The spinal vertebrae are separated by discs that act as shock absorbers; cervical discs are those in the neck region of the spine. A cervical herniated disc occurs when a portion of the disc's nucleus (nucleus pulposus) bulges through a tear in the outer band (annulus fibrosis). This herniation can place pressure on the surrounding spinal nerves, causing inflammation and pain. The treatments for cervical herniated discs can be divided into supportive treatment and surgery.
Supportive Treatment
Cervical herniated discs can generally be treated without surgery. Muscle relaxants can reduce muscle spasms, and hot packs may also be helpful when applied during the first 48 hours of an episode of acute pain. Anti-inflammatory drugs may be taken orally to relieve mild pain and swelling, and prescription painkillers can alleviate more severe pain. More powerful anti-inflammatory drugs, such as cortisone, also can be injected directly into the epidural space of the spinal canal to relieve debilitating pain.
Physical therapy can increase flexibility and decrease the pain of cervical herniated discs. These exercises typically consist of gentle massage and stretching. Therapeutic devices, such as neck braces and traction, may be used to help a herniated disc heal. Patient education can teach about risk factors, proper posture and additional exercises.
Surgical Treatment
A cervical herniated disc may also be corrected with surgery if supportive treatment measures fail. The primary objective of all these procedures is to relieve the pressure on the spinal cord and nerve roots. Spinal surgery is typically performed with an endoscope and microscope to make it as minimally invasive as possible.
The most common surgical approach for herniated discs in the upper spine is an anterior cervical discectomy. In this procedure, the surgeon enters the neck from the front and removes all or part of the herniated disc. The soft tissue in the neck is separated to expose the herniated disc. The disc is removed and the space is filled with a bone graft that's usually taken from the patient's own hip. The bone is then shaped so that it will eventually fuse with the two affected vertebrae. Additional devices, such as plates or screws, may be used to stabilize the spine in rare cases. A posterior approach for cervical disc surgery is used to perform a laminotomy. In this procedure, part of the bone that covers a spinal nerve is removed.
Post-operative recovery is typically quick, and most patients are able to go home within two days. Pain medication may be taken as needed, and the patient can gradually increase activity levels. The post-operative pain should begin to subside within two weeks after surgery.
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