The cervical spine consists of seven vertebrae, which are named C1 to C7 (C stands for cervix, Latin for throat or neck). Between these vertebrae are intervertebral discs, which are water-containing buffer discs with a firm fibrous ring. A herniated disc in the cervical spine refers to damage to one or more intervertebral discs in this section of the spine. It is also known as a cervical disc herniation. This can be associated with a narrowing of the spinal canal in the cervical spine, known as spinal canal stenosis. There is often shoulder and neck pain, which can radiate into the arms and hands. Neurological symptoms such as gait disorders are also possible. Here you will find further information and selected clinics for herniated discs in the cervical spine.
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Brief overview:
- What is a slipped disc in the cervical spine? A herniated disc, i.e. the protrusion of disc material from the spaces specifically between the vertebrae of the cervical spine.
- Cause: A congenital weakness in the connective tissue means that the disc tissue is less elastic and stable and can therefore become displaced.
- Symptoms: Shoulder and neck pain often occurs. Motor problems, such as gait disorders, can also occur.
- Treatment: A herniated disc in the cervical spine can be treated conservatively. The patient is given pain-relieving medication and undergoes physiotherapy.
- Surgery: Surgery is necessary if conservative measures are unsuccessful. The damaged disc is removed and either replaced with a prosthesis or the adjacent vertebrae are fused together.
- Risks of surgery: If surgery is not performed carefully, disc residues in the spinal canal can be overlooked, and nerve injuries or bleeding are also possible.
- Aftercare: Conservative therapy is followed by physiotherapy. Three weeks of rehabilitation is often necessary after surgery.
- Prognosis: In most cases, conservative treatment is sufficient to cure the condition in the long term. In severe cases, however, healing can take considerably longer and permanent damage is possible.
Article overview
- What is a slipped disc in the cervical spine?
- Causes of a herniated disc in the cervical spine
- Symptoms and diagnosis of cervical disc herniation
- Treatment for herniated discs and spinal canal stenosis in the cervical spine
- Aftercare for a herniated disc in the cervical spine
- Healing prospects for a herniated cervical disc
What is a slipped disc in the cervical spine?
The seven cervical vertebrae are located at the top of the spine and support the skull, with which the top two cervical vertebrae form the upper cervical joint .
In the case of a herniated disc in the cervical spine, disc tissue from the gelatinous nu cleus protrudes backwards out of the disc through the fibrous ring of the disc (annulus). The disease is listed under the ICD code M50.
This type of disc damage can occur in any of the 24 intervertebral discs in the spine. The lumbar spine is most severely affected. Herniated discs in the cervical spine (cervical spine) are also a common disease, especially in middle age.
This diagram shows the disease mechanism of a herniated disc in the cervical spine © Henrie / Fotolia
A distinction is made between
- disc prolapse (herniation), in which the fibrous ring breaks open and allows the inner nucleus to escape,
- disc protrusion , in which the disc is deformed while the fibrous ring is still intact.
If a larger part of the prolapse is displaced into the spinal canal, this is referred to as a free sequestrum. In either case, pressure is exerted on the spinal nerves, leading to pain and neurological deficits.
The different stages of a herniated disc © bilderzwerg / Fotolia
Causes of a herniated disc in the cervical spine
The cause is primarily a congenital weakness of the intervertebral disc tissue. The tissue is less elastic and stable.
Intervertebral discs themselves are not supplied with blood and only receive their nutrients through tissue fluid, which is regularly pressed in and out during movement. During sleep, the intervertebral discs regenerate by reabsorbing water - after all, they consist of 90% water.
Over the course of a lifetime , the intervertebral discs and bony vertebrae age. The ability of the intervertebral discs to regenerate decreases. The vertebrae now react to incorrect loading with wear and ossification of the small vertebral joints (facet syndrome or spondylarthrosis). The video shows these symptoms:
These wear and tear diseases of the spine are also known as spondylosis. They can narrow the spinal canal, which is formed by the round recess in the middle of the vertebrae. So-called spinal canal stenosis results in a lack of space. This in turn has a negative effect on the spinal cord and the spinal nerves that branch off from it.
Nerve compression and pressure on the spinal cord cause severe pain.
Symptoms and diagnosis of cervical disc herniation
A fresh herniated disc can lead to acute compression of a nerve root. The pain then radiates along the nerve root to individual fingers. This radiculopathy can lead to loss of function, i.e. motor problems.
