Murphy Law Firm

A Quick Overview of the Spine:

Your spine, or backbone, consists of the column of 33 bones and tissue that extends from your skull down to your pelvis. Providing the support of your head and body, your backbone encloses and protects a cylinder of nerve tissues, called the spinal chord. The 33 bones in your spine are called vertebrae (one is called a vertebra). The upper 24 vertebrae join together like links in a chain. In between each vertebra is an intervertebral disk, a band of cartilage that acts as a shock absorber between the vertebrae. When someone has a “slipped disk,” he or she has an intervertebral disc that has slipped out of position, thus causing friction between two vertebrae and extreme pain from nerves being exposed. The lowest nine vertebrae are fused (joined) together in two groups, forming the sacrum and coccyx.

The cervical vertebrae are the seven vertebrae that form the upper part of your spine, between the skull and the chest. The thoracic vertebrae are the 12 bones between your neck and your lower back. Thoracic vertebrae have cup-shaped surfaces called facets, in which the ribs rest and connect to the spine. These ‘joints’ help the ribs to move up and down during breathing.

The lumbar vertebrae are the five largest and best of all vertebrae. They are found in your lower back between the chest and hips. The muscles of the back are attached to the lumbar vertebrae.

Your sacrum and coccyx are the bones found at the base of your spine. The triangular sacrum - made up of five vertebrae fused together - supports the spine and connects it to the pelvis. Your coccyx, or tailbone, is formed from four fused vertebrae and has little function.

The vertebral foramen is the hollow part of the vertebrae where the spinal chord (nerve tissues) attaches to your brain and sends signals all over your body.

What is Cervical Disk Herniation?
The vertebrae in the neck area of the spine, known anatomically as the cervical vertebrae, are separated by flexible disks of shock absorbing cartilage. These disks have a soft gelatinous core (known as the nucleus) and are made of flexible fibrous tissue. An injury to one of these disks, known as disk herniation, may result in pain and the compression of nerve roots or the spinal cord.

Herniated disks are often referred to as ‘slipped,’ or ‘ruptured’ disks. With a herniated disk injury, the nucleus tissue located in the center of the disk is forced out of position. While the disk itself does not ‘slip,’ pressure on the core of the disk may be so b that a fragment of the nucleus herniates or ruptures out of the outer layer (the annulus) of the disk. Because the spinal canal into which this fragment moves has limited space, a herniated cervical disk presses against spinal nerve roots or against the entire spinal cord.

Causes of Cervical Disk Herniation?
Most disks that become herniated are in an early stage of degeneration. Beginning at about age 25, the disks of the spine begin to dehydrate, losing their elasticity. This makes them more vulnerable to minor injury and the normal stresses of daily life. At around age 45, with narrowing of the disc, fibrous tissue begins to form around the intervertebral disks, making them more stable and less likely to be damaged by herniation.

Damage to a disk may also result from a sharp bending or twisting movement, or from improperly lifting a heavy object. Sometimes traumatic injury is involved.

The disks of the thoracic section of the spine, immediately below the cervical vertebrae, may also become herniated, though this is a fairly uncommon back injury. It is much more likely for the disks of the lower back, in the lumbar region, to be affected by herniation.

Symptoms of Cervical Disk Herniation?
When a disk herniates, the surrounding tissues become swollen and inflamed. Both the tissues and the disk may press against a spinal nerve or the spinal cord, resulting in pain, numbness, or other discomforting sensations. Pressure on the spinal cord affects the ability of the nerves to send and receive messages from the brain to the systems of the body that control sensory, motor, and autonomic function. Recurring pain, numbness, or weakness in one of the arms, as well as in the neck area, is a common symptom of cervical disk herniation.

A herniated cervical disk usually limits motion of the neck and head, and is aggravated by bending or turning the neck. Pain also may radiate into one arm, in a pattern characteristic of the particular nerve root involved. Many patients find some relief by holding the arm elevated and behind the head, as this position reduces tension on the nerve root. Patients often indicate that the pain was first noticed upon waking up, without identifiable trauma or any other precipitating event.

In those patients with chronic and progressive cervical disk herniation and or arthritic changes of spinal stenosis, a condition known as myelopathy may result. These people may experience hyperactive or pathological reflexes, as well as a spastic gait. In extreme cases of spinal cord compression, sphincter and sexual function may be compromised as well. Sometimes there is a sensation of generalized weakness in the hands and arms, or a feeling of heaviness in the legs accompanied by obvious difficulty walking usual distances or up stairs.

A herniated cervical disk is typically preceded by an episode of neck pain or a long history of intermittent episodes of neck pain. In about two thirds of all cervical herniations, the C6-7 disk is the one involved. The C5-6 disc is affected about 20% of the time, with C7-T1 about 10%, and the C4-5 about 2%.

Diagnosis of Cervical Disk Herniation?
Treatment for cervical disk herniation begins with making an accurate diagnosis, distinguishing this condition from others that may produce similar symptoms. The doctor may ask you to move your neck, arms, and shoulders in specific ways while administering tests to aid the physical diagnosis.

