The cervical disc herniation, more commonly known as a hernia in the neck, it's a pathology benign, which however can have disabling consequences for the patient. Among these, also the cervicobrachialgia, or a severe pain that radiates from the neck to the extremity of a limb. It is therefore important to understand the structure of our spine and the links between pathology and this disorder.
Anatomy of the spine
The spinal column (spine) is divided into three zones: cervical, dorsal and lumbosacral. In the neck area, the cervical spine it is made up seven vertebrae, called cervical vertebrae (indicated by the acronyms from C1 to C7). These are separated by the intervertebral discs, whose central nucleus has a pulpy consistency, being composed of approximately 90% water; the nucleus is in turn surrounded by a fibrous ring. This structure allows the disc to act as a shock absorber during spinal movements, allowing them to be smooth.
The anterior part of the vertebrae is made up of discs and a vertebral body, while the posterior part contains bony arches (laminae and spinous arches) separated by ligaments and two intervertebral joints at each level.
Inside the vertebra, through the cervical spinal canal, passes the spinal cord, or the central nervous structure that connects the brain to the rest of the body: all information regarding motor function, sensitivity, and the functioning of internal organs flows through here. 16 nerves exit the spinal cord. cervical nerve roots, equally divided between the right and left (from C1 to C8). A right and a left nerve exit from an opening present in each intervertebral space (foramen intervertebral), moving towards the muscles and skin of both arms.
What is a cervical disc herniation and what causes it?
Between the causes of cervical disc herniation, there may be the natural wear and tear of the discs in this specific region of the spine, which occurs over time. Poor posture, whiplash, increased load on the spine, repetitive stress and vibration on the affected area, and muscle or ligament weakness can also contribute.
In any case, it may result in a disc disease: the disc can lose hydration, elasticity, thickness. In a degenerated vertebral disc, if the ring does not break but deforms to respond to the protrusion of the nucleus, we speak of disc protrusionIf the fibrous ring of the disc breaks, the nucleus pulposus can come out and move towards the spinal canal or the foramina: this is how theslipped disc. Generally, its consistency is soft, but it can also be hard in the presence of calcifications and osteophytes (small bone spurs). Three types of herniated discs must also be distinguished:
- contained under a ligament of the spinal canal
- expelled in the canal, as the nucleus of the disc has managed to break the ligament
- migrated when the fragment goes down or up in the canal
Among the consequences of cervical disc herniation: cervicobrachialgia
A hernia in the neck may not manifest itself with precise symptoms, or on the contrary can compress a nerve root and sometimes even the spinal cord.
Among the main symptoms of cervical disc herniation are: neck pain, a severe pain in the neck. When this radiates into the shoulder or along the arm and hand, it is called cervicobrachialgia, a real medical condition. It is a painful sensation that is usually very strong, characterised by the perception of electric shocks and tinglingCervicobrachialgia pain may also be accompanied by weakness in the hands or armsOften, symptoms appear in exactly one or more areas of the arm, each of which is the responsibility of a different nerve root (from C5 to C8).
Symptoms of a herniated cervical disc
If a nerve root is compressed, it may result in paresis (weakness) or the paralysis (absence of movement) of some muscles in the arm corresponding to the area of that nerve. Other symptoms of a herniated cervical disc may therefore also include: headache or feeling dizzy.
If the spinal cord is compressed by the hernia, a cervical myelopathy, with weakness in all limbs (both upper and lower), urinary disorders and sexual dysfunction.
Diagnosis of cervical disc herniation
In the presence of cervicobrachialgia, the neurosurgeon's clinical examination allows the possible localization of the compression to be traced. The following are then essential: instrumental examinations.
The most effective test to reach a diagnosis of cervical disc herniation is the Cervical Magnetic Resonance Imaging, through which it is possible to analyze the state of the disc, clearly see the spinal cord, nerve roots and ligaments, and precisely recognize the hernia.
Means Cervical CT scan It is instead possible to visualise the arthritic vertebrae and beaks in even more detail.
To study the bones and the positioning of the spine, a Radiography with the patient standing. To examine the movement of the spine, you can also use dynamic radiographs.
With theElectromyography (EMG) The electrical activity of the various muscles of the arm is recorded, looking for one or more areas of pain linked to compression of the nerve roots.
I Somatosensory Evoked Potentials (SES) or Motor Evoked Potentials (MEP) Instead, they record motor and sensory electrical activity through the spinal cord.
Cervical disc herniation: when to operate?
Surgery isn't necessarily the right treatment for a herniated cervical disc. A specialist, after thoroughly assessing the patient's condition, will determine the appropriate treatment plan. If no serious symptoms occur, such as paresis or paralysis, or signs of spinal cord compression, it is advisable to first follow a drug therapy and/or physiotherapeutic therapy. Approximately 80% of patients with cervicobrachialgia benefit from taking painkillers, anti-inflammatory drugs, and steroids, or even see the symptoms resolve spontaneously. This is why, in conjunction with pain management therapy, the neurosurgeon generally waits a month or two from the first symptoms before proposing a surgeryThis may become urgent in case of paralysis or myelopathy. If these more serious manifestations are absent, but the pain is persistent and impacts the quality of life, the possibility of surgical intervention can be evaluated. discectomy and cervical arthrodesis or cervical arthroplasty.
Explanatory video on cervical disc herniation (in English)
Explanatory video on cervical radiculopathy (in English)
