There are soft-tissue discs between the bony vertebral bodies in your cervical spine that are called intervertebral discs. These discs are composed of a soft gel-like center called the nucleus pulposus, and a tough outer lining that surrounds the disc called the annulus fibrosis. The intervertebral disc creates a joint between each of the vertebral bodies that allows them to flex and extend, rotate slightly, and move with respect to one another. When the outer lining that surrounds the disc tears, the soft center squeezes out through the opening, creating a "herniated", "slipped", or "ruptured disc". Each of these terms describes the same process. You can imagine this process as similar to having a tube of toothpaste with a crack in it. If you exert pressure on the cracked tube (disc annulus) and toothpaste (disc nucleus) flows out the crack.
Tears in the outer lining of the disc can be very painful by themselves. Once a tear has occurred, pressure from everyday activities, such as flexion and extension of the neck, can help to push the disc's nucleus through the ruptured annulus. When you have a tear in your annulus, but the nucleus has not been squeezed out of the center of the disc, then you will usually have pain in your neck only. However, if you have torn annulus and the ruptured nucleus is irritating a nerve root, then you can have pain in your shoulders, arms and in your neck at the same time. disc herniations can cause different patterns of pain, numbness, and weakness in your body, depending upon where the slipped disc is located along your spine, and how the disc is pressing against your spinal cord and nerve roots.
When a nerve root or the spinal cord is being pinched, you may experience pain in your neck, and pain or numbness in one or both of your arms and hands. In severe cases, the muscles that are controlled by the nerve root that is being compressed by the disc herniation may become weak. The pain that you feel in your neck, back, and arms can come from a combination of a tear in the annulus fibrosis, from the pressure that the disc herniation puts on the nerve, or from irritation, inflammation and swelling within the nerve.
The diagnosis of a herniated cervical disc begins with a complete physical examination of the neck, arms and lower extremities. Your doctor will examine your neck for flexibility, range of motion, and the presence of certain signs that suggest that your nerve roots or spinal cord are affected by the disc herniation. This often involves testing the strength of your muscles and checking your reflexes to make sure that they are still working normally. You will often be asked to fill out a diagram that asks you where your symptoms of pain, numbness, tingling and weakness are occurring.
A routine set of x-rays is also usually ordered when a patient with neck pain goes to see a doctor. Many times, these x-rays are normal because the disc is composed of soft-tissue which does not show up on the x-ray. Instead, in situations where a herniated disc is a likely cause of a patient's symptoms, doctors will order an MRI or a CT scan. An MRI scan is very useful for determining where disc herniations have occurred and where the nerve roots or spinal cord are being compressed. A CT scan is often used to evaluate the bony anatomy in the cervical spine, which can show how much space is available for the nerve roots and spinal cord within the spinal canal. The nerve roots exit the spinal canal through a bony tunnel called the neuroforamen, and it is at this point that the nerve roots are especially vulnerable to compression by disc herniations.
A CT scan or an MRI is often not ordered until a decision has been made to proceed with surgery. This is because scientific studies show many people with "normal" necks have evidence of significant cervical disc herniations on MRI scans, and these people do not have any symptoms of neck pain. Therefore, MRI's are usually ordered only when the diagnosis is unclear, or after it becomes apparent that the patient is not going to get better with non-surgical options and the surgeon needs to determine what type of surgery is best to relieve the symptoms.
Your doctor will be able to discuss with you what your diagnosis means in terms of treatment options. For most people who do not have evidence of nerve root compression with muscle weakness, the first line of therapy includes non-steroidal anti-inflammatory drugs and physical therapy. A soft cervical collar is often prescribed in order to allow the neck to have a chance to rest.
Surgery for cervical disc herniations is offered as an early option for people who have evidence of muscle weakness that is being caused by nerve root or spinal cord compression. This is because muscle weakness is a definite sign that the nerves are being injured (more seriously than when pain is the only symptom) and relieving the pressure on the nerves is more of an urgent priority. In other situations, surgery is offered after physical therapy, rest, and medications have failed to adequately relieve the symptoms of pain, numbness and weakness.
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