The radiographic evaluation of a suspected spine disorder begins with plain X-rays. While a herniated disk will not be seen on X-ray (being composed of soft tissue rather than bone), other associated changes may be seen, such as the characteristic bony ridges of cervical spondylosis. X-rays also allow the doctor to accurately assess the alignment of the spine.

MRI (magnetic resonance imaging) scans offer a view of soft tissues in the neck, showing good definition of the disk, cord compression, and root compression. Sometimes, when it is necessary to observe more bony detail, a myelogram/CT scan is used.

If x-rays or other imaging tests show that your particular case of cervical disk herniation is severe, involving compression of nerve roots or the spinal cord, your doctor may refer you to an orthopedist or neurosurgeon surgeon for further evaluation.

Treatment of Cervical Disk Herniation?
After determining the severity of your condition, your doctor will advise you regarding forms of treatment. Conservative methods, involving bed rest, pain medication, and physiotherapy, are normally pursued as a first course of treatment. The majority of disk herniations (90%) do not require surgery, and will resolve with non-operative treatment. Features of conservative treatment typically include:

resting the neck area by maintaining a comfortable posture and painless activity level for period of a few days to several weeks, sometimes using a cervical collar or neck brace
using non-steroidal anti-inflammatory medication
an epidural steroid injection may be performed in cases of severe pain, utilizing a spinal needle under x-ray guidance to direct the medication to the exact level of the disk herniation
a physical therapist may develop a course of rehabilitation based on successful modes of treatment, such as traction, ultrasound, electrical muscle stimulation, whirlpool, and so on, proven beneficial to herniated disk patients

Non-steroidal anti-inflammatory medications such as aspirin, acetaminophen or ibuprofen may be recommended to decrease swelling and relieve pain. Sometimes time-released medication is most effective. While other painkillers may be prescribed, narcotic pain medication is generally avoided.

Patients who have a severe episode of pain may benefit from a single treatment of a steroid epidural, injected directly into the affected part of the neck. This form of treatment can often relieve the situation to such a degree that other treatment measures can then be put into place.

Surgical Treatment of Cervical Disk Herniation?
Surgical procedures may be considered in the event that conservative therapy does not bring about sufficient pain relief. Surgery should also be considered when there is significant compression of the spinal cord with signs of cord dysfunction or myelopathy as these symptoms and signs may be permanent even after surgical decompression.

Surgical treatment for herniated cervical disks varies according to the severity of the injury. One method is known as microdiskectomy. It involves the open removal of the part of the herniated disk that puts pressure on the spinal cord.

Another common surgical method is known as anterior cervical decompression and fusion. Like microdiskectomy, this is a major operation involving open incision, dissection of muscle and tissue, and possible bone graft procedures. Both operations involve a hospital stay of 3 to 5 days. Many patients may be up walking the same evening or the next morning after surgery. Some discomfort when swallowing, from retracting the esophagus, commonly occurs, but this is usually a mild and transient symptom.

Patients who have sustained one disk herniation are at increased risk statistically for experiencing another. Approximately 5% of the time the herniation recurs at the same level; more rarely, there may be a new disk herniation at another level. Many of the factors involved in disk herniation are related to one’s level of physical conditioning and work or behavioral habits. People who are overweight have an increased risk of disk herniation, as do those who attempt strenuous physical labor (such as moving heavy objects) when they are out of shape.

People who have experienced a herniated disk, whether treated conservatively or with surgery, are advised to become knowledgeable about caring for their backs: using proper lifting techniques, practicing a specific set of stretching and strengthening exercises, and modifying their activities to protect the backbone. All of these measures may significantly reduce the chance of repeated injury to the spine.

Major surgery for cervical disk herniation usually requires a recovery and rehabilitation period of at least 4 to 6 weeks. A spine operation may involve the specialized skills of both an orthopedic surgeon, whose expertise concerns bones and joints, and a neurosurgeon, someone familiar with spinal cord injuries.

Possible Complications of Cervical Disk Herniation?
Outcomes of surgery for cervical disk herniation are dependent on the state of one’s general health, including mental and emotional health. It is important to work with your doctor to decide on the most effective treatment procedures, evaluating and comparing the risks of surgery with the expected benefits.

The use of alcohol, tobacco, or drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers, and corticosteroids, increases surgical risk.

Although surgery for cervical disk herniation is usually without any significant problems, there may occasionally be unforeseen complications associated with anesthesia, including respiratory or cardiac malfunction. The surgery itself may be complicated by infection, injury to nerves and blood vessels, fracture, weakness, stiffness or instability of the joint, pain, or the need for additional surgeries.

Serious neurological complications are very rare with contemporary surgical techniques. At least 90% of patients experience improvement in symptoms of neck and arm pain, with about 80% showing improvement when weakness of the leg is involved.

Surgery should always be undertaken when the patient is in the best possible health, with any other chronic conditions under effective management. Follow your surgeon’s directions carefully before and after any surgical procedure, keeping in mind that recovery depends not on surgery alone but also on commitment to the rehabilitation process.

The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician.

info obtained from:
http://www.dynomed.com