Introduction
A herniated disc of the cervical spine (cervical spine) causes tissue of the gelatinous core of an intervertebral disc (nucleus pulposus) in the area of the cervical spine to leak out, usually due to a constant malposition of the head. The tissue usually emerges backwards into the spinal canal, to the side of the nerve roots, or less frequently downwards to the next lower intervertebral disc and its nerve roots. Due to the pressure on the respective nerve roots, a herniated disc in the cervical spine can cause various symptoms, such as restricted movement, neck or headaches, as well as pulling electrifying pain at the site of the prolapse, which can radiate to the fingertips.
In addition, neurological symptoms such as paralysis or loss of strength in the arms, hands and fingers or sensory disturbances (e.g. formication, tingling or numbness) can also occur. If the herniated disc of the cervical spine causes compression of the spinal cord, this can even result in life-threatening impairment of breathing. In the therapy of a herniated disc of the cervical spine, both conservative and surgical concepts can be considered.
In most cases a herniated disc of the cervical spine can be treated conservatively, i.e. without surgery, since the leaked tissue of the disc usually resorbs itself after some time. The aim of conservative therapy of a herniated disc of the cervical spine is to reduce pain and strengthen the neck and back muscles in order to prevent incorrect loading or overloading of the cervical spine. The conservative therapy of a herniated disc of the cervical spine therefore mainly includes the administration of various painkilling drugs and regular physiotherapy. If the patient does not respond to the conservative therapy or if additional neurological complaints (e.g. paralysis or sensory disturbances) occur, surgery for the cervical spine herniated disc should be performed.
Drug therapy
The conservative therapy of a herniated disc of the cervical spine includes the administration of various drugs. Especially important is the administration of painkillers, which prevent pain in a herniated disc of the cervical spine and at the same time have an anti-inflammatory effect. In most cases, preparations from the group of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac or naproxen are used.
In the case of intolerance or contraindications against NSAIDs, paracetamol can be used as an alternative, which also has an analgesic and anti-inflammatory effect via a different mechanism than NSAIDs. If the pain of a slipped disc in the cervical spine does not respond to the above-mentioned drugs, stronger painkillers from the group of opioids, such as morphine or tramadol, must be used. These drugs are only available on prescription, as they can sometimes cause severe side effects such as dizziness, constipation, nausea and vomiting.
If the pain is chronic in a herniated disc of the cervical spine, i.e. the pain persists over a longer period of time, atypical painkillers from the group of antidepressants and anticonvulsants can also be tried. These drugs are normally used to treat depression or epilepsy. However, they are also approved for the treatment of nerve pain and are still effective when conventional painkillers such as NSAIDs or opioids no longer have an analgesic effect.
In addition to the above-mentioned painkillers, drugs for muscle relaxation, the so-called muscle relaxants, also play a role in the drug therapy of a herniated disc in the cervical spine. Important representatives are for example Baclofen or Flupirtin. Muscle relaxants are also subject to prescription due to numerous side effects such as fatigue, dizziness, nausea or cardiac arrhythmia.
If oral administration of medication, i.e. taking medication in the form of tablets, does not lead to pain relief, drugs such as local anaesthetics or cortisone can be injected directly at the affected nerve root with a fine needle as an alternative conservative therapy for a slipped disc of the cervical spine. Cortisone is a hormone which belongs to the class of glucocorticoids. It is produced in our body in the adrenal cortex and is subject to a cycle that depends on the time of day.
It is secreted in the morning and more frequently in stressful situations (“stress hormone”). It causes a mobilisation of the body’s energy reserves and slows down immune reactions. Cortisone can also be produced synthetically in the laboratory.
As it has a very effective anti-inflammatory effect, it is also one of the best known and most frequently used drugs. Nowadays there are many drugs that are descendants of cortisone. These include prednisolone, betamethasone, dexamethasone and many more.
These are available in the form of ointments, tablets, suppositories, asthma/nasal sprays and as a liquid for injection. Since in the case of a herniated disc the pain is usually localized at a specific point, the cortisone injection is the method of choice. Once the site of the herniated disc has been identified, the medication can be specifically placed at the desired location with an injection.
It is important to know that although cortisone can acutely reduce pain, it does not reverse the herniated disc. The cortisone treatment does not therefore eliminate the cause of the pain, but only prevents you from noticing it. The herniated disc usually heals by itself.
If this should not be the case, it would have to be treated surgically. In periradicular therapy, the cortisone injection can be placed precisely with the help of imaging techniques such as CT or MRI. Here, one tries to inject exactly into the nerve root which is pressed and irritated by the herniated disc.
Imaging gives you direct control over the location of the needle tip and allows you to place the injection very precisely. In most cases, the vertebral bodies are approached from behind, i.e. from the back, as this is the best access route. The preparations containing cortisone then reduce local inflammatory processes at the nerve root which cause the pain.
As a result of the pressure and the inflammation, the nerve roots swell up, causing them to become even more constricted. The cortisone has a decongesting effect and leads to a reduced pressure pain. This treatment is carried out several times at intervals of several weeks in the pain therapy of a herniated disc.
If this method does not lead to a reduction in pain for a longer period of time, surgery must be considered. Usually, however, this problem resolves itself and the herniated disc recedes. However, if it is too large and the pain persists, the disc must be surgically removed.
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