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Definition
Herniated disc means displacement of the nucleus from its normal postion
within the boundaries of its outer fibrous ring (the annulus). The disc
structure is composed of the soft centered nucleus and the outer fibrous
ring (the annulus). The disc structure is postioned in between the vertebra.
Herniations commonly occur posteriorly(towards the back of the body) due
to a thinner boundary. The spinal nerves and dura (fluid filled sack containing
spinal cord and cervical spinal nerves at this level of the spine) are
located behind the disc structure.
Diagnosis
The diagnosis is made from the history, physical exam performed by the
doctor and diagnostic imaging studies (MRI, myelogram, CAT scan with contrast).
If the herniation puts pressure on a cervical spinal nerve, then the patient
may complain of pain, weakness or numbness in the arm. If the herniation
puts pressure on the spinal cord and a cervical nerve, then in addition,
the patient may have numbness in both hands, clumsy hands, difficulty
walking, electric shocks through the body with movement of the neck, bowel
and bladder symptoms or paralysis.
Non-Surgery Treatment
Most cervical disc herniations put pressure on a single cervical nerve
and those patients can be treated with non-operative measures: restriction
of activity, cervcial collar, traction, medications, epidural steroid
injections. A cervical disc herniation that produces symptoms from the
spinal cord is usually operated on.
Surgical Treatment
The surgical indications for cervical disc herniation is indicated for
nerve root symptoms: weakness, numbness and pain in an arm or due to the
spinal cord symtpoms: numbness in both hands, clumsy hands, difficulty
walking, electric shocks through the body with movement of the neck, bowel
and bladder symptoms or paralysis
Prognosis
Many patients with cervical disc herniations effecting a cervical spinal
nerve improve without surgery. In those patients undergoing surgery for
nerve decompression, the surgical results are generally good. Patient
with a cervical disc herniation producing pressure and symptoms from the
spinal cord, the surgical results depend on many different factors.
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