A cervical fusion (fixing cervical vertebrae)

or disc prosthesis (artificial joint in the neck) can be avoided with endoscopy.

Cervical disk herniation animation:

What are the symptoms of a cervical disc hernia ?

shoulder blade, shoulder & ARM pain:

With a disk herniation there is often radiating pain towards the shoulder and arm, sometimes to the fingers. The complaints are then only present in one arm. The irradiation is sometimes preceded by a short period of sudden severe neck pain or stiff neck. Most complaints of a disc herniated disc are in the arm. The place where the pain appears depends on which nerve is pinched in the neck. There is a big difference between pure neck pain and neck pain with radiation to an arm. The radiation to the arm is also referred to as 'cervicobrachialgia'. The radiating pain increases when coughing, sneezing and head and neck movements. With symptomatic herniated disks in the neck there is typically severe ARM pain.

The severity of the symptoms depends on how much pressure the hernia causes on the nerve or the mylon. In addition to arm pain, reduced strength in the shoulder, arm or fingers and sensory disturbances such as tingling, burning or deafness can also be caused by a hernia. With extremely large hernias, the radiation can also be present in the legs, making walking more awkward.

NEcK pain:

A typical story of a patient with complaints caused by a disc hernia is the development of sudden severe neck pain with or without a stiff neck, which disappears spontaneously and often completely after a week. In the following weeks the radiating pain (to the shoulder blade, shoulder, arm or fingers) occurs.

The neck pain in a cervical hernia is usually not directly caused by the disc disorder but by the cramping of the back muscles.

What is a herniated disk ?

HOW DOES THE HERNIated DISC ARISE?

In between all vertebrae an intervertebral disc serves as a shock absorber. Its main function is to absorb movement and shocks like a "shock absorber". This disc consists of an outer ring ("annulus fibrosus", often called "annulus") containing a kind of soft core ("nucleus pulposus") consisting of jelly-like tissue.

A herniation caused by a tear in the outer ring where the nucleus can protrude outside the disc through this opening.

What if the cervical herniation compresses a nerve?

If a tear occurs in the outer ring, neck pain occurs. If the tear is large enough, gel escapes from the disc and a disc herniation hernia devellops. If this herniated disc also 'accidentally' compresses a nerve, the cervico-brachalgia, the typical arm pain is evoced.  

WHAT IF A HERNIAtion DOESN'T PRESS ON A NERVE?

A cervical disk herniation can also protrude without compressing a nerve. In that case there is only neck pain, which usually disappears spontaneously after about ten days. This is why we often see hernias on a scanner, without any complaints of arm pain. These 'gentle' hernias can be regarded as a normal ageing process and are usually only responsible for a sore neck.  

Do I have a herniation or a bulging disc?

Another form of disc wear is the "bulging disc". With a bulging or "bulging" of the shock absorber there is generalized an broad bulging of the disc. With every movement of the spinal column, the mobile disc starts to bulge

A bulging disc is also very common and can to some extent be regarded as a normal wear and tear process of the neck. This bulging occurs slowly and does not usually oppress the nerves.

They are syptomatic thy mostly cause of episodic neck pain, they do not usually give rise to arm or leg pain.  Bulging discs do not evolve to disk herniations. A very large bulging can cause a narrowing of the canal.

However, the bulging disk and disk herniation can be CLEARLY seen on a scan. If they not compress nerves they are considered as normal aging.

So it's not that all of these are also the cause of symptoms. Usually this can be regarded as an 'accidental finding' on imaging. Almost 70% of the people do have one or more non-compressive herniations or bulging: this without having neck complaints.

What are the causes of a herniated disk?

• A congenital weakness of the intervertebral disc tissue. This means that in some families back problems occur more often and already at a younger age. Smoking causes accelerated wear and tear of the intervertebral discs.

• Smoking increases the chance of developing a herniated disc and also makes it more difficult to heal.

• Lack of exercise weakens the trunk muscles. These muscles are the 'active' shock absorbers that release the 'passive' shock absorber from the disc. In the absence of call muscles, the disc must absorb all forces and is therefore more sensitive to injuries.

A continuous overload in combination with the natural aging process causes the intervertebral discs to show signs of wear and tear. The pressure on the back is greatest at the level of the lower intervertebral discs, which is why hernias occur most frequently on the two lower links of the back. Therefore, 90% of all hernias occur between L4 and L5 or L5 and S1. 

When the disc is weakened, sudden twisting or increased load can cause a herniated disc. A violent cough or sneeze can also cause an acute herniated disk 

Between the age of 20 and 40 there is a higher risk for development of a herniated disc. At a later age, the jelly of the nucleus becomes too dry and stiff to be able to slip through a crack in the outer ring.

What are the possible treatments for a neck herniation ?   

The treatment is at first almost always 'conservative', which means as much as therapy without surgery. An attempt is made to help reduce or eliminate the pain symptoms as quickly as possible.  The most important first target of this therapy are the complaints in the leg. After thorough examination of the patient, a treatment plan is drawn up. Often the first therapy is a combination of medication and continued normal activities. Resting is not a treatment for back related complaints. It may be beneficial because the muscles relax, but it has been scientifically proven that this only weakens the trunk muscles. The back then weakens instead of healing. 

Taking sufficient pain medication, keeping moving and picking up normal life as soon as possible is the best advice. 

With some people the pain doesn't diminish or the symptoms are too severe. Then transforaminal infiltrations can be prescribed. Under local anaesthesia a cocktail of analgesic and anti-inflammatory drugs is injected through the lateral ventricles (the "foramina"). The aim of this is to cause the hernia and nerve to swell, so that the pinching of the leg nerve and thus the leg pain disappears. Usually, two transforaminal infiltrations are given over a period of three weeks. These infiltrations are carried out in our centre by experienced anaesthetist-algologists. They require a short hospital stay of two hours. If necessary, they can be organised at relatively short notice by the referring specialist. 

If these treatments do not help or in case of paralysis symptoms, it is sometimes decided that an operation becomes necessary. In our department they are extremely minimally invasive. By means of a keyhole surgery of the back: the full endoscopic cervical discectomy can efficiently treat the various causes of leg pain in the back. These are the least invasive procedures possible, which efficiently remove the hernia without collateral tissue damage.

A cervical fusion (fixation of cervical vertebrae) or disc prosthesis (artificial joint in the neck) can be avoided.