Herniated Disc in the Neck
To better understand what is a herniated disc in the neck, patients should first familarize themselves with the anatomy of the cervical spine. In the spinal column there are discs between each vertebra. These discs are made up of soft gelatinous material (the nucleus pulposus) that acts as cushioning, or shock absorption, for the spine. They allow a certain amount of flexibility to the spine’s movements without the risk of harder bony elements grinding against each other and causing damage. Each disc has a tougher outer fibrous shell (the annulus fibrosus) which is there to keep the disc in shape.
The Beginning of Disc Herniation
If these discs themselves become damaged, or misshapen, or if there is weakening and stretching of the outer fibers, the jelly-like center can protrude from its desired location between vertebrae and put pressure on the spinal cord and its nerve fibers. A severe bulging neck disc, with tearing of the outer layers of the disc is called a herniated disc in neck and involves the disc pushing into the spinal canal. In the case of a herniated disc in neck, the herniation occurs in the cervical spine (neck). All other herniated disc conditions, thoracic and lumbar, are called herniated discs in the back. Although quite uncommon, a herniated disc can occur in the thoracic region of the spine
see a disc that is herniated and pinching a nerve.
When a Bulging Disc becomes a herniated disc in neck
Bulging neck discs may remain asymptomatic for years and then become a herniated disc in neck upon acute stress or simply through prolonged degeneration of the outer fibrous casing. This can cause acute neck pain and possibly back pain, and radiating pain through the upper body and limbs. Herniation of the discs in the cervical neck means that the spine’s vertebrae are more likely to rub together causing further degeneration of the spinal column. Osteophyte growth may result which has a narrowing effect on the foramina in the spine and can lead to conditions such as cervical spinal stenosis. Herniated disc alongside ankylosing spondylitis, rheumatoid, and osteoarthritis can create serious mobility issues, with chronic neck pain and physical debility.
Herniated Disc Diagnosis
Diagnosis of herniated disc in the neck and other regions of the spine is usually made through X-ray, MRI, or CT scan, confirming a physician’s suspicions in most cases. Other discs close to herniating may also be observed in these scans, necessitating immediate treatment and preventative strategies. Anti-inflammatory medications, analgesics, and non-surgical spinal decompression, along with physical therapy are likely to be recommended by physicians in the first instance, with herniated disc in neck surgery reserved for intractable conditions after other efforts have failed to relieve pain and restore quality of life.
Herniated Disc in Neck Causes
Stress injuries such as whiplash from car accidents, or over-vigorous exercise and contact sport injuries can cause bulging or herniated disc in neck conditions. Herniated disc conditions may also appear in the lumbar and thoracic spine regions. Although unlikely, it is possible that chiropractic manipulation or other physical therapy could be a contribute to the cause of a herniated disk in the neck. In most cases the disk may be bulging or already compromised, making it highly important that any physical therapist working on a patient with back and neck pain be fully apprised of their situation and health prior to commencing treatment.
This image depicts a bulging disc as it worsens to become a herniated disc
Conditions that Contribute to the Cause
Arthritis and degenerative spine conditions, such as ankylosing spondylitis, and spinal stenosis, may also contribute to long-term problems. Herniation is usually a result of acute stress on the spine, although it can be due to longer term damage and a bulging disc that suddenly reaches breaking point and herniates. Healthy disc cartilage is spongy and malleable, unlike unhealthy discs which become dry and brittle, breaking and herniating easily upon acute stress. A herniated disc is often referred to as a ‘slipped’ disc, although no actual slipping has occurred.
Consistently poor posture, bad footwear and awkward sleeping habits can all contribute to stress and degeneration of the spine and associated connective tissue. Devices for neck pain and back pain relief often help improve posture and may prevent further complications from herniated discs or bulging discs. As discs become flattened, brittle, and stressed the circulation and delivery of nutrients to the tissue becomes restricted, further exacerbating the spine condition. Supplementation of those nutrients which support connective tissue health, such as glucosamine, chondroitin, and MSM, may be advisable in an attempt to inhibit this degeneration.
