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Cervical Disc Herniation




One of the most important aspects of assessment in massage is to determine if it's appropriate to work on a specific condition. While massage is safe in most cases, there are some instances where harm can be done if inappropriate treatment is applied.

A cervical disc herniation is just such a condition. It's important to identify this condition, as it also should be evaluated by another health professional to make sure massage is appropriate. However, if performed appropriately, there are some beneficial massage approaches.

Cervical Disc Herniation Surgery India, Cost Spinal Disc Herniation India, Cervical Disc Replacement Surgery, Cervical Disc Herniation Treatment Hospitals, Cervical Disc Herniation Surgery Center A herniated disc (also called herniated nucleus pulposus or HNP) results from sudden or long-term compression loads on the spine. Herniations are more common in the lumbar region than in the cervical, but can still produce significant pain or disability when they occur. Cervical disc herniations produce pain or neurological dysfunction in the neck or upper extremities. They are relatively common and frequently occur in asymptomatic individuals, so presence of a herniated disc does not necessarily imply a pathological problem.

Cervical Disc Herniation Causes

The most common symptom of a cervical disc herniation is neck pain that radiates (spreads) down to the arm in various locations. The specific location of the arm pain depends on which disc is involved. There can also be associated paresthesias (pins and needles) and in some cases weakness of some of the arm muscles.

Patients find that turning their head away from the painful side helps. Extending the head makes the pain worse so that looking up is avoided. Bending the head down usually gives some relief. Most of the symptoms of a disc herniation are related to pressure on a specific nerve root. Rarely, large disc herniations can cause pressure on the spinal cord. Pressure on the spinal cord can result in a problem called cervical myelopathy. It can cause among other things spasticity which can present as problems walking.

Cervical Herniated Disc Symptoms

Arm pain from a cervical herniated disc is one of the more common cervical spine conditions treated by spine specialists. It usually develops in the 30 - 50 year old age group. Although a cervical herniated disc may originate from some sort of trauma or injury to the cervical spine, the symptoms, including arm pain, commonly start spontaneously.

The arm pain from a cervical herniated disc results because the herniated disc material “pinches” or presses on a cervical nerve, causing pain to radiate along the nerve pathway down the arm. Along with the arm pain, numbness and tingling can be present down the arm and into the fingertips. Muscle weakness may also be present due to a cervical herniated disc.

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Forearm flexion

Wrist extension




Upper arm, thumb

Middle finger, all fingertips

Ring and little fingers

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These symptoms can be present in varying degrees and may not be present in all patients. If symptoms do not improve with conservative (non-surgical) treatment or are very severe, an imaging study may be ordered. An MRI of the cervical sign is a very sensitive test for cervical disc herniation. In some cases it may be necessary to continue with a cervical myelogram and post-myelogram CT scan. Some patients may also undergo electromyography and nerve conduction velocity testing (EMG/NCV).

Cervical Disc Herniation Diagnosis

As always, a careful history and physical examination are the first steps in diagnosis. The symptoms of a cervical disc herniation are always on the same side as the disc herniation. In other words a right sided disc herniation between the fifth and sixth cervical vertebrae will always cause pressure on the right sixth cervical nerve root.

Diagnostic Tests for a Cervical Herniated Disc :

After the initial exam, special diagnostic imaging tests may be required to better diagnose a cervical herniated disc.

MRI Scan to Identify a Cervical Herniated Disc
The single best test to diagnose a herniated disc is an MRI (Magnetic Resonance Imaging) scan. An MRI scan can image any nerve root pinching caused by a herniated cervical disk.

CT Scan with Myelogram to Identify a Cervical Disc Herniation
An MRI is the best first test, although occasionally a CT scan with a myelogram may also be ordered, as it is more sensitive and can diagnose even subtle cases of nerve root pinching.

Cervical Disc Herniation Treatment

The treatment of cervical disc herniation can be divided into two categories, conservative (non-surgical) and surgical. In some rare cases of very large disc herniation causing significant pressure on the spinal cord, surgery may be considered the conservative option.

Cervical Disc Herniation Surgery India, Cervical Disc Herniation Treatment Hospitals, Cervical Disc Herniation Surgery Center, Cost Spinal Disc Herniation India, Cervical Disc Replacement Surgery In general, conservative management consists of maneuvers to reduce pressure on the nerve root. Immobilization with the neck in a flexed forward position may be helpful. Straining should be avoided. Medication in the form of an anti-inflammatory such as aspirin, ibuprofen, naproxen, celebrex or vioxx may be taken. As these medications have side effects, patients should carefully read the package material or consult their doctor if taking any medications for longer than a few days. Physical therapy may be prescribed. This can consist of traction, mild stretching, exercise, heat, massage and ultrasound. These can be using in various combinations depending on the patient. A course of home cervical traction may be helpful. In some cases, a referral may be made to a pain management specialist or a physiatrist. These are doctors with special training in the diagnosis and treatment of pain. Various injections in and around the cervical spine can be performed. The particular type of injection depends on the individual patient. Up to 95 percent of patients will get better without the need for surgery.
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Surgical treatment is reserved for patients who exhibit the signs and symptoms that require urgent decompression, patients who can not or do not wish to spend the time to allow conservative approaches to work and patients who have failed conservative management after a reasonable amount of time (six to eight weeks). Surgery for cervical disc herniation is divided into two approaches, anterior (from the front) and posterior (from the back). Since the disc is located in front of the spinal cord, the anterior approach is the more direct approach. The most common anterior operation is the anterior discectomy and fusion (ACDF). The disc is removed and usually replaced with a small piece of bone (either from the patient's hip or from cadaver donor).

Sometimes, metal plates and screws may be used to assist the fusion. Depending on the type of surgery performed, a cervical collar may need to be worn for anywhere from a week to twelve weeks. The posterior approach is much less commonly performed. In this operation, a small amount of bone is removed from the back of the spine over the affected nerve root. Gentle retraction may allow removal of a soft disc. Few surgeons perform this operation.

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