If you feel pain in your neck, which spreads to your shoulders, arms and hands and a tingling or numbness in your hands, you may have a CERVICAL DISCAL HERNIA.
Cervical disc herniation occurs when a fragment of the inner part of the disc (the nucleus pulposus) escapes through a rupture in the outer layer (the fibrous ring). It can occur at any age and is generally related to the degenerative process of the spine, although it can also be caused by trauma. Usually the development of these changes is due to a set of factors such as: poor posture, physical inactivity, repetitive movements, stress and genetic factors.
Since the cervical region is connected to different parts of the body (head, shoulders, chest and lower back), simple everyday tasks can be uncomfortable and painful.
The most frequent symptoms of hernia are muscle spasms, difficulty in neck movements, pain that starts at the nape and radiates to the shoulders and scalp, a feeling of heaviness in the shoulders and upper back sometimes accompanied by burning, tingling or numbness of the arms and hands, headaches and decreased strength in one or both arms. In the cervical region, the hernia can compress one of the cervical nerve roots and the main symptom is severe pain in one of the arms (brachialgia), or it can compress the spinal cord causing a severe neurological condition (myelopathy).
- The fastest and most accessible exam is the CERVICAL SPINE RADIOGRAPHY, which allows you to see degenerative changes in the cervical spine but does not allow you to make the diagnosis.
- The CT scan already allows the diagnosis of the hernia to be performed, but it is not the test that presents the best images on the soft tissues and on the compression of the spinal cord or on the nerve roots.
- The essential exam for the diagnosis is the NUCLEAR MAGNETIC RESONANCE which allows to see the characteristics of the discs and to assess the precise diagnosis. It is a more expensive and time-consuming test, but it does not involve radiation for the patient.
- It may also be necessary to perform an ELECTROMIOGRAPHY, to analyse the degree of involvement of the nerve roots, and to avoid compression of peripheral nerves.
Cervical Disc Prolapse Treatment in Delhi
The cervical disc prolapse treatment in Delhi varies depending on the stage of the disease. See the most suitable for each case.
In the early stages, neck pain crises should be treated with medical and preventive measures.
However, the treatment of degenerative disc disease should be appropriate to the stage of the disease diagnosed by imaging and the type of symptoms presented by the patient.
Cervical pain: medical and preventive measures
The cervical pain crises should be treated with the following measures:
- Change of habits: care in the performance of physical efforts, avoid the adoption of incorrect postures and physical exercise;
- Physiotherapy: massage, ultrasound and specific exercise programs;
- Weight control;
- Medication: anti-inflammatory and muscle relaxants.
In cervical pain with pain and numbness of the limb, medical treatment or surgical treatment may be indicated.
What to do when you have a crisis?
In the event of a neck pain crisis, accompanied by pain and numbness of the upper limb, the initial treatment should be medical, including:
- Medication: anti-inflammatory, muscle relaxants and analgesics;
- Physiotherapy: treatment programs stipulated according to the characteristics of each case, including, for example, massages, ultrasounds or specific exercise programs.
When should surgical treatment for cervical disc herniation be considered?
Surgical treatment may also be indicated when:
- A herniated disc is diagnosed and there is a strong relationship between the patient’s images and complaints;
- Conservative treatment failed for a period of 4 to 8 weeks, depending on the degree of existing disability;
- There is a very intense pain that is resistant to the most potent analgesic treatment;
- A motor deficit at the level of the upper limb is diagnosed, and surgical treatment should be performed as soon as possible, to maximize the chances of neurological recovery.
What are the surgical procedures?
Spinal hernias are one of the areas of intervention in neurosurgery and orthopaedics.
There are 2 types of surgical approach in the cervical disc prolapse treatment in Delhi:
- Anterior approach to the cervical spine;
- Posterior approach of the cervical spine.
Anterior approach to the cervical spine
Surgical intervention is performed by the spine surgeon in Delhi under general anaesthesia and with an anterior approach to the cervical spine.
After making a small skin incision in the anterior cervical region, the planes are dissected through the inner side of the sternocleidomastoid muscle, between the trachea, the esophagus and the vascular-nervous bundle (carotid artery, jugular vein and vagus nerve), in order to reach the anterior face of the vertebral bodies.
Once the space to be operated is located, the intervertebral disc is removed in its entirety and the disc fragments that are extruded into the spinal canal and are responsible for neurological impairment.
Whenever necessary, bone protrusions from the back of the vertebral plates (osteophytes) that are considered relevant to the clinical situation can also be removed.
Finally, a spacer can be placed in the disc space, with bone graft, in order to maintain the disc height and foraminal diameter and promote fusion between the vertebral bodies.
The other alternative will be the placement of a disc prosthesis that allows the preservation of movement between the vertebrae.
The advantages of the disc prosthesis are:
- Promoting faster recovery;
- Reducing the likelihood of degenerative wear on adjacent disc spaces.
Posterior approach of the cervical spine
In the case of very lateralized or foraminal disc hernias, the approach may be posterior.
Thus, the cutaneous incision will be posterior cervical and, after dissection of the muscular planes to reach the posterior elements of the spine, a part of the yellow bone and ligament that constitute the posterior wall of the spinal canal is removed.
After exposing the spinal canal and the conjugation hole, the displaced intervertebral disc fragments are removed and decompression of the suffering nerve root is ensured.
This intervention can be performed with minimally invasive techniques, through small skin and muscle incisions, allowing:
- A faster and less painful recovery;
- A quick return to active life.