Introduction
The cervical spine consists of seven cervical vertebrae. The intervertebral discs are each located between two vertebral bodies of the spine and are responsible for the mobility of the spine. An intervertebral disc consists of two parts of an outer zone, the annulus fibrosus and a gelatinous core, the nucleus pulposus.
In the context of a herniated disc, the nucleus of the disc (nucleus) shifts towards the spinal canal or a nerve root and breaks through the outer zone of the disc. The spinal cord or the affected nerve root is compressed by the exiting nucleus of the intervertebral disc and the classic symptoms such as pain, sensory disturbances or even paralysis of certain muscles occur. You can find more detailed information on the topic “intervertebral disc” under
- L5 Syndrome
- Illustration intervertebral disc
- Illustration herniated disc
- Intervertebral disc
Therapy
A herniated disc does not always have to be surgically treated immediately. A conservative therapy should always be attempted first. Surgery is necessary after 4 months at the latest (usually after about 6 weeks) in cases of existing paralysis or more severe neurological disorders, pain that is resistant to therapy or worsening symptoms.
If the clinical examination confirms the suspicion of a herniated disc, a conservative therapy should always be carried out first if the symptoms are mild. Painkillers such as ibuprofen are recommended to reduce the pain. In addition, muscle relaxants or warmth via a hot-water bottle or heat plaster can also help.
Physiotherapy is also prescribed. There is no need to take it easy, but sports, exercise and special back exercises, which are learned in physiotherapy, are useful. An immobilization of the neck by means of a neck brace may be indicated especially at night, but should not be done over a longer period of time.
The herniated disc can recede independently within a few weeks as a result of these therapeutic measures. Additional information under: Physiotherapy in case of a slipped discTo learn the correct movement of the cervical spine, as well as to restore full mobility, a physiotherapeutic treatment can be started. This is useful both in conservative treatment and after surgery.
The physiotherapist carries out specific exercises together with the patient and also shows exercises that can be done alone at home. It is important that the exercises are continued regularly at home after learning them. The therapy programme and the exercises are individually adapted to the patient and his or her symptoms.
The aim is to strengthen the muscles in the back and neck area and to relieve the cervical spine, for example through postural exercises. Sport can be very useful for strengthening the back. Exercise is generally recommended after a slipped disc.
Depending on the choice of sport, however, it should be discussed with the treating physician. Especially walking, swimming or special back training and gymnastics are recommended. Fitness training for the shoulder neck and chest muscles is particularly suitable.
Sports that place a heavy strain on the cervical spine, such as tennis, should be avoided. Physiotherapy is the most important factor in the treatment of a slipped disc. However, in acute cases, at best, it should be done for a short period of time or at night with increased movement.
Through targeted light movement and muscle building of the spine, the herniated disc can be almost completely repaired. Even after an operation, physiotherapy is indispensable to maintain the success of the therapy and to prevent further spinal problems. The primary aim of the exercises is to restore movement after an acute herniated disc and to strengthen the muscles in the neck in the long term in order to relieve the strain on the intervertebral discs.
The exercises must be learned with a professionally trained physiotherapist and continued independently at home. In the treatment of herniated discs, the trend today is to operate less frequently. This development is correct, since only rarely operations bring about an improvement of the symptoms and still too often operations are performed.
The possibilities of surgery are replacement or removal of the intervertebral disc. However, it has been shown that sufficient pain therapy and targeted movement and muscle build-up can achieve an equally lasting relief of symptoms. An operation is only useful if an acute herniated disc causes paralysis and clear nerve damage.
If there are signs of irreversible damage to the nerves and spinal cord, emergency surgery should relieve the nerve to minimize the damage. Even after a long period of unsuccessful physiotherapy and pain therapy, an operation can be considered if conservative measures obviously have no benefit. Before surgical therapy, an imaging must be performed to prove the herniated disc.
Only if the location of the herniated disc and the clinical symptoms match, an operation makes sense. The standard procedure is the ventral discectomy, because with an access from behind always the spinal cord lies in front of the vertebral body and could be injured. The disc is not accessed from behind via the neck/back, but from the front via the neck.
The advantage of this procedure is that in addition to a narrowing caused by the intervertebral disc, bony constrictions can also be removed (e.g. by bony attachments to the vertebral bodies). In this technique, after a small incision in the neck, surrounding structures such as vessels, muscles and the trachea are carefully pushed to the side to expose the affected section of the cervical spine. The affected intervertebral disc space is opened and the disc is completely removed.
To stabilize the spine, a so-called cage made of titanium is inserted into the disc space. A disadvantage is that the spine stiffens in the affected area and a restriction in movement can be the result. Nowadays there are also special disc prostheses that can be used instead of a cage.
The prosthesis is based on the structure of an intervertebral disc and maintains the mobility of the spine in the affected area. However, it can only be used in young patients who have no degeneration of the spine. In addition, the prostheses are not optimal because of the high load on the cervical spine.
Dorsal foraminotomy is another surgical technique that can be considered. However, this is only used in cases of lateral herniated disks or if there are several herniated disks that compress only one nerve root. The access is via the neck.
The back muscles are carefully pushed to the side to reach and remove the disc at the affected height. However, this procedure is inferior to the procedure from the front in the case of bony attachments. As with any operation, this procedure also involves risks.
In addition to bleeding in the surgical area, infections or wound healing disorders, it can also lead to injuries of nerves or spinal cord. This manifests itself with sensory disturbances or disturbances of movement up to paralysis. However, nerve injuries are very rare.
Furthermore, surrounding structures such as the windpipe, thyroid or oesophagus can be injured. Temporary hoarseness may occur after the operation, but this usually disappears again. Osteopathy is a field of alternative medicine that can be used to supplement conservative or surgical therapy.
In osteopathy, all areas of the body and organs are examined to uncover conflicts in the body and other causes of the herniated disc. The treatment includes certain manual grips and exercises, which are intended to activate the body’s self-healing powers and eliminate any imbalances in the body. Osteopathy can be a useful supplement to acute therapy, but may not be the only therapy for pain or symptoms that indicate nerve involvement.
Acupuncture can also be a useful addition to pain and movement therapy as well as to surgery after a slipped disc. It originates from traditional Chinese medicine and is used especially for prolonged pain. Targeted needles, which are inserted into the skin at specific points, are intended to set processes in the body in motion that activate self-healing powers.
Acupuncture should also not be the only treatment for an acute herniated disc with symptoms, as its therapeutic possibilities are limited. You can find more information on acupuncture hereThe duration of the herniated disc can vary greatly and depends on various factors, such as the severity of the symptoms, the involvement of other body structures, the choice of therapy method and the personal response to the therapy. Slight herniated discs can be healed within a few days to a few weeks with a suitable conservative therapy, or can be completely without symptoms. In other cases, the nerve involvement can be so strong that complete healing is not achieved and symptoms persist chronically. Often the therapeutic success of physiotherapy sets in within a few weeks, so that a decrease in symptoms is achieved on average after 4-6 weeks.
