News For Health

Cervical Disc Disease

Clinical Aspects

As in the lumbar and thoracic spine, herniation of the contents of an intervertebral disc may occur when a tear occurs in the annulus fibrosus. However, whereas in the lumbar spinal canal only nerve roots are present, in the cervical canal the spinal cord may be compressed. The symptoms and signs produced are the result of nerve root compression, spinal cord compression, or both.

The most common complaint is neck pain which limits motion and is aggravated by neck extension. Pain also may radiate into one arm, in a pattern characteristic of the particular root involved (see below). Patients often hold the arm elevated and behind the head, presumably because this maneuver reduces the tension on the nerve root and thus lessens the pain. In most cases, the onset of pain is upon awakening, without identifiable trauma or other precipitating event.

Manifestation 

Level of Disc Herniation 

C4-5 

C5-6 

C6-7 

C7-T1 

Root Compressed 

C5

C6 

C7 

C8 

Weakness 

deltoid 

biceps 

triceps, wrist extension 

hand intrinsics, wrist flexion 

Sensory Loss 

lateral shoulder 

lateral arm & forearm, thumb & lateral aspect of index finger 

middle finger 

ring & little fingers 

Reflex Involvement 

deltoid, pectoralis 

biceps 

triceps 

finger flexion 

Table 1. The most common clinical manifestations of cervical disc herniation.

Table 1 shows the usual cervical root syndromes (radiculopathy). Note that the C6-7 disc is the most frequently herniated, about 2/3 of cervical herniations. The C5-6 disc is involved about 20% of the time, the C7-T1 about 10%, and the C4-5 about 2%.

If the disc herniation compresses the spinal cord, certain deficits may result (myelopathy). Weakness in the hands and arms may be more generalized or bilateral, rather than confined to a root distribution. In addition, there may be leg weakness, usually manifested initially by a feeling of heaviness in the legs and noticable difficulty in walking usual distances or up stairs. Examination may show hyperactive reflexes, pathological reflexes, and a spastic gait. Finally, sphincter and sexual function may be compromised, usually later in the progression of myelopathy. Cervical spondylotic myelopathy is discussed in the following section.

Lhermitte's sign refers to a sudden electrical sensation down the neck and back triggered by neck flexion. This was originally described in a patient with multiple sclerosis and dorsal column dysfunction. The conditions which can produce a Lhermitt's sign are:

  1. multiple sclerosis
  2. cervical spondylosis
  3. cervical disc herniation
  4. cervical spinal cord tumor
  5. Chiari I malformation
  6. radiation myelopathy
  7. subacute combined degeneration (caused by vitamin B12 deficiency)

Other signs may help in aiding the physical diagnosis. These are very suggestive of cervical disc herniation when present, but are frequently absent in the presence of the disease (that is, they are specific but not sensitive). Spurling's sign refers to the reproduction or exacerbation of pain upon pushing down on the head and bending it toward the involved side. The reduction of pain when axial traction is applied to the head is also suggestive of a disc. Finally, in the shoulder abduction test raising the affected arm above the head reduces the pain.

Radiographic Studies

The radiographic evaluation of a suspected spine disorder begins with plain X-rays. A herniated disc, being composed of soft tissue rather than bone, will not be seen on X-ray, however other associated changes may be seen, such as the characteristic bony ridges of cervical spondylosis. In addition, the alignment can be accurately assessed.

MRI has in most cases become the study of choice in cervical disc herniation. Its superior resolution of soft tissues gives good definition of disc material, cord compression, and root compression. When bony detail is required, a myelogram/CT should be obtained. This is more invasive than MRI and may produce effects such as headache, but in some cases may be essential in defining the anatomy.

Treatment

With non-surgical modalities such as physical therapy, electrical stimulation, manipulation, many patients with acute cervical radiculopathy from disc herniation will experience improvement or resolution of pain. If the symptoms do not improve within 3-10 days, sometimes computerized, axial distraction is indicated. This treatment is often effective when protocols of 30-45 days are followed and surgery can most often be avoided. Surgery is indicated when symptoms worsen or fail to improve. Surgery should also be considered when there is significant compression of the spinal cord with signs of cord dysfunction.

Surgical treatment is usually anterior cervical decompression and fusion (ACDF). An incision is made in the neck, usually to the right of the midline. A plane between the muscles of the neck is taken to the cervical spine. The disc material is removed, and the level is usually fused with bone from the patient's hip or banked bone (allograft). Postoperatively, patients may be up walking the same evening or the next morning. Discomfort in swallowing, from retracting the esophagus, occurs commonly and is usually mild and transient. Patients are usually discharged home in 3 to 5 days.

Serious neurologic complications are very rare with modern techniques, probably around 2%. Improvement in symptoms of neck and arm pain is seen in about 90%, while improvement in leg weakness occurs in about 80%.

Review Our Keys To Wellness
We have added several items of iterest in the last month. Take a look.

Click above to find menus to absolute health and wellness as well as little known but effective treatment for many symptoms.

How To Improve Immunity
Click above to review some proven methods of attaining Wellness.

Our Patients Get Results
Click above to see how patients have responded. Our most appreciated compliment is the kind words of patients who have received relief. You could be one of them.

The Rear End Collision

These are becoming more frequent now and you need to know what to do if you are hit from behind or slip into someonw else. Follow these simple rules if you are involved in a car accident and are not hospitalized:

  • Stay calm and reduce movements of the spine
  • Ice packs on the spine and neck for 5 minutes per hour will help for the first few days
  • See your chiropractic physician right away - He is the only provider trained to evlauate spinal subluxations

For more information, click here!

Spinal Decompression: Enroll now if you have arm or leg pain, numbness or loss of strength.

We have a new exercise DVD for all parts of the body. These protocols range from simple stretching for increased range of motion to resistive movements for strength and rehabilitation.

SUBSCRIPTIONS
Pass this subscription to a friend! If you have someone who would like to receive this information each month, please send them this email for subscription: newsletter subscription - c/o bruce@piclinic.com

MONTHLY REMINDER PLAN
Sign up today for our monthly telephone reminder. Our automated telephone system will call you the day before your regular monthly appointment and remind you. Monthly chiropractic adjustments have shown to improve health and reduce aches and pains. A reduced fee is available to all who join.

OUR STAFF
Dr. Bruce Gundersen - Chiropractic Orthopedics
Christine - Massage Therapy
Erin Maddux - Assistant

To Schedule an appointment,bruce@piclinic.com or call 801-272-8471.

We provide this information as a public service to our patients in an effort to improve health. If you do not wish to receive this information, just email bruce@piclinic.com and say you wish to be removed.

Thank you.

Holladay Physical Medicine - 4211 Holladay Blvd. Salt Lake City, UT - 801-272-8471 Please read the Disclaimer