Anatomy & Background
Between each vertebra of the spine, there is a fibrocartilagenous structure called the intervertebral disc. This disc is at all levels of the cervical spine except for the first and second vertebra (atlas and axis). The intervertebral 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.
Loss of neck motion, pain radiating to the arm, numbness and weakness may be caused by inflammation, damage or degeneration of a disc. Discs that tend to suffer the highest rate of degeneration and herniation are the cervical fifth and sixth (C5-C6) and the cervical sixth and seventh (C6-C7).
When the outer walls (annulus) of the disc become weak the nucleus polposus can push the walls out creating a bulge. Bulging discs are common and may be asymptomatic. They can occur as part of the aging process. If the bulge does put pressure on the nerves and surrounding soft tissue it can become symptomatic.
How it happens
- Degeneration – or general wear and tear – that breaks down the walls of the disc.
- Repetitive motions, like bending and twisting, especially in combination, places the most stress on the outer fibrous rings (annulus fibrosis).
- Discs are most susceptible to injury in the sitting or bending position as the pressure on the disc is displaced to the front (anteriorly) pushing the contents of the disc posterior laterally toward the thinner and weaker annulus fibrosis.
- Sudden fall or trauma, like a motor vehicle accident.
- Repetitive stress injuries, like those from over-the-head motions and heavy lifting.
- Genetic factors may contribute to the likelihood of intervertebral disc disease.
- Smoking makes you more susceptible to disc herniation and degeneration.
When a bulging disc occurs, the symptoms will depend on the location of the bulge along the spine, and what soft tissue structures are affected. Cervical or neck disc injuries can effect the back of your head, your neck, arm, shoulder blade and your hand. Symptoms can vary from none at all to very mild, if the disc is the only structure involved, or can be more severe. Other symptoms can include:
- Pain in your neck or radicular to the arm (pain radiates out from a specific point and around to local areas) and down to the hand if the disc presses on the nerve root.
- Sensory changes – such as numbness, tingling, or parasthesia 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’s condition. In severe cases paralysis may occur.
- Diminished reflexes in the upper extremity.
- Muscle spasms and changes in posture in response to the injury.
- Loss of motion including difficulty moving your head and neck.
- Sitting for extended periods of time may produce neck and arm pain.
Treat Bulging Disc
Treatment of a bulging disc or injury will depend on the severity of the condition. When treating acute disc or back problems, treatment recommendations can include:
- Rest: avoid the activities that produce the pain.
- Anti-inflammatory and other pain medications.
- Ice the effected area to help reduce pain and any associated muscle spasms. Apply ice right away and then at intervals for about 20 minutes at a time. Do not apply directly to the skin.
- Physical therapy for back and disc problems must remain conservative at the beginning to avoid aggravation. Your therapist will probably emphasize rest, reducing the inflammation and increasing the blood circulation for healing. Once the initial inflammation has been reduced, stretching and strengthening exercises will be started to restore flexibility to the joints and muscles involved. The exercises will also improve the strength and stability of your spine. Each program should be based on the structure causing the problem and symptoms so as to not further aggravate the problem.
- Instruction to correct and maintain good posture.
- A brace or the use of supports may be necessary to reduce stress on the disc, muscles and cervical spine.
In mild cases, rest, ice and medication may be enough to reduce any pain you feel. Many patients do well with this recommendation. 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 the activity that caused the problem should be gradual so as to prevent flare-ups.
Moderate to Severe Cases
If the problem persists, consult with your health care provider. 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.
In addition to performing a thorough examination your physician may order the following tests to make a more precise diagnosis:
- X-ray to determine if there is any joint degeneration, fractures, bony malformations, arthritis, tumors or infections present.
- MRI to determine any 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.
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 pain management medications for mild to moderate pain.
- If over the counter medications are ineffective, your physician may recommend a stronger prescription pain medication.
- Anti-inflammatory drugs or prescription NSAIDS (non-steroidal anti-inflammatory drugs) to reduce inflammation following acute injury.
- Muscle relaxers to reduce acute muscle spasms.
- Prescription medication designed specifically to reduce nerve damage and pain.
- Injections (explained below).
Severe or non-responsive disc condition
If your pain does not respond to conservative care after 8-12 weeks, surgery may be necessary. If you continue to experience some of the following symptoms, your doctor may recommend you for a surgical procedure:
- Increase in radiating or radicular pain from the neck to the arm.
- Pain or nerve damage that gets worse.
- Increased weakness in the upper extremity and/or the hand.
- An increase in numbness or parasthesia in the arm.
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 (if pain persists and doctor recommends)
- Endoscopic Decompression
- Endoscopic Foraminotomy
- Percutaneous Decompression
- IDET Intradiscal Eletrothermal Therapy
- Selective Endoscopic Discectomy
- Spinal Cord Stimulator
- Epidural Lysis of Adhesions