Intervertebral disc herniation is one of the most common causes of neck and arm pain, and the most common among working-age people and athletes.
An intervertebral disc herniation is the protrusion of the soft nucleus of the intervertebral disc through the fibrous annulus. The herniated nucleus begins to irritate the nerve root or pinches it completely, causing the symptoms of a herniated disc.This condition is most common in people of working age. Intervertebral disc herniation can occur during sports or as a result of neck trauma. The symptoms of this lesion appear suddenly.
In cervical intervertebral disc herniation, the pain in the arm is caused by irritation of one of the nerve roots in the neck by the bulging nucleus. The pain spreads down the arm. In addition to the pain, tingling and numbness can be felt all the way down to the fingertips, and muscle spasms may also occur.
Intervertebral discs are not very large and there is not much space for the nerves to pass through, so even the smallest intervertebral disc herniation can irritate or pinch a nerve and cause the characteristic symptoms.
Symptoms of cervical hernias
A herniated disc in the neck causes symptoms in the upper arm, forearm and hand, and sometimes in the shoulder. In some people, a herniated intervertebral disc nucleus can compress and irritate the spinal canal. This is a much more serious condition, with neck pain, impaired fine motor skills, objects falling out of your hands, numbness, and problems with coordination and gait. Urgent treatment is needed.
Risk factors
The development of a spinal hernia is a long-term, chronic process, the causes of which are not fully understood, but there are known risk factors that influence the progression of a hernia. The risk of intervertebral disc herniation in the cervical spine is increased by reduced physical activity and irregular posture, which leads to an uneven distribution of pressure on the intervertebral disc and to the protrusion of the nucleus pulposus beyond the disc. Neck herniation is also more likely in older people, as intervertebral discs gradually lose water and become less elastic with age . Irrational diet also contributes to structural changes in the discs.These factors, combined with irregular ergonomics when lifting objects, new and repeated injuries, and continuous wear and tear on the intervertebral discs, increase the risk of cervical herniation.
Neck herniation can occur either as a result of a sudden eruption of the nucleus pulposus, or as a gradual progression of the nucleus pulposus as the fibres of the annulus fibrosus become more and more damaged. The latter may take weeks or months to finally erupt through the fibrous ring of the intervertebral disc.
There are four stages of intervertebral disc protrusion:
1. Protruding - the erupting nucleus pulposus remains inside the annulus fibrosus, but the altered shape of the intervertebral disc may increase the pressure on the spinal cord.
2. Prolapse - the erupting nucleus pulposus damages the inner structure of the annulus fibrosus, but does not go outside the intervertebral disc because it is still held in place by the outer layer of the annulus fibrosus.
3. Extrusion - the fibrous ring ruptures and the nucleus pulposus erupts into the epidural space between the wall of the spinal canal and the dura mater.
4. Sequestration - the structures of the nucleus pulposus are dispersed throughout the epidural space.
Treatment
Not all patients with cervical intervertebral disc herniation require surgery. In cases where the symptoms are not pronounced and do not cause extreme discomfort, conservative (non-surgical) treatment may be used, which may include medication (non-steroidal anti-inflammatories, painkillers, or drugs that reduce muscle tone and spasm) or physiotherapy. If physiotherapy is prescribed, a physiotherapist will design an individual exercise programme.
Surgical treatment is used when there is severe damage to the disc and there is pressure on the spinal nerve roots or spinal canal.The aim of surgery is to relieve the pressure on the spinal nerves from the soft tissue nucleus. The most common procedure is a discectomy. This is a procedure in which part of the damaged disc is removed. This procedure is usually performed from the front of the neck, but sometimes it is necessary to remove part of the thin bony plate covering the canal to reach the affected disc.
SOURCES:
https://www.spineuniverse.com/conditions/herniated-disc/cervical-herniated-disc-or-ruptured-disc
