Symptoms of a slipped disc of the cervical spine

The cervical spine carries the head and supports its mobility. In the area of the cervical spine, nerves that innervate the arms and hands and the diaphragm emerge. If nerve root irritation or compression of the nerve roots occurs, they can become inflamed, which is perceived as pain.

This pain in the neck, shoulder area and arms is usually the first sign that the nerves are inflamed. In addition, there is a sensation of discomfort in the affected dermatomes (areas of skin innervated by the nerve), which increases over time and is constantly present. These sensations include numbness or a tingling in the arm or hand, similar to ants’ feet, and may be a further sign of a slipped disc.

Excessive pain or burning sensation is also counted as a sensation of discomfort. In addition, it can also occur that the muscle strength decreases. As a result, weakness in the arm and hand occurs.

Patients also have symptoms such as headaches, dizziness and also ear noises, such as tinnitus, occur. Sensory disturbances, such as numbness or tingling, can also occur in the face. The symptoms occur more frequently when the head is tilted, either to the side or backwards.

During these movements, 5% of patients feel something that can be compared to an electric lightning bolt passing through the whole body (Lhermittian sign). In addition, the pain increases when lying down, it can even become so bad that lying down is no longer possible because the pain is too strong. If paralysis or loss of sensation occurs, a doctor should be consulted urgently.

In addition, the pain increases when lying down, it can even become so bad that lying down is no longer possible because the pain is too strong. If paralysis or loss of sensation occurs, a doctor should be consulted urgently. The pain associated with the herniated disc in the cervical spine is caused by the compressed nerves through the displaced disc.

Depending on how much the nerve or its root is compressed, the strength and nature of the pain also varies. It may be sharp, burning and precisely localised (e.g. : shooting pain/rewritten knocking pain/Hermittsches sign) or dull, pulling and difficult to localise. The pain occurs mainly in the neck and shoulder area, radiating into the arms and head are also possible. A worsening of the pain in a herniated disc of the cervical spine occurs when the head is tilted backwards or sideways, or when lying down and at night.

Diagnosis

The initial consultation with the patient is an important part of the diagnostic process. The expressed complaints such as back pain, especially in the neck and shoulder area, can indicate a prolapse of the cervical spine. In addition, the doctor asks questions such as “Have you noticed any numbness or tingling in your arms or individual fingers?

With simple physical examinations, the suspicion of a slipped disc in the cervical spine can be strengthened. If signs of paralysis, sensory disturbances or a reduction in strength of the arm or finger muscles occur, this indicates a complicated course of a herniated disc of the cervical spine. However, such a disease can also occur asymptomatically, i.e. without any real symptoms.

Then only an imaging procedure can detect a herniated disc of the neck. A decrease in the height of the intervertebral disc can indicate a prolapse in an X-ray. Computer tomography (CT) or magnetic resonance imaging (MRT) are available for an exact diagnosis.

In an MRI of the cervical spine, sectional images of the cervical spine are taken. Here one can see the exact location of the herniated disc of the cervical spine. A herniated disc of the cervical spine can be treated conservatively or surgically.

While the conservative treatment corresponds to the therapy of the herniated disc of the cervical spine (physiotherapy, pain therapy), there are some differences in the surgical procedure. In the so-called microtherapy, which belongs to the pain therapy of a herniated disc, a fine needle is inserted between the vertebral bodies under CT control and a local anaesthetic is injected near the disc. Percutaneous nucleotomy is one option for the surgical treatment of a herniated disc of the cervical spine.

Here, small cannulas with increasing lumen are placed near the herniated disc in an endoscopic procedure. Small microsurgical instruments are then inserted, the herniated disc is visualized and removed. In some cases the disc is pre-treated with an enzyme.

This causes the disc nucleus to become smaller. Another surgical method is the microsurgical operation, in which small skin incisions are made over the affected area of the cervical spine. This operation is performed using an operating microscope.

The disc is approached from the front, probed and then removed. Furthermore, the herniated disc is removed. If, in addition to the herniated disc, bony constrictions also exist, these can also be removed in the same session.

A stable implant, also known as cage, is used to replace the disc. If there is only a single herniated disc or if the herniation is only in one segment, the indication for a disc prosthesis can be given. This operation is performed under general anesthesia and takes about 2 hours.

The operation on the cervical spine is performed from the front. This is done through an incision in the skin. Access from the front minimizes the risk of spinal cord injury.

