Cervical Disc Herniation

Anatomically, there are cushions between the vertebrae that we call discs. A cervical (neck) disc herniation is the condition that develops when the cartilage-like structures protruding from these cushions in the neck region compress the nerves and spinal cord. Most neck pain is what is popularly described with various terms such as a stiff neck or catching a chill; it is "mechanical-type neck pain" caused by the tightening and straining of the muscles and connective tissues associated with the neck. Neck pain is a common condition, found in about 60% of the population. It is usually due to mechanical causes, most often muscle strain, and less frequently can develop from conditions such as a cervical disc herniation or cervical arthritis (bone spurs).

A cervical disc herniation usually presents with pain radiating from the neck down a single arm, along with numbness in the arm and hand. This picture may be accompanied by weakness in that arm and hand. If the herniated disc fragment is very large and is also pressing on the spinal cord, it can cause numbness and weakness in the legs as well. In a cervical disc herniation, the pain is felt more in the arm than in the neck. A cervical disc herniation is most often confused with shoulder joint problems. These conditions can also cause shoulder pain and some arm pain. Because of the pain, the patient may feel that the arm is weak. In shoulder joint disorders, there is a restriction in the range of shoulder movement. To distinguish between shoulder and neck disorders, we sometimes resort to shoulder injections. We try to reach a diagnosis with intra-articular injections in frozen shoulder, and with subacromial injections in shoulder impingement syndrome and rotator cuff tendinitis. These injections can also be therapeutic in patients who have a shoulder problem. In patients with a cervical disc herniation who do not also have a shoulder joint problem, there is no restriction of shoulder movement or associated pain. If the arm pain decreases when the patient places the arm above the head, the pain may be coming from a cervical disc herniation. If the pain increases in the arm when the arm is compressed, this too suggests that the arm pain may be arising from a cervical disc herniation. The two groups of conditions are distinguished from one another by the way the type of pain changes in certain positions of the arm and head. For this reason, examination by an experienced physician is very important in cervical disc herniation.

In people who have neck pain, or who have a neck X-ray taken for any reason, a finding called straightening of the neck (loss of the cervical curve) is very commonly encountered. It is not a disease in its own right. This condition is mostly seen on films taken during painful periods in patients in whom mechanical neck pain is the main problem. The normal alignment of the cervical vertebrae is in the shape of a forward-arching curve. During periods of severe pain, this curve can flatten as the neck muscles contract. The purpose of this reflex is actually to protect the neck and to make the patient guard it. It usually resolves with appropriate medications and physical therapy. Even after the neck pain has passed, the straightening of the neck may continue for some time longer. Once the pain has resolved, this condition improves completely with exercises that strengthen the neck muscles and restore their health. More rarely, straightening of the neck can also be seen in association with cervical arthritis (bone spurs) and disc herniations. In that case, whatever the cause of the straightening of the neck may be, it must be treated.

When making a diagnosis of a cervical disc herniation, we physicians take three criteria into account: the nature, severity, and timing of the complaints; the examination findings; and the radiological investigations (cervical MRI). Only when the findings from these three criteria completely match is a diagnosis of a cervical disc herniation made. A cervical disc herniation is not diagnosed by MRI alone! Not every neck pain is a cervical disc herniation! Not every cervical disc herniation requires surgery!

The great majority of patients diagnosed with a cervical disc herniation recover with non-surgical treatments known as "conservative treatment." Rest, medications (painkillers, muscle relaxants, cortisone, etc.), the use of a neck collar, and appropriate physical therapy programs generally provide benefit in the great majority of patients. When weakness in the hands or arms accompanies severe arm pain, and imaging can demonstrate a significant nerve or spinal cord compression that accounts for it, surgery should be recommended to the patient.

The majority of surgical procedures performed for cervical disc herniations are carried out through small incisions on the front of the neck. Using the microsurgical technique (cervical microdiscectomy) through 3-4 cm incisions made on the right or left front of the neck, it is possible to reach the vertebrae, after which the entire disc can be removed together with the fragments that are causing the pressure. Between the two vertebrae from which the disc has been removed, a single mobile or fixed metal or special silicone piece that will take over the function of the disc is placed, along with a plate and screws if necessary.

On the evening of the day of surgery, or one day later, patients are fitted with a neck collar and are helped up and walked. If everything goes well, they are discharged one day after the operation. After the operation, we recommend using a neck collar for about one month. This ensures that the surgical area heals properly and soundly and that the patient protects the neck. During this one month, provided the collar is kept on, the patient can do whatever tasks they wish and can walk. They can return to their normal activities within about 2-3 weeks.

After a properly performed cervical disc herniation operation, there is no possibility of a herniation forming again at the same level. However, the formation of a new herniation between other vertebrae is always possible. For this reason, it is important that the patient follow the physician's recommendations to the letter after surgery. In cervical disc herniation patients who have been well evaluated, correctly diagnosed, and given the correct operation, the outcome is highly satisfying. The success rate of our operations is over 95%.