Herniated Disc in Neck Symptoms
A herniated disc in neck can cause another commond condition called a pinched nerve in neck. This is a result of a disc pushing against a cervical nerve root resulting in a dull pain that radiates down the shoulders and often into the arms and hands, with tingling and paraesthesia in the fingers often one of the first symptoms of a herniated disc or bulging disc. Weakness in the arm muscles may accompany the dull pain in some cases. Tingling, clumsiness and lack of fine motor control can also be symptoms of a herniated disc in the neck. Other symptoms of a herniated disc result from nerve compression and nerve transmission problems, such as imbalance when walking, and both bowel and bladder incontinence.
and severe usually results in a herniated disc
When a Bulging Disc becomes Herniated
Symptoms of a bulging disc that have appeared over time may suddenly become chronic and severe on herniation of that disc. Accurate and early diagnosis of a bulging disc may allow intervention that prevents it from herniating, thereby reducing the likelihood of severe symptoms and acute neck pain. Sudden trauma to the neck may precipitate this escalation of symptoms, whether through an accident or even, in some cases, spinal manipulation from chiropractors, massage therapists, or osteopaths.
Common areas where Herniated Discs Occur
Herniated or bulging discs in other regions of the spine will have similar symptoms involving the lower extremities. The cervical and lumbar regions of the spine are the most common problem areas for discs as there is so much pressure put on these areas and so little margin for error in terms of available space for nerves and blood vessels to travel through.
The most common site for disc herniation is at C5-C6, where the C6 nerve root exits the spinal column. Herniation at this site will usually lead to muscle weakness in the biceps, and in the wrist extensor muscles. Pain that radiates down into the thumb of the hand along with tingling and numbness indicate a herniation at C5-C6.
Shoulder Pain Symptoms from a Herniated Disc
Other signs of specific disc herniation include weakness in the deltoid muscles and possible shoulder pain without numbness and tingling which can occur when the disc C4-C5 has herniated. C6-C7 herniation usually results in tricep weakness extending into the finger muscles. Numbness and tingling are common in this case, with pain down into the middle finger. Pain that radiates down the arm and into the little finger side of the hand may indicate a disc herniation at C7-T1 (the trigeminal nerve), also associated with loss of grip strength.
Herniated Disc in Neck Diagnosis
Herniated discs are more likely to cause neck pain symptoms than a bulging disc and are generally diagnosed and confirmed through MRI or CT scan, or x-ray. Symptoms may have an acute onset and be the first sign of a problem with the disc, despite it having potentially been a bulging disc prior to herniation. Acute symptoms of a herniated disc should be reported to the physician so as to allow them to make an informed assessment of the spine condition. It may be that the patient can then recall previous symptoms of a bulging disc in neck that they had not previously connected, such as weakness, tingling, paraesthesia, and numbness.
Usually a herniated disc in neck is a candidate for surgery as the disc’s outer fibers are unlikely to repair themselves, even with the pressure removed from the disc through traction or other methods. Prompt diagnosis means that the problem should be easier to treat with damage having been limited to some degree.
Herniated Disc Neck Treatment
Physicians tend to recommend a conservative course of action with regard to bulging discs in the neck (and back). If the issue is a herniated disc then intervention, through cervical spine surgery, is likely to be advised. Reducing inflammation through heat and ice packs can help in herniated disc neck treatment, along with natural anti-inflammatories, steroid injections, and NSAIDs.
Another available herniated disc neck treatment option is non-surgical spinal disc decompression. Similar to traction, but more advanced and successful as a treatment option, this involves slowly separating discs that have become compressed. As the discs are gently pulled apart this creates a vacuum allowing vital nutrients and oxygen to enter the area of damage and begin the healing process. Doing this slowly and oscillating between pulling and relaxing also downgrades the likelihood of spasming of the supportive surrounding musculature which can impair long term outcomes of this treatment. The vacuum created also serves to ‘suck’ the herniated disc’s gelatinous center back into the correct position, allowing the outer fibers of the disc to heal without the pressure of compressed material.