The intervertebral disc is removed and a movable plastic core is inserted, which is fixed and anchored between the vertebrae. The advantage of this surgical method is that early mobilisation is possible again after the operation and immediate physiotherapy can be connected to the operation. Due to the plastic core between the vertebrae, the spine does not lose its mobility.

Patients can be discharged home approximately 2 days after the operation. They must still wear a neck brace for a few weeks. The prognoses show a very low complication rate.

Thus 85%-90% of all patients are free of complaints after the operation. For this reason, conventional surgical methods, such as joint stiffening, are being performed less and less frequently. A few weeks after the operation, the patient’s progress can be monitored by means of CT or MRI of the cervical spine.

Herniated discs are still operated on too frequently, although in most cases a targeted and professionally guided physiotherapy is just as promising. The exercises for therapy must be learned in detail and initially instructed, because the cervical spine is a sensitive and mobile structure, which must be protected at the same time. The most important exercise is to learn a healthy head and body posture and to maintain it in everyday life.

Often, during office work, the head is placed too far back in the neck, which puts a strain on all the structures of the cervical spine. The upright posture can be supported muscularly in addition to mindfulness in everyday life. With the help of terabands, the erection of the upper thoracic spine can be strengthened, which is often partly responsible for slipped discs in the cervical spine.

During these exercises, the thoracic spine should be fully erected against tension of the ligaments and the shoulder blades should be guided backwards. To stretch and strengthen the cervical and neck muscles, the neck can be bent forward and sideways against slight resistance. The resistance can be generated by the weight of the own arm or by gravity.

Forward flexion can be done lying on the back by slowly moving the chin to the chest against gravity. Initially, the cervical spine should not be overstretched, as it is often involved in the mechanism that causes the herniated disc. To relieve the discomfort associated with the herniated disc in the cervical spine, many different medications are used.

Particularly important are painkillers and muscle relaxants (drugs that relax the muscles). The range of different painkillers is wide. For mild to moderate pain, conventional painkillers that are not subject to prescription can be used.

These include ibuprofen, diclofenac or paracetamol. For particularly severe pain and only under medical supervision, opioids can be prescribed to relieve the pain. However, opioids are not suitable for long-term use as they have serious side effects (constipation, nausea, vomiting) and can lead to habituation and dependence.

Another starting point for drug therapy are drugs for muscle relaxation. These include, for example, sedatives (active substances from the benzodiazepine group), which, in addition to the desired effect, also cause fatigue, drowsiness and gastrointestinal complications. These substances can also be addictive if they are taken for a long time.

Neuralgia is treated with drugs that are otherwise used to treat epilepsy and can also cause drowsiness. You can find extensive information on this topic at Drugs for a herniated disc Surgery is preferred to conservative therapy if it has failed and the symptoms still persist after a few weeks, or if neurological deficits (sensory disturbances, muscle weakness, paralysis) occur in addition to pain. Furthermore, a herniated disc of the cervical spine is operated on if the spinal cord has been damaged (myelopathy).

The operation is carried out in the hospital under general anaesthesia. The intervertebral disc surgery is a minor procedure, which can now be performed minimally invasive through a surgical microscope. The operation is used to remove the leaked tissue without damaging the spinal cord.

From this point on, two different procedures can be chosen. One possibility is to stiffen the vertebrae in the cervical spine by connecting the vertebral bodies affected by the incident with a placeholder (bone graft or similar) instead of the intervertebral disc and with metal plates and screws. This should serve to stabilize the spine again, which means that patients will lose mobility in the stiffened spinal segment.

This method is mainly used in older patients due to the loss of flexibility. If a patient has already suffered a herniated disc of the cervical spine at a young age, one would be more likely to implant a disc prosthesis after the defective disc has been removed. For both operations, the surgeon can distinguish between two access routes for the disc surgery: either from the side of the neck (front) or starting from the neck (back).

The operation takes between 60 and 90 minutes regardless of the access route. Afterwards the patient has to stay in hospital for 4-6 days before being discharged home, where he/she should take it easy for the first 4-6 weeks. After this period of rest, the reconstruction of the neck and neck muscles can be started within the framework of physiotherapy.

Complications rarely occur during disc surgery of the cervical spine. Depending on the access route, vessels or nerves can be injured, damage to the spinal cord has become very rare due to the minimally invasive approach. However, after a cervical spine disc surgery, as with all other operations, wound infections or wound healing disorders, as well as post-operative bleeding can occur.