"A Pinched Nerve in the Neck"
What is it?
In between the vertebrae of the neck are cervical discs. The cervical disc serves to cushion the weight of the head while allowing the vertebrae to move. When a piece of the disc escapes through a tear in its thick containment ligaments called the annulus, this is called a cervical disc herniation. Herniations occur into the spinal canal and can compress the spinal nerves or even the spinal cord.
Most often, patients do not remember a specific event or injury that caused their disc herniation. It most often seems to start without any apparent reason. Occasionally, an automobile accident, work injury, or sports injury is the cause. The thick containment structure for the disc, the annulus, becomes thin starting around age 30 - 40. This leads to disc bulging and herniation. The annulus can also be torn from an injury. When the annulus tears, the disc material is no longer contained and can extrude or herniate through the tear in the annulus and enter the spinal canal.
Signs and Symptoms
The most common symptom of a disc herniation is pain that radiates across the shoulder and into the arm, through the forearm and often into the hand. The area of arm pain depends on which disc in the neck is herniated. A herniated disc may also cause pain across to the shoulder only and not down the arm. It may cause pain only into certain fingers. Numbness over parts of the arm or hand is common. Weakness in muscle groups associated with the nerve is also not uncommon. An injured cervical disc can also cause referred pain around the shoulder blade or scapula. Headaches and neck pain are also common. If the disc herniation is large enough to compress the spinal cord, numbness, tingling or weakness in the legs might develop.
Nonoperative Treatment Options
Most cervical disc herniations that cause radiating arm pain will improve over the first six to eight weeks after symptoms occur. The majority of patients who have arm pain will notice that the pain slowly improves over this two month time frame and numbness and weakness may also improve. The initial treatment approach should include anti-inflammatory medications such as aspirin, Advil or Aleve. Physical therapy including general traction can also play a roll and provide some relief. In some cases, epidural steroid injections may be appropriate. It is very important that patients with a cervical disc herniation not have passive manipulation of the cervical spine such as chiropractic treatments. Such forceful movement on the cervical spine can cause more of the disc to herniate, increasing the arm pain, numbness, weakness, with potentially catastrophic results. Such manipulation of the neck should be avoided completely.
If radiating arm pain, numbness, tingling or weakness persists beyond six to eight weeks, surgery may be indicated. Surgery is also indicated if profound weakness exists, if there is progressive numbness or weakness, or if symptoms in the legs develop. If none of these are present, the decision to proceed with surgery is made on the basis of the patients desire to obtain relief from the radiating arm pain. Surgery for a cervical disc herniation is not recommended for patients who only have neck pain.
The procedure to remove the disc from the neck is very commonly performed in the United States with excellent results. A 1 1/2 inch incision is made in the left front of the neck. The trachea and esophagus are retracted toward the patient's right while the pulse and neck vessels are retracted leftward. The cervical spine is very close and accessible in the front part of the neck. The cervical disc is then removed and in its place, a piece of bone graft from the bone bank is positioned to maintain the height of the vertebrae and prevent neck pain from developing after the surgery. Often, a titanium plate is placed across the disc to make it more stable. Surgery takes 1 to 1 1/2 hours and the patient awakens with a cervical collar in place. The collar is worn for six weeks while the bone heals. Following this, the collar is removed and the patient can resume most activities.
The results from cervical diskectomy have shown approximately a 95% chance at good or excellent relief from the radiating arm pain. Numbness generally improves. Weakness in the effected arm may require some physical therapy to fully recover. Improvement and strength in the arm is expected over time. After three to four months from surgery, the patient can resume full-unrestricted activities. About 7% of neck motion is lost when a disc is removed. Most people do not notice a difference in their neck motion after surgery.
The complications from this surgery are very rare. The most common of these is the failure of the bone fusion. This happens in 5 to 8% of patients. When it occurs, half of the patients have no symptoms from it and nothing further is required. For the patients who do develop neck pain as a result of the failure of fusion, additional surgery may be required to obtain a solid fusion of the disc and alleviate the neck pain. The risk of paralysis with this surgery is one in several thousand. Infection rate is less than one in a hundred. Other complications are even more rare.
The long-term outlook for patients who have undergone cervical disc herniation is excellent. Patients are able to resume full activity, in some cases even including full contact sports. For patients who have several herniated discs removed, collision sports such as football should be avoided. Even for those patients involved with heavy labor jobs such as construction, the expectation is that these patients will be returned to work without restriction.