Herniated Disc Surgery
Surgical intervention may be necessary, however, with the possibility of spinal fusion or artificial disc insertion. Initially a discectomy will be performed. This is where the damaged disc is removed, and may also involve the removal of any osteophytes which are exacerbating the stenotic condition of the cervical spine. Decompression of the spine will also occur during the surgery, allowing the cervical nerves and blood vessels to function properly and begin attempts at repair. Spinal fusion may be conducted, by using bone grafts and metal plates and screws to create a bond between vertebrae, thereby stabilizing the portion of the spine and providing relief from pain. Insertion of an artificial disc may provide an alternative option for structural support and pain relief after a discectomy. Known as spinal arthroplasty, this procedure is conducted through the anterior neck (accessing the spine from the front), and, depending on the patient’s physical condition, should have a fairly short recovery time. Most patients are up and walking about the day after surgery.
Along with the usual risk of complications with any surgery, spinal arthroplasty has the added risk of allergic reaction to the implant material, or the movement of the artificial disc after surgery. The disc itself is made of stainless steel, and is closely matched to the patient’s natural vertebral size and shape. The disc should allow the usual range of movement of the spine. Arthropalsty is not suitable for those with more than one area of disc herniation; spinal fusion may be the more appropriate surgical option if there are several types of this spine condition present. All in all herniated disc neck treatment by conservative means should be attempted before any surgery is considered.
Herniated Disc and Headaches
A herniated disc and headaches are commonly connected although many patients, and their physicians, fail to make the association, leaving them with often debilitating symptoms that remain unaddressed. Simple painkillers and NSAIDs are unlikely to provide sufficient relief for headaches caused by herniated disc material compressing the cervical spinal nerves. This mechanical obstruction may necessitate surgery to fully relieve the neck pain, headaches, and radiculopathy that results from disc herniation in the cervical spine.
Diagnosing Disc Herniation and Headaches
Headaches are just one possible symptom of a herniated disc in the cervical spine, with arm pain, shoulder pain, altered sensation, numbness, weakness, and muscle wasting also possible ramifications of a herniated disc. Dizziness and nausea may also accompany a herniated disc and headaches. Chronic intermittent pain in the neck that is followed by acute severe neck pain may indicate a bulging disc that has suddenly herniated. A patient with signs of a herniated disc is likely to be scheduled for x-rays, CT scan, or an MRI to assess their condition and some patients may also undergo epidural steroid injections to identify the causative spinal nerves and discs.
Treating Herniated Discs and Headaches
Whereas bulging discs often heal themselves, given adequate rest and avoidance of inappropriate activities, herniated disc are more likely to require neck surgery such as a discectomy to relieve nerve compression. The majority of disc herniations do resolve themselves however, given sufficient rest, appropriate physical therapy, anti-inflammatory medications, and possibly muscle relaxants. Patients self-medicating using over-the-counter remedies such as acetaminophen (Tylenol) may accumulate considerable liver damage before receiving a diagnosis of disc herniation and others may find that neck pain medications based on opioids lose their effectiveness over time.
Disc Herniation, Circulation, and Headaches
On some occasions the headaches suffered by a patient with a herniated disc may be connected to ischaemia rather than nerve compression. This is where the cervical spinal blood vessels are compressed leading to a reduction in circulation to the head and neck. The treatment for this condition is likely to be the same as for those suffering from pinched nerves in the neck as the desired effect is a decompression of the spine.
Inflammation, Stress, and Headaches
Patients experiencing chronic neck pain and headaches may find that relaxation techniques can be of benefit as their symptoms could be exacerbated by tension in the neck muscles. Lowering stress levels can also have an effect on inflammation in the body, thus reducing nerve compression and symptoms. Lower stress may also help patients reduce their need for neck pain medications and thereby lower their risk of side-effects. Some patients find that initially the symptoms of a herniated disc and headaches are connected to stress and then become and everyday occurrence necessitating more aggressive treatment. The symptoms of disc herniation and headaches are sometimes referred to as hangover headaches as they can feel very similar to the effects of a hangover but without the actual alcohol consumption. Many patients report symptoms such as an initial dull ache and tightness at the base of the neck which then spreads up and into the head and becomes recognizable as a herniated disc and headache.