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Cervical Disc Herniation Treatment in Portland, OR

Anatomy of Cervical Discs

Cervical discs, like discs throughout the spine, consist of a strong outer ring of collagen (the annulus) that holds a softer, spongier portion of inner disc (the nucleus). In cervical disc herniations a portion of the outer annulus tears and some of the inner nucleus herniates, or pushes out. When a disc herniates it can place pressure on a nerve or the spinal cord.

Causes

Most cervical disc herniations occur without a precipitating cause. A blow to the head, a motor vehicle accident, or rapid twisting injury can cause a herniation.

Symptoms of Cervical Disc Herniation

Most cervical disc herniations present initially with neck pain that resolves over days to a few weeks. If a nerve is pinched, however, pain near the scapula or shoulder-blade is common. Numbness, tingling, or pain in the arm or hand can occur. Occasionally, patients will experience weakness. Symptoms are frequently worse during neck extension and head tilt toward the painful arm. Patients may find relief by raising the arm and placing one's hand on the head, because the stretch on the nerve is minimized.

If the disc herniation compresses the spinal cord, myelopathy can result. Symptoms may include arm or leg weakness or numbness, bowel or bladder incontinence, difficulty using the hands, and trouble with balance.

Treatments for Cervical Disc Herniation

Most cervical disc herniations will resolve spontaneously over two to six weeks. The herniated piece of disc begins to shrink and the nerve is no longer irritated. Early treatment involves heat or ice, anti-inflammatory medicines (such as ibuprofen or steroids), muscle relaxant medicines, and narcotics. Physical therapy, including cervical traction, can help reduce pain.

If more conservative treatments fail, epidural injections are a minimally invasive way to help with arm pain. Steroids are injected around the irritated nerve under x-ray guidance.

Finally, surgical intervention is considered when symptoms last for several weeks without improvement, there is weakness in the arm that does not improve, or the spinal cord is compressed (myelopathy). If the disc is herniated to the side of the spinal cord, surgery may be performed through the back of the neck. The surgeon removes only the herniated fragment of disc (posterior cervical foraminotomy). Surgery is more commonly performed from the front, or anterior approach. This operation involves removing the entire disc and performing a cervical fusion or disc replacement. Overall, surgery is highly effective in relieving scapular and arm pain, with success rates above 85%.

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