Shoulder and neck pain is common. Almost all patients also suffer from restricted movement of the cervical spine.
Shoulder and neck pain is one of the typical symptoms of a herniated disc in the cervical spine © detailblick-foto / Fotolia
Spinal canal stenosis in the cervical spine can cause neurological symptoms that are difficult to diagnose. Pressure-related changes in the spinal cord can also lead to gait disorders , for example.
Treatment for herniated discs and spinal canal stenosis in the cervical spine
A distinction is made between conservative and surgical treatment. The success rates of conservative therapy are good, especially in the cervical spine.
Conservative (non-surgical) therapy
A herniated disc is an acute inflammatory process with swollen tissue and nerve compression. In principle, a herniated disc can heal on its own and the leaking disc tissue is broken down by the body. This requires time and medical support.
Treatment begins with the administration of anti-inflammatory and pain-relieving medication (NSAIDs such as diclofenac and ibuprofen). Muscle relaxants (available on prescription, for example methocarbamol) and physiotherapy treatments help to relieve severe muscle tension. Manual therapy and local application of heat are generally well tolerated. A period of around 8 weeks should be planned for conservative therapy.
Highly effective and well documented in studies are
- Injections into the area of the affected nerve root and
- the technically demanding administration of medication into the spinal canal of the cervical spine.
Watch the video to see the procedure for interventional pain therapy for a herniated cervical spine disc:
Surgery for herniated discs and spinal canal stenosis in the cervical spine
Surgical removal of the intervertebral disc (nucleotomy) and the herniated disc is the treatment of choice for
- chronic complaints despite conservative therapy or
- acute disc herniation with paralysis.
Herniated discs in the cervical spine are mainly operated on from the front to remove the diseased disc.
In young patients without osteoarthritis of the vertebral joint
- intervertebral disc prostheses or
- stabilizing rings made of titanium or plastic, a so-called cage,
can be used to replace the defective disc. In middle-aged and older patients, a fusion of the adjacent vertebral bodies with a bone block or a placeholder is performed in place of the disc.
In the case of spinal canal stenosis in the cervical spine, the cause of the narrowing can also originate from structures on the back. In these cases, a so-called dorsal decompression is performed using various techniques. This involves removing or opening up bony vertebral arches to create more space for the spinal cord.
Possible complications and risks of surgical treatment
The indication for disc surgery must be made very carefully. Complication rates are then low and primarily relate to possible injury to the spinal cord skin or incorrect positioning of the space maintainer.
If the operation is not performed carefully with the aid of a microscope, disc residues in the spinal canal can be overlooked.
Bleeding or nerve injuries in the access area on the neck occur very rarely.
Aftercare for a herniated disc in the cervical spine
Conservative therapy or injection therapy should be followed by physiotherapeutic exercise treatment. It is important that the patient learns to do their own exercises regularly. In the case of previously damaged cervical spine structures, it is important to avoid strain, especially tensile strain, on the cervical spine.
Stretching shortened muscles is helpful for a physiological, i.e. healthy, posture. One-sided desk work in particular shortens the chest and arm muscles. Stretching exercises can help and should initially be carried out under professional guidance.
Physiotherapy is necessary to fully restore mobility © pololia / Fotolia
Operations on the cervical spine are generally very well tolerated and are only a minor burden for the patient. The postoperative hospital stay is usually limited to a few days.
A recovery and healing phase of around 6 weeks can be expected after the operation. The operation is often followed by three weeks of rehabilitation or follow-up treatment (AHB).
Healing prospects for a herniated cervical disc
In most cases, herniated discs in the cervical spine can be treated conservatively. Injections are the most effective. The relatively rare operations required for herniated discs in the cervical spine quickly relieve the pain and have a high success rate.
Spinal canal stenosis of the cervical spine is difficult to diagnose but has serious symptoms. It is therefore often recognized late. Surgery can then often only limit the damage, but no longer provide a cure.
In the case of diseases of an intervertebral disc in a segment, the chances of success are good with both conservative and surgical procedures. In the case of acute disc herniation, the pain can be treated very well both by injections and, in appropriate cases, by surgery. If nerve damage is not yet so severe, it will recover within a few months postoperatively.
If several segments - usually in the lower cervical spine - are affected by disc wear, only relief can be achieved.
In the case of severe spinal canal stenosis in the cervical spine with signs of spinal cord damage, permanent damage to the spinal cord may occur. Even if surgery is performed, this can only be partially reversed.