Intervertebral Disc


Between each vertebra lies a fibrocartilagenous structure called the intervertebral disc. This disc can be found at all levels of the cervical spine except for the first and second vertebra (atlas and axis). The disc is comprised of a series of outer fibrous rings (annulus fibrosis) and a soft center (nucleus pulposus). The walls of the disc are thinnest and weakest posterior laterally where the spinal nerves exit the spinal column. The disc serves as a joint between the vertebrae, functions as a cushion and allows movement between the vertebrae.

Inflammation, damage or degeneration of a disc may produce loss of neck motion, pain radiating to the arm, numbness and weakness. The cervical fifth and sixth C5-C6 and cervical sixth and seventh C6-C7 levels have the highest rate of disc degeneration and herniation.

Slipped Disc


A slipped disc is a misnomer, because the disc does not actually slip out of place between the vertebrae. Instead, a “slipped disc” occurs when the outer walls of the intervertebral disc are torn. Other terms for this condition are herniated disc, prolapsed disc, or ruptured disc. When outer annular rings are torn the center gel-like nucleus pulposus can push out and place pressure on the other structures in the general area. The slipped disc usually occurs at the posterior lateral wall where the annulus fibrosis is thinnest. Unfortunately, this is also where the nerves of the spine exit and track distally into the body. The larger the tear, and the further the nucleus pushes out into the surrounding area, the more severe the symptoms and the pain. A slipped disc in the cervical spine can result in cervical radiculopathy, creating symptoms such as pain, tingling, numbness, and weakness into the arms.

Causes of a Slipped Disc


  • Degeneration or general wear-and-tear which can to a break down of the walls of the disc.
  • Repetitive bending and twisting motions especially in combination. These motions place the most stress on the outer fibrous rings.
  • Discs are most susceptible to injury in the sitting or bending position as the anterior pressure on the disc are pushing the contents of the disc posterior laterally toward the weak walls and spinal nerves.
  • A sudden fall or similar trauma can result in a disc herniation.
  • Repetitive stress injuries such as over-the-head activities and heavy lifting.
  • Genetic factors and poor posture may contribute to disc stress, degeneration and eventual herniation.

Symptoms


When a disc is herniated, or slipped, the symptoms that result will depend on the location of the herniation and what structures will be effected. Cervical or neck disc injuries can effect the back of the head, neck, arm, shoulder blade, and the hand. Symptoms can vary from mild to none-at-all if the disc is the only structure involved or if:

  • There is pain in the neck or radicular to the arm and down to the hand and the disc presses on the nerve root.
  • Sensory Changes such as numbness, tingling
  • if the nerve is compromised.
  • Weakness, muscle atrophy or wasting in the arm or hand may occur if the motor portion of the nerve is effected by the disc. In severe cases paralysis may occur.
  • Diminished reflexes in the upper extremities.
  • Muscle spasms and changes in posture in response to the injury.
  • Loss of motion and inability to move the head and neck.
  • Sitting for extended periods of time may produce neck and arm pain

Please note that a patient with a herniation may be symptom free if the disc does not press on a sensitive soft tissue structure.

Treatment of a Slipped or Herniated Disc


Treatment of a disc herniation or injury will depend on the severity of the condition. When treating acute disc or back problems:

  • Rest. Avoid the activities that produce any pain (jumping, running, climbing stairs, kneeling, squatting, etc).
  • Anti-inflammatory medication and other pain medications.
  • Apply ice to the neck and cervical spine to help reduce pain and associated muscle spasms. Apply it right away and then at intervals for about 20 minutes at a time. Do not apply directly to the skin.
  • Instruction in correction and maintenance of good posture.
  • Any braces or the use of supports may be necessary to reduce stress on the disc, muscles and cervical spine.
  • Physical therapy for back and disc problems must remain conservative in the beginning to avoid aggravating the condition. Your therapist should emphasize rest, reducing the inflammation and increasing the blood circulation for healing. Once the initial inflammation has been reduced, a program of stretching and strengthening should be initiated to restore flexibility to the joints and muscles involved, while improving strength and stability of the spine. Each program will be based on the structure causing the problem and symptoms. A program not tailored to the specific problem may aggravate symptoms.

Mild Cases


In mild cases many patients found that rest, ice and medication were enough to reduce the pain. Once the pain is reduced, physical therapy is recommended to develop a series of postural correction, stretching and stabilization exercises to prevent re-occurrence of the injury. Return to activity should be gradual to prevent a flare up of symptoms.

Moderate to Severe Cases


If the problem persists, consult with your health care provider next. Your physician should perform a thorough evaluation to determine the possible cause of your symptoms, the structures involved, the severity of the condition, and the best course of treatment.

Medicine Intervenes


In addition to performing a thorough examination your physician may order the following tests to make a more concise diagnosis:

  • X-ray to determine if there is any joint degeneration, fractures, bony malformations, arthritis, tumors or infection present.
  • MRI to determine and soft tissue involvement including visualization of the discs, spinal cord and nerve roots.
  • CT scans which can give a cross section view of the spinal structures
  • EMG – which is used to determine nerve involvement or damage.

Medications to consider


Your physician may recommend several medication options individually or in combination to reduce the pain, inflammation and muscle spasm that may be associated with disc injuries.

  • Over the counter medications for mild to moderate pain.
  • Narcotics if over the counter medications are not effective your physician my prescribe stronger pain medication.
  • Anti-inflammatory medication or prescription NSAIDS to reduce inflammation following acute injury.
  • Muscle Relaxers to reduce acute muscle spasm.
  • Nerve Pain medication by prescription designed specifically to reduce nerve damage pain.
  • Injections such as facet injections, nerve blocks or epidural injections. These may involve the injection of corticosteroids to a specific structure to reduce local inflammation.

Severe or Non responsive Disc Conditions


In the case of conditions that do not respond to conservative care after 8-12 weeks surgery may be indicated. Talk to your physician if you continue to experience some of the following symptoms:

  • Increase in radiating or radicular pain from the neck to the arm
  • Pain or nerve damage that is getting worse
  • The development or increased weakness in the upper extremity and or hand
  • Increase in numbness or parasthesia in the arm
  • Loss of bowel and bladder control

Medical Procedures to consider


Injections like facet injections, nerve blocks or an epidural. These may involve the injection of corticosteroids to a specific structure to reduce local inflammation.

  • Caudal Epidural Injections
  • Interlaminar Caudal Epidural Steroid Injections
  • Transforaminal Epidural Injections
  • Selective Nerve Root Blocks

Surgical Procedures


  • Endoscopic Decompression
  • Endoscopic Foraminotomy
  • Percutaneous Decompression
  • IDET Intradiscal Eletrothermal Therapy
  • Selective Endoscopic Discectomy
  • Spinal Cord Stimulator
  • Epidural Lysis of Adhesions