What is a cervical disc herniation?
It is a disease caused by the deterioration of the intervertebral disc that suffers the wear and tear of years of overload, often in the context of excessive physical workload from work or sports.
It occurs when the disc ruptures and a part of it moves outside the intervertebral space in which it is usually located, cushioning the movements between the vertebrae.
If the displaced fragment is large enough, it can compress some of the nearby nerve roots and produce the pain radiating to the arm characteristic of this disease. If the compression occurs on the spinal cord, the condition is more severe and can cause difficulty walking and problems with manual dexterity or sensitivity.
How is a cervical disc herniation diagnosed?
The suspected diagnosis is made based on the patient’s signs and symptoms; generally, a cervicobrachialgia (cervical pain radiating to the arm) of greater or lesser intensity, sometimes accompanied by tingling in the territory of the compressed nerve root (paresthesias) and less frequently, loss of strength in some muscle group. Spinal cord involvement presents with weakness and loss of sensitivity, and typically, with an increase in some of the reflexes that we can explore.
Magnetic resonance imaging, of which some examples can be seen on the right, is the primary test to confirm the diagnosis, location, and importance.
What is the treatment for a cervical disc herniation?
In the same way, as in lumbar disc herniation, the initial treatment is conservative if the condition is of debut and recent appearance. It is based on relative rest and analgesic and anti-inflammatory drugs. More than 80% of patients will improve with these measures in 8-10 weeks.
Surgery is indicated if, after this time, the symptoms persist, if they are very intense and do not subside despite this pharmacological treatment, or if signs of neurological function failure appear that recommend early release of the nerve root. Also, and earlier, if the signs of neurological dysfunction affect the spinal cord.
Today’s surgical treatment considered standard is removing the herniated intervertebral disc by releasing the compressed root or spinal cord using microsurgical techniques. Access is usually made through the anterior face of the neck in a minimally invasive way, taking advantage of a skin fold and with an incision of about 3 cm. This intervention, known as cervical microdiscectomy, is associated with placing a prosthesis between the vertebrae to maintain stability and separation. The hospital stay is about 48 hours and has excellent results in more than 90% of cases.
