Cervical hernia and cervicobrachialgia

THECervical disc herniation, more commonly also known as a neck hernia, it is a pathology benign, which however can have disabling consequences for the patient. Among these, also the cervicobrachialgia, that is a severe pain that spreads from the cervical to the extremity of a limb. It is therefore important to know the structure of our spine and the links between the disease and this disorder.

Spine Anatomy

The spine (rachis) is divided into three zones: cervical, dorsal and lumbo-sacral. In the neck area, the cervical spine it is made up seven vertebrae, called cervical vertebrae (indicated with abbreviations from C1 to C7). These are separate from intervertebral discs, whose central core has a pulpy consistency, as it is composed of about 90% of water; the nucleus is in turn surrounded by a fibrous ring. This structure allows the disc to act as a shock absorber during the movements of the spinal column, which can thus be fluid. 

The anterior part of the vertebrae is formed by the discs and a vertebral body, while in the posterior part there are bony arches (laminae and spinous) separated by ligaments and two intervertebral joints at each level.

Inside the vertebra, through the cervical spinal canal, passes the spinal cord, namely the central nervous structure which connects the brain to the rest of the body: from here all the information concerning motor function, sensitivity and functioning of internal organs circulate. 16 protrude from the spinal cord cervical nerve roots, equally divided between right and left (from C1 to C8). A right and a left nerve exit from an opening in each intervertebral space (foramen intervertebral), moving towards the muscles and skin of both arms.

Cervical spine
Radiography

What is a cervical disc herniation and what are the causes?

Between the causes of cervical disc herniation, there may be the natural wear of the discs in this specific region of the column, which occurs over time. Incorrect postures, whiplash, increased load on the spine, repeated strain and vibration on the affected area, muscle or ligament weakness can also affect. 

Either way, one can turn out 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, it is called disc protrusion. If the fibrous ring of the disc is broken, the nucleus pulposus can escape, which goes towards the spinal canal or the foramina: this is how theslipped disc. Typically, its consistency is soft, but it can also be hard in the presence of calcifications and osteophytes (small bone spurs). It is also necessary to distinguish three types of disc herniation:

  • contained under a ligament of the spinal canal
  • expelled in the canal, as the disc nucleus managed to break the ligament
  • migrated when the fragment descends or rises in the canal

Among the consequences of cervical disc herniation: cervicobrachialgia

A neck hernia may not manifest itself with precise symptoms, or on the contrary it can compress a nerve root and sometimes even the spinal cord.

Among the main symptoms of cervical disc herniation is the neck pain, severe pain in the neck. When this radiates into the shoulder or down the arm and hand, it is called cervicobrachialgia, real medical condition. It is a usually very strong painful sensation, characterized by the perception of electric jerks and pins and needles. Neck brachialgia pain can also be accompanied by weakness in the hands or arms. Symptoms often occur in exactly one or more areas of the arm, each of which belongs to a nerve root (C5 to C8).

Cervical disc herniation symptoms

If a nerve root is compressed, the paresis (weakness) or the paralysis (absence of movement) of some muscles of the arm corresponding to the area of ​​that nerve. Among the other symptoms of cervical disc herniation can therefore also be understood headache or feeling dizzy.

If, on the other hand, the spinal cord is compressed by the hernia, one can develop cervical myelopathy, with weakness in all limbs (therefore both upper and lower), urinary disorders and sexual dysfunctions.

Diagnosis of cervical disc herniation

In the presence of cervicobrachialgia, the clinical examination of the neurosurgeon allows to trace the possible localization of the compression. The instrumental examinations.

The most effective test for diagnosing cervical disc herniation is the Cervical magnetic resonance, through which it is possible to analyze the state of the disc, clearly see the medulla, nerve roots and ligaments, and accurately recognize the hernia.

Means Cervical CT scan on the other hand, it is possible to view the vertebrae and arthritic beaks in even more detail.

To study the bones and placement of the spine, a Radiography with the patient standing. To examine the movement of the spine, one can also resort to dynamic radiographs

With the'Electromyography (EMG) the electrical activity of the various muscles of the arm is recorded, looking for one or more areas of suffering linked to the compression of the nerve roots. 

I Somato-Sensitive Evoked Potentials (PESS) or Motor (PEM) instead, they record motor and sensory electrical activity through the spinal cord.

Cervical disc herniation C3C4 (MRI)
Cervical disc herniation C5C6 (MRI)

Cervical disc herniation: when to operate?

Surgery is not necessarily the right therapy for a cervical herniated disc. Once the patient's pathology has been thoroughly studied, it is the specialist who evaluates the correct treatment path. If no severe symptoms occur, such as paresis or paralysis, or the signs of a spinal cord compression, it is advisable to follow one first pharmacological and / or physiotherapeutic therapy. About 80% of patients with cervicobrachialgia benefit from taking pain-relieving, anti-inflammatory and steroidal drugs, or even see the symptoms resolve spontaneously.  That is why, in conjunction with an analgesic (pain management) therapy, the neurosurgeon typically waits a month or two from the first symptoms before proposing a surgery. This can become urgent in case of paralysis or myelopathy. If these more serious manifestations are absent, but the pain is persistent and impacts on the quality of life, the opportunity for an intervention of discectomy e cervical arthrodesis or cervical arthroplasty.

Explanatory video on cervical disc herniation (in English)

Explanatory video on cervical radiculopathy (in English)

Dr. François LECHANOINE

Senior Consultant Neurosurgeon, specialist in Cerebral, Vertebral minimally invasive and pediatric surgery, at the Maria Cecilia Hospital in Cotignola, the Piccole Figlie Hospital in Parma and the Domus Nova in Ravenna, highly specialized hospitals, accredited by the NHS and affiliated with most of the international insurance circuits .

Secretariat: open from Monday to Friday from 09:30 to 13:00 and from 15:00 to 18:00

 (+348) 916 3317 XNUMX

Studies: Milan, Rome, Naples, Caserta, Bari, Mola di Bari, Domegge di Cadore, Ravenna, Castrocaro Terme, Fermo.
 

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