. Next to this part of the disc we have a spinal nerve on each side. When a disc herniates in this location, a spinal nerve can be affected. Depending on how much disc material herniates, a spinal nerve can either be irritated and inflamed or actually compressed.


f. Why do disc herniations happen?

Disc herniations happen for a variety of reasons. A common situation is a whiplash injury from a car accident or sports accident. In other patients it is the final result of many small injuries which happen over time.
Disc herniations can also have a genetic component, i.e. can run in families. Sometimes one of the genes in charge of making a certain disc protein can be defective, leaving the disc weakened from birth.
In all of these situation, the outer shell of the disc (annulus fibrosus) weakens and allows    the softer core of the disc (nucleus pulposus) to push through. After the core material pushes through it can cause pressure or irritation of the spinal cord or spinal nerves which are located just outside the disc.

g. What symptoms do patients with disc herniations have?

The pain from a disc herniation can be felt in different ways, depending on where the disc herniated and how much material herniated.
Pain can be felt from the neck or shoulder down the arm and even into the hand.
Sometimes patients feel numbness or tingling as well. In cases of severe compression of the spinal nerves, true weakness in an arm or even the legs can be felt.
In other patients, the herniation does not affect the nerve itself, but inflames the outer shell (Annulus Fibrosus) of the disc or some of the structures next to it. This may result primarily in neck pain, which is often sharp, deep pain which radiates up and down the spine. This pain is often felt in the back of the neck, between the shoulder blades and can travel to the shoulders and head. Spasms of the back muscles are very common in this situation.
Unlike other pain syndromes where the pain may vary during the day, pain from disc herniation is often very steady and annoying.
Here again are some of the common symptoms of cervical disc herniations:


1.       Neck pain radiating into the arm or hand

2.       Numbness and tingling in the arm or hand

3.       Weakness in the arm or hand
4.       Neck stiffness
5.       Pain with neck movement
6.       Pain between the shoulder blades
7.       Pain and spasm in the neck muscles


In our next Blog we will present some of the treatments for Cervical Disc Herniations!

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