Cervical Disc Herniation

April, 2020 Neck Pains

The cervical discs are elastic pads that are built to facilitate the movement of the vertebrae. Cervical disk extrusion occurs when the gelatinous material of the disc nucleus protrudes from the outer wall of the cervical disc.

Symptoms

The most prominent symptoms of cervical disc herniation are:

Radicular  pain from neck to arm and fingers

Paresthesia or muscle weakness in the shoulder, arm and fingers

Etiology

Genetic factors, aging, trauma.

Diagnosis:

Imaging : Imaging tests provide complete information about the vertebral and spinal cord and arthritis problems, including

Cervical x-ray : to evaluate infection or bone mass and degenerative changes.

Computed tomography :CT scans can be used for evaluate bones.

MRI : Used to examine soft tissues including discs and spinal nerves .

Nerve and muscle function test (EMG&NCV) :It is used to determine the      physiological function of the nerves and muscle

Treatment

The basis of cervical disc treatment is not only to relieve pain and symptoms but also to relieve disc herniation and pressure on the nerve roots.

Rest : Rest should only be relative

Cervical collar : Temporary closure of cercical collar is recommended only in cases of highly advanced discs that cause canal stenosis and the risk of spinal cord injury. Prolonged use of the neck can weaken the spine muscles, leading to greater trauma transmission and greater advancement of osteoarthritis and disc herniation.

Medications : Medications are used to relieve symptoms in the acute phase, as well as to restore muscle strength and relaxation, including muscle relaxants (peripheral and central), anti-inflammatory analgesics, and in severe cases, limited usage of opiate drugs. In the non-acute phase of arthritis, combined soy and avocado medications can also be used to prevent the progression and recovery of arthritic lesions.

Non Invasive Treatment :

1) Physiotherapy:

In physiotherapy, a combination of passive techniques and exercises is used to strengthen muscular structure and corrective movements. Passive therapeutic modalities such as ice / heat, ultrasound and electrical stimulation relieve pain and cramps in a patient with a cervical disc. The patient with neck dislocation protects the muscles by increasing the flexibility and range of motion by performing specific exercises. Patients do not have to worry about switching to this treatment, even patients with pain and movement problems benefit from isometric exercises.

2) Massage and Manual Therapy and Manipulation:

The basis of these techniques performed by hand also strengthens the muscular structure of the tissues around the vertebrae.

3) Power laser:

The use of high-power pulse laser will increase cellular energy and repair damaged tissues and prevent the progression of arthritis.

INTERVENTIONAL PAIN PROCEDURES:

Interventional procedures are performed by a pain specialist under the guidance of X-ray (fluoroscopy) or ultrasound in the operating room.

1) Diagnostic and therapeutic injections:

Spinal injections such as combined steroids and topical anesthetics in the epidural space are used to reduce inflammation and neutralize the chemical  inflammatory mediators (caused by disc pressure),also in this case epidural radiofrequency in  these areas can be used to improve and prolong changes in addition to injections.

2) Interventional intradiscal procedures:

In these procedure a fine needle is inserted through a X-Ray (fluoroscope) guidance into the center of the disc, using chemical agents (Discogel) or Laser or Radifrequency to decrease intradiscal pressure which results in reduced pressure and protrusion of the disc.

 

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