Problems of the Cervical Spine
The height of the disc maintains the separation distance between the adjacent bony vertebral bodies. This allows motion between the vertebrae to occur, with the cumulative effect of each spinal segment yielding the total range of motion of the spine in any of several directions. Proper spacing is also important because it allows the intervertebral foramen (the opening the nerve must pass through) to maintain its size, which allows the individual nerve roots room to exit without being compressed or "pinched."
Shock absorption allows the spine to compress and rebound when the spine is stressed during such activities as jumping and running. Importantly, it also resists the downward pull of gravity on the head and trunk during prolonged sitting and standing.
The elasticity of the disc allows "motion coupling" so the spinal segment may flex, rotate and bend to the side all at the same time during a particular activity. This would be impossible if each spinal segment were locked into a single axis of motion.
The jelly-like central portion of the disc is called the Nucleus Pulposus. It is composed of 80% to 90% water. The solid portion of the nucleus is a very special type of connective tissue.
The outer ligamentous ring around the Nucleus Pulposus is called the Annulus Fibrosus, which completely seals the nucleus, and allows pressure inside the disc to rise as the disc is loaded. The annulus has overlapping radial bands, not unlike the plies of a radial tire, and this allows forces to be handled by the annulus without rupture under normal stress.
The disc functions as a hydraulic cylinder. The annulus interacts with the nucleus. As the nucleus is pressurized, the annular fibers serve a containment function to prevent the nucleus from bulging or "herniating." The gelatinous nuclear material directs the forces outward, and the hoops of annular fibers help distribute that force without injury.
Pain Caused by the Disc
Cervical disc disease can cause pain and other symptoms in two ways:
1. Herniated disc
If the annular fibers stretch or rupture, allowing the pressurized nuclear material to bulge or herniate and compress nerves, arm and shoulder pain and weakness may result. This is the condition called a pinched nerve, slipped disc or herniated disc. This condition will typically cause radiating arm pain as a result of the irritation against the nerve root.
The overwhelming majority of patients with a herniated cervical disc heal without surgery. If surgery is indicated, it involves removal of the portion of herniated disc material, such as a discectomy or microdiscectomy.
2. Degenerative disc disease
Improper movement over time as well as trauma from an accident can also cause disc degeneration and pain. For example, the disc may be damaged as the result of some trauma that overloads the disc, and portions of the annular fibers may tear. These torn fibers can then cause an inflammatory response when they are subjected to increased stress, and may cause pain, directly or indirectly, by muscle spasms as the neck muscles try to compensate. When there is compression of the spinal cord, caused by arthritis, bone spurs or narrowing of the spinal canal, a condition called cervical spondylotic myelopathy (CSM) can occur.
A cervical myelogram is a test in which the radiologist places X-ray contrast (X-ray dye) into the fluid-filled sac that surrounds the lower cervical nerve roots.
For a cervical myelogram, you will be placed on your stomach on the X-ray table with a rolled-up blanket or pillow under your mid-section to produce a gentle curve in your back. This helps to spread the backbones apart. Your skin is then cleansed and anesthetized. A very thin needle is placed between the backbones until the tip of the needle is in the fluid-filled space that surrounds the spinal nerves. Approximately 10 to 12 ccs of X-ray contrast is introduced through the needle. X-ray films are then obtained.
Following the myelogram, you will go to the CT Scan Room for additional X-ray pictures.
The entire procedure takes approximately one hour, with one-half hour in each room. After the CT myelogram, you will be brought back to your chair. An additional hour of recovery in this department is advised to allow for rest, initiation of fluids and explanation of your discharge instructions.
When you go home you are to stay on complete bed rest for a full 24 hours after the myelogram. You are encouraged to drink fluids in excess. By following these instructions, you will help to prevent the most common adverse effect of a myelogram, which is the possibility of a headache.
A post-myelogram headache can occur when the small puncture hole in the fluid-filled sac does not heal, and allows for the leakage of spinal fluid out of the hole. Bed rest will help the small puncture hole to close, and the excess fluids will allow your body to keep up with the loss of the small amount of spinal fluid that may leak out of the hole.
Conservative Treatment Options
Conservative treatment options for your cervical, thoracic and/or lumbar spine may include one or all of the following:
When conservative treatments fail to help your spinal condition, a surgical consultation is recommended to determine what surgical options are available.
- Physical therapy
- Psychological/emotional biofeedback
- Injections/nerve blocks
- TENS unit
- Muscle stimulators
- Pain management
- Body mechanics
- Aquatic therapy
- Body braces for the spine
Understanding Cervical Discectomy and Fusion
Injury, arthritis, wear and tear, and poor posture can damage the discs in the cervical or neck area of the spine. This damage can cause the disc, which is located between two vertebrae, to "bulge," placing pressure on nerves, nerve roots or spinal cord, resulting in severe pain and numbness in the neck and arms. To relieve this condition, a surgical procedure called a cervical discectomy may be performed. Basically, the "bulging" or herniated disc is removed and the pressure on the other structures is eliminated. In many cases, the surgeon will join together or fuse the affected vertebrae to add stability to the neck. This can be done using a bone graft alone or with other devices. The doctor will most often reach the cervical spine through a small incision in the front of the neck (anterior), though in some cases, the incision will be in the back (posterior) of